Lecture Outline
   Energy Sources
   Nutrition Requirements
   Diet Advancement
   Micronutrients for wound healing
   Enteral versus Parenteral Nutrition
     • Case studies
         Energy Sources
   Carbohydrates
    • Limited storage capacity, needed for CNS function
    • Yields 3.4 kcal/gram
    • Pitfall: too much=lipogenesis and increased CO2 production
   Fats 
    • Major endogenous fuel source in healthy adults
    • Yields 9 kcal/gm
    • Pitfall: too little=essential fatty acid (linoleic acid deficiency-dermatitis 
     and increased risk of infections
   Protein
    • Needed to maintain anabolic state (match catabolism)
    • Yields: 4 kcal/gm
    • Pitfall: must adjust in patient with renal and hepatic failure
       • Elevated creatinine, BUN, and/or ammonia
     Nutrition Requirements
   Healthy Adults
        • Calories: 25-35 kcals/kg
        • Protein: 0.8-1 gm/kg
        • Fluids: 30 mls/kg
   Requirement Change for the Surgical Patient
   Special Considerations
    • Stress
        • Injury or disease
        • Surgery
   Pre-hospital/pre-surgical nutrition
             Nutrition 
   The surgical patient…
     • Extraordinary stressors (hypovolemia, hypervolemia, bacteremia, 
      medications)
     • Wound Healing
        • Anabolic state, appropriate vitamins (A, C, Zinc), and adequate 
         kcals/protein.
   Poor Nutrition=Poor Outcomes
     • For every gram deficit of untreated hypoalbuminemia there is ~30% 
      increase in mortality
       Post-Operative Nutrition 
            Requirements
   Calories: 
     • Increase to 30-40 kcals/kg
     • Patient on ventilator usually require less 
        calories ~20-25 kcal/kg
   Protein:
     • Increase to 1-1.8 grams/kg
   Fluids: 
     • Individualized