hypermetabolic state
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2021 ◽  
Vol 30 (21) ◽  
pp. S12-S19
Author(s):  
Mahmoud Al-Kalaldeh ◽  
Ghada Abu Shosha ◽  
Noordeen Shoqirat ◽  
Mahmoud Alsaraireh ◽  
Rawan Haddadin

Background: Severe brain attack patients demonstrate hypermetabolic state and gastrointestinal dysfunction, leading to faster onset of nutritional failure. Aim: To estimate the time point where the development of nutritional failure is more probable among patients with acute brain attacks in the intensive care unit (ICU). Methods: Direct bedside observation for selected nutritional parameters was performed. When enteral nutrition was initiated, observation was performed at five points over 9 days. Findings: 84 patients with 55% mortality risk and on mechanical ventilation were included. Over the observation period, gastric residual volume increased (144 ml vs 196 ml), body weight decreased (79.4 kg vs 74.3 kg), and serum albumin reduced (3.6 g/dl to 3.1 g/dl). Caloric attainment and malnutrition score deteriorated, and feeding-related complications increased. Nutritional failure was evidently prevalent between the third and fifth day of observation. Conclusion: An earlier period of enteral nutrition entails higher probability of nutritional failure among severe brain attack patients in the ICU.


2021 ◽  
Vol 22 (18) ◽  
pp. 9782
Author(s):  
Maria Greabu ◽  
Silviu Constantin Badoiu ◽  
Iulia-Ioana Stanescu-Spinu ◽  
Daniela Miricescu ◽  
Alexandra Ripszky Totan ◽  
...  

It has become widely accepted that insulin resistance and glucose hypermetabolism can be linked to acute pathologies, such as burn injury, severe trauma, or sepsis. Severe burns can determine a significant increase in catabolism, having an important effect on glucose metabolism and on muscle protein metabolism. It is imperative to acknowledge that these alterations can lead to increased mortality through organ failure, even when the patients survive the initial trauma caused by the burn. By limiting the peripheral use of glucose with consequent hyperglycemia, insulin resistance determines compensatory increased levels of insulin in plasma. However, the significant alterations in cellular metabolism lead to a lack of response to insulin’s anabolic functions, as well as to a decrease in its cytoprotective role. In the end, via pathological insulin signaling associated with increased liver gluconeogenesis, elevated levels of glucose are detected in the blood. Several cellular mechanisms have been incriminated in the development of insulin resistance in burns. In this context, the main aim of this review article is to summarize some of the drugs that might interfere with insulin resistance in burns, taking into consideration that such an approach can significantly improve the prognosis of the burned patient.


2021 ◽  
Vol 22 (10) ◽  
pp. 5159
Author(s):  
Silviu Constantin Badoiu ◽  
Daniela Miricescu ◽  
Iulia-Ioana Stanescu-Spinu ◽  
Alexandra Ripszky Totan ◽  
Silvia Elena Badoiu ◽  
...  

Severe burns represent an important challenge for patients and medical teams. They lead to profound metabolic alterations, trigger a systemic inflammatory response, crush the immune defense, impair the function of the heart, lungs, kidneys, liver, etc. The metabolism is shifted towards a hypermetabolic state, and this situation might persist for years after the burn, having deleterious consequences for the patient’s health. Severely burned patients lack energy substrates and react in order to produce and maintain augmented levels of glucose, which is the fuel “ready to use” by cells. In this paper, we discuss biological substances that induce a hyperglycemic response, concur to insulin resistance, and determine cell disturbance after a severe burn. We also focus on the most effective agents that provide pharmacological modulations of the changes in glucose metabolism.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A952-A953
Author(s):  
Camila Alejandra Villavicencio ◽  
Alberto Franco-Akel ◽  
Regina Belokovskaya ◽  
Sanket Agarwal ◽  
Nicholas F Homsy ◽  
...  

