FASTING SURGICAL PATIENT

3.2 CARBOHYDRATES

The human body has an internal supply of stored carbohydrates in the
form of glycogen.
This is enough for a 24 hr. without food intake.
Therefore, glucose (I.V)is the principal means of sparing protiens in a fasting surgical patient.
A minimum of 400 cal in 24 hours can minimise protein breakdown in starvation, it can cut it down by 50%.
In stress state of surgery, and in the presence of sepsis, insulin inhibited lypolysis does not work, thus
gluconeogenesis continues, and hyper-glycaemia occurs.

Wound repair also requires glucose and some amino acid (arginine)
Calories and protiens

Carbohydrates
Glucose is the major energy fuel used by the body.
The maximum rate of oxidation is 4-5 mg/min (7.2 g/ kg/day) 60-70% of body calories requirements are met through carbohydrates.
Carbohydrate stores are virtually depleted after a greater than 24 hours fast, with liver glycogen depleted and only small amounts of muscle glycogen remaining.
In the Krebs tricarboxylic acid cycle, glucose in completle oxidation, produces a larger amount of high energy phosphate, than in the incomplete oxidation of anaerobic glycolysis that produces lactate.
Glucose is an efficient means for protein sparing with at least 400 calories required in 24 hours.
Glucose can reduce the degree of proteolysis up to 50%. Numerous cell types, including muscle, neural tissue, red blood cells can thus be saved.
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