Objectives This chapter will: 1. Provide an overview of the stress response. 2. Review changes in the hypothalamic-pituitary-adrenal axis during critical illness. 3. Review stress hyperglycemia. 4. Review stress hyperlactemia. 5. Describe the sick euthyroid/low T3 syndrome. 6. Describe changes…
Objectives This chapter will: 1. Describe the main alterations in carbohydrate and lipid metabolism in isolated and complicated acute renal failure. 2. Elucidate the mechanisms of carbohydrate and lipid metabolic dysfunctions. 3. Highlight the therapeutic implications of the metabolic alterations.…
Objectives This chapter will: 1. Discuss the concept, pathogenesis, and impact of protein energy wasting in a patient with critical illness and acute kidney injury. 2. Discuss the significance of muscle wasting in conjunction with protein catabolism early in critical…
Objectives This chapter will: 1. Explain the impact of several modalities of renal replacement therapy on metabolism and nutrient balances. 2. Describe the effect of extracorporeal circuits and different types of anticoagulation on the inflammatory state of the patient. 3.…
Objectives This chapter will: 1. Describe the pathogenesis of hypermetabolism in critical illness. 2. Delineate the components of total energy expenditure. 3. Review techniques for the measurement of energy expenditure in critically ill patients. 4. Explain how to estimate energy…
Objectives This chapter will: 1. Help the reader understand the significance of acid-base disturbances in the critical care setting. 2. Identify common iatrogenic acid-base disorders in the intensive care unit. 3. Acknowledge common drugs used in clinical practice causing acid-base…
Objectives This chapter will: 1. Analyze the biologic origin and chemical characteristics of carbon dioxide, explaining the key role of this molecule in acid-base equilibrium. 2. Briefly summarize the mechanisms regulating spontaneous breathing activity fundamental to understand the pathophysiology of…
Objectives This chapter will: 1. Define alkalinity and alkalosis. 2. Discuss the pathophysiology of metabolic alkalosis. 3. Provide an algorithm for the differential diagnosis. 4. Address complications and options for medical management. Metabolic alkalosis, either as a primary disturbance or…
Objectives This chapter will: 1. Define renal tubular acidosis. 2. Review the types of this disorder. 3. Describe the relevant renal acid-base physiology and pathophysiology. 4. Present clinical methods of diagnosis and differential diagnosis. 5. Discuss treatment. Definition Renal tubular…
Objectives This chapter will: 1. Review the major factors that modulate physiologic lactate production and utilization. 2. Discuss the mechanisms that modulate lactate during critical illness. 3. Review acid-base aspects of lactic acidosis. 4. Review causes of lactic acidosis that…