Abstract Thyroid storm (TS) is a rare and life-threatening condition due to a profound hypermetabolic state, leading to decompensation of homeostasis. It is commonly associated with a precipitating factor such as surgery, trauma, or infection. Occasionally, the clinical presentation may be non-specific, thus causing a potential delay in diagnosis. This could be problematic due to the condition’s high mortality rate, especially if not recognized early. Thyrotoxic jaundice presenting with a pattern of cholestatic hyperbilirubinemia (HBR) has been reported in the literature, although uncommon. We present the case of a 71-year-old woman with unexplained jaundice and direct HBR who was diagnosed with impending TS in the setting of toxic multinodular goiter (TMNG). This is a case of a 71-year-old woman with a remote history of hypothyroidism who presented with acute onset right upper quadrant abdominal pain, jaundice, a non-tender asymmetric nodular large goiter, and bilateral non-pitting leg edema. Ancillaries were significant for total and direct HBR of 4.3 and 3.5 mg/dL, respectively. An abdominal sonogram, abdomen CT and ERCP, all ruled out an obstructive biliary etiology. Unfortunately, the patient developed post-ERCP pancreatitis, with subsequent worsening of direct HBR. TSH was found to be suppressed, free T4 was significantly elevated at 4.3 ng/dL. A Burch-Wartofsky score of >40 was highly suggestive of TS. In addition, elevated thyroglobulin levels ruled out exogenous thyrotoxicosis, the absence of orbitopathy, pretibial myxedema, and negative TRAb pointed towards TMNG as the most likely etiology of hyperthyroidism. This diagnosis was confirmed through neck ultrasound, showing multiple nodules and the absence of high vascularity of the thyroid gland. The patient was managed in the ICU with beta-blockers, methimazole, potassium iodide solution, glucocorticoids, and bile acid sequestrants, leading to satisfactory and significant clinical improvement of thyrotoxicosis and bilirubin levels. Hepatic dysfunction has been described in patients with hyperthyroidism since the nineteenth century. Although the underlying mechanism remains unclear, it may be multifactorial. Different hypotheses have been proposed suggesting that the hypermetabolic state secondary to decompensated hyperthyroidism causes a supply-demand mismatch between hepatic oxygen consumption and hepatic blood flow, decreasing the oxygen tension in the centrilobular region resulting in cholestasis. Furthermore, hepatic hypermetabolism in response to excess thyroid hormone leads to the saturation of the bile flow rate. A possible direct toxic effect of T4 in the hepatocytes has been described although further research is needed. This case highlights the importance of considering decompensated hyperthyroidism as a differential diagnosis of cholestatic HBR.


2021 ◽  
Vol 4 (1) ◽  
pp. 27
Author(s):  
Muhammad Aulia U H ◽  
Iswinarno Doso Saputro ◽  
Magda Rosalina Hutagalung

Background: The incidence of burns in Indonesia progressively increases with the increase in its population and industries. From January to September 2000, 158 patients were treated in the burn unit of Dr Soetomo Hospital with a mortality rate reaching 5,8%. Burns have a direct effect in causing both local and systemic changes in the body, not occurring in other injuries. In severe burns, a hypermetabolic state can occur, which increases cardiac workload and causes muscle atrophy and other morbidities. The purpose of this study is to examine the effect of propranolol on the hypermetabolic state in severely burned patients by measuring various clinical & laboratory parameters.Methods : This is an experimental study using pre and post test control group design with the objective of assessing the treatment outcome with oral propranolol given in 15 consecutive days for burn patients involving 25%- 60% TBSA. Measurements were taken three times, on day 0, 7 and 14.Results : Obtained 16 samples divided into 2 groups. In the treatment group, there was a significant decrease in CRP levels on days 0, 7 and 14 (p <0.05). The Mid Arm Circumference variable did not obtain a significant decreasing on days 0, 7 and 14. The albumin level studied showed a significant decreasing on day 0 & 7 days with a value of p = 0.045. From the comparison between the two groups, there were significant differences in CRP levels on days 0 & 14, with the mean value of the treatment group -5.12 + 2.88 and the mean value of the control group 2.86 + 7.37, and the value of p = 0.019.Conclusions: This study successfully proved that the administration of propranolol can overcome the effects of hypermetabolism which is characterized by decreasing in CRP levels.


Author(s):  
Katsuhiko Tsunekawa ◽  
Ryutaro Matsumoto ◽  
Kazumi Ushiki ◽  
Larasati Martha ◽  
Yoshifumi Shoho ◽  
...  

