Term
| What is the difference between SIRS, sepsis, and septic shock? |
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Definition
SIRS is a constellation of symptoms including elevated heart rate, temperature, respiratory rate, and WBC count.
Sepsis = SIRS + infection
Septic shock = sepsis + hemodynamic instability
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Term
| What factors can cause SIRS? |
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Definition
SIRS can be caused by infection (sepsis) or by non-infection etiology such as trauma, pancreatitis, hemorrhage, ischemia, burn injury, etc.
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Term
| What type of inflammatory response is seen in patients with sepsis? |
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Definition
| Patients with sepsis exhibit both an inflammatory and anti-inflammatory response |
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Term
| What is the standard medical treatment for sepsis? |
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Definition
| Administration of antimicrobial agents and removal of the infectious source |
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Term
| Have efforts to reverse sepsis been successful? How does this affect nutrition intervention? |
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Definition
| No, not at all. Current nutritional therapy focuses on support of patients DURING sepsis rather than trying to stop it. |
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Term
| How does sepsis affect carbohydrate metabolism? |
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Definition
| Hyperglycemia and insulin resistance are uniformly found in sepsis |
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Term
| How does sepsis affect gluconeogenesis? |
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Definition
| Moderate or severe infection is associated with at 150% to 200% increase in glucose production |
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Term
| What are the mechanisms for hyperglycemia 2/2 sepsis? |
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Definition
- Increased gluconeogenesis
- Decreased glucose uptake
- Insulin resistance
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Term
| How does sepsis affect protein metabolism? |
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Definition
| Protein breakdown and synthesis are both accelerated during sepsis, but patients generally remain in net negative nitrogen balance |
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Term
| How does sepsis affect lipid metabolism? |
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Definition
| It causes lipolysis, which can often induce hypertriglyceridemia |
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Term
| How does sepsis affect energy expenditure? |
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Definition
| Sepsis is associated with a significant increase in energy expenditure (20-60% above basal energy expenditure) |
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Term
| What are the advantages of lipids as an energy source in sepsis? |
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Definition
- Lipids are energy-dense which allow for volume-restricted delivery of calories (useful for renal failure or pulm edema)
- Respiratory quotient is smaller for lipids than carbohydrates
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