NUTRITION IN STARVING SURGICAL PATIENTS

3.3 FATS

Our main problem is supply of calories to a starving surgical
Patient, we need to prevent muscle breakdown loss, and supply
Enough calories for metabololic body requirements

Lipid supplementation can supply high energy source in starving
Patients, without the risk of hyper-glycaemia despite continuing
gluconeogenesis.
In stress and surgery 25-45% of energy can be sourced from lipids.
The fat is limited to 2 gm per Kg/body wt/ 24 hours to avoid fat
overload syndrome (fever, back pain, chills, etc.)

Fat basic facts
In normal circumstances Fats provide the body’s calories requirement (15 – 20%).
In starvation, the majority of calories have to be provided by fat which is converted to ketene bodies produced in the liver.
Steroids, catechols, glucagons, and some cytokines promote lipolysis, while insulin is an inhibitor.
Fat as 20% of non-protein calories in normal or moderate stress conditions seems to be optimal for hepatic protein synthesis.
The fat overload syndrome in parental feeding of fever, back pain, chills, pulmonary Insufficiency, and impairment of the reticuloendothelial system can occur.


4. NUTRITIONAL PROBLEM
All surgical patients cannot be assumed to be in healthy status.
Many patients seeking surgical treatment have been ill, with a
complaint for a variable period ranging from days (acute conditions) to weeks in chronic patients.
During this period their nutritional intake has been affected.
Some may be in alarming state of malnutrition.
Although minor degrees of proteins, and calorie limitation does
not affect the surgical outcome, most severe forms of nutritional
disorders do jeopardize post-surgical recovery, for they effect
wound healing, resistance to infection and thus the recovery
period is prolonged.

The most severe disorder effecting nutrition, are those that
effect oral intake (starvation) and these are disorders of
gastrointestinal tract.

Disorders of an inflammatory nature also cause catabolism and
thus are responsible for the negative nutritional status.
Malignant disorders may also be responsible for disturbing the nutritional status.
Any questions be sent to drmmkapur@gmail.com
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