Abstract Background Few nutritional markers reflect the hypermetabolic state of athletes with high levels of skeletal muscle. Although branched-chain amino acids (BCAA) play crucial roles in protein metabolism in skeletal muscle, the relationship between skeletal muscle mass and amino acid imbalances caused by the metabolism of BCAA and aromatic amino acids remains unclear. The aim of this study is to test the hypothesis that athletes with high levels of skeletal muscle mass have plasma amino acid imbalances, assessed by serum BCAA to tyrosine ratio (BTR) which can be measured conveniently. Methods The study enrolled 111 young Japanese men: 70 wrestling athletes and 41 controls. None of them were under any medications, extreme dietary restrictions or intense exercise regimens. Each participant’s body composition, serum concentrations of albumin and rapid turnover proteins including transthyretin and transferrin, BTR, and thyroid function were assessed. Results Compared to the controls, the athletes had significantly higher skeletal muscle index (SMI) (p < 0.001), and lower serum albumin concentration (p < 0.001) and BTR (p < 0.001). Kruskal–Wallis tests showed that serum albumin concentration and BTR were significantly lower in the participants with higher SMI. Serum albumin concentration and BTR were inversely correlated with SMI by multiple regression analysis (logarithmic albumin, β = − 0.358, p < 0.001; BTR, β = − 0.299, p = 0.001). SMI was inversely and transthyretin was positively correlated with serum albumin (SMI, β = − 0.554, p < 0.001; transthyretin, β = 0.379, p < 0.001). Serum concentration of free 3,5,3′-triiodothyronine (FT3) was inversely correlated with BTR, and, along with SMI and albumin, was independent predictor of BTR (SMI, β = − 0.321, p < 0.001; FT3, β = − 0.253, p = 0.001; logarithmic albumin, β = 0.261, p = 0.003). However, FT3 was not correlated with SMI or serum albumin. Serum concentrations of rapid turnover proteins were not correlated with BTR. Conclusions Increased skeletal muscle mass enhances the circulating amino acid imbalances, and is independently facilitated by thyroid hormones. Serum BTR may be a useful biomarker to assess the hypermetabolic state of wrestling athletes with high levels of skeletal muscle.


Redox Biology ◽  
2021 ◽  
Vol 38 ◽  
pp. 101808
Author(s):  
Csaba Hegedűs ◽  
Tamás Juhász ◽  
Eszter Fidrus ◽  
Eszter Anna Janka ◽  
Gábor Juhász ◽  
...  

Author(s):  
Meghna Prashant Nair ◽  
Shubhi Shubhangi Bhatnagar ◽  
Ansh Chaudhary ◽  
Bhupendra Chaudhary

Hyperthyroidism with its excess circulatory thyroid hormones commonly presents with systemic features like palpitation, weight loss and heat intolerance. This hyperadrenergic, hypermetabolic state with its peripheral and central nervous system affection produces protean neurological manifestations which are generally overlooked by internist. Features of neuropsychiatric nature, cognitive impairment, and dementia movement disorder like tremors or chorea may be presentation of undetected hyperthyroidism. Affliction for muscles presents with proximal myopathy with or without myalgia in 50-70% of long standing hyperthyroid state. Similarly thyrotoxic periodic paralysis due to low serum potassium in adult male is often misdiagnosed as Guillain-Barré syndrome, however replacement of potassium drastically reverse the condition. There is a strong association between autoimmune thyroiditis and ocular myesthenia which post difficulties in clinical diagnosis. Despite of so much variability in clinical presentation attainment of euthyroid state coupled with beta blocker in many situations is helpful to resolve most of the issues. Keywords: Hyperthyroidism, Grave's, Tremors, Myopathy, Periodic paralysis.


Author(s):  
Ansh Chaudhary ◽  
Amit Rastogi ◽  
Bhupendra Chaudhary

Being one of the most common endocrinal disorders, the thyroid diseases having an extended spectrum from subclinical hypothyroidism to life threatening thyroid storm. Hyperthyroidism a hypermetabolic state with excess circulating thyroid hormones present as common systemic features like weight loss, palpitation, heat intolerance as well as peripheral and central nervous system manifestations.[1] Few of the initial neurological symptoms are often misdiagnosed as psychiatric disorders.


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