Term
| How do TBI and SCI alter metabolism? |
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Definition
TBI results in a vigorous hypermetabolic, catabolic stress response that is proportional to the severity of the injury and motor dysfunction
SCI was originally also thought to elicit a hypermetabolic response. However, studies have shown that SCI patients actually have a slightly lower metabolic need than normal. |
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Term
| What changes in body composition develop after SCI? |
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Definition
- Reduction in LBM
- Reduction in bone mineral density
- Increased fat mass
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Term
| How does stroke alter metabolism? |
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Definition
| Patients in the acute phase after stroke do NOT experience hypermetabolism. Energy needs are only very slightly elevated from baseline (7 to 14%). |
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Term
| What type of fluid support is used after TBI? Why? |
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Definition
| Fluid resuscitation is a key component of TBI treatment in order to maintain adequate cerebral perfusion pressure to prevent hypotension |
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Term
| Are crystalloid or colloid solutions preferred for fluid resuscitation after TBI? |
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Definition
| There is no evidence that albumin (colloid) solutions instead of crystalloid solutions are beneficial in the setting of TBI (and it may actually increase mortality) |
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Term
| What are the advantages of using NS for fluid resuscitation? |
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Definition
Advantages of using NS include isotonicity and lack of salt-free water, which diminishes negative effects on plasma osmolality or cerebral edema
Even LR contains some free water and may contribute to cerebral edema |
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Term
| Should dextrose-containing IVF be used for fluid resuscitation in TBI patients? Why? |
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Definition
| No because of the potential to cause hyperglycemia |
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Term
| What is the maximum GIR for avoiding complications associated with hyperglycemia and impaired glucose utilization in TBI? |
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Definition
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Term
| What are the different levels of NDD diets? |
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Definition
- NDD1: pureed
- NDD2: mechanical soft
- NDD3: soft
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Term
| What equations are recommended for estimating energy and protein needs in TBI? |
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Definition
- 120% to 160% of estimated basal needs using Harris Benedict Equation
- 1.5-2 g protein/kg
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Term
| How does neuromuscular blockade in the context of TBI affect estimated energy expenditure? |
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Definition
| Neuromuscular blackade virtually eliminates the hypermetabolic response associated with TBI |
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Term
| How does barbiturate-induced coma following TBI affect energy expenditure? |
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Definition
| Barbiturate-induced coma dampens the hypermetabolic response associated with TBI, although it is still above baseline |
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Term
| How do quadriplegia and paraplegia affect energy expenditure? |
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Definition
| Paraplegic patients have higher energy needs (28 kcal/kg) than quadriplegic ones (23 kcal/kg) |
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Term
| How does SCI affect long-term metabolism? |
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Definition
| SCI patients have decreased metabolism (about 20 kcal/kg) for years following injury due to lower physical activity and lower RMR |
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Term
| How does SCI affect long-term protein needs? |
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Definition
| Individuals with SCI have long-term protein needs similar to normal population (0.8-1 g/kg) |
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Term
| What factors affect estimated energy needs in patients with CP? |
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Definition
Energy needs increase with increased fat-free mass
Energy needs decrease with increased age |
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Term
| What types of sodium disorders are common after neurologic injury? |
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Definition
- SIADH
- Cerebral salt wasting
- Diabetes insipidus
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Term
| What symptoms distinguish SIADH from cerebral salt wasting? |
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Definition
SIADH patients are usually euvolemic
CSW patients are typically volume depleted |
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Term
| What are the common causes and treatment of SIADH after neurological injury? |
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Definition
- TBI and stroke are common casues
- Fluid restriction is common treatment
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Term
| What are the common causes and treatment of CSW after neurologic injury? |
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Definition
- TBI is a common cause
- Sodium supplementation is common treatment
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Term
| Are SIADH and CSW long-term or short-term complications of neurologic injury? |
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Definition
| SIADH and CSW are usually transient after neurological insult and relates to the early stages of the disease |
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Term
| What are the causes and treatments of diabetes insipidus in neurologic injury? |
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Definition
- DI can be neurogenic or nephrogenic
- Nephrogenic DI usually associated with pituitary dysfunction or devastating neurological event
- Treatment involves supplementation of salt-free water and use of vasopressin or analogs
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Term
| How does diabetes insipidus generally present? |
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Definition
| DI is related to a deficiency of vasopressin, resulting in hypernatremia |
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Term
| Why is there interest in BCAAs in neurologic injury? |
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Definition
| They increase hepatic and muscle synthesis as well as inhibit muscle protein breakdown. BCAA supplementation has been shown to lower the disability rating score in patients with TBI. |
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Term
| Why is there interest in L-arginine supplementation in neurologic injury? |
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Definition
| L-arginine upregulates the immune system via conversion to nitric oxide. However, effectiveness is controversial and there is no recommendation on its use |
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Term
| Are nutrient supplementation/immune-enhancing formulas recommended for neurologic injury? |
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Definition
| No...more research needs to be conducted |
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