Define cachexia. List the factors that may predispose to cachexia AND the consequences of cachexia in a ventilated patient with sepsis and multi-organ dysfunction syndrome.
Answer and interpretation
- Weight loss and skeletal muscle wasting due to illness where the body does not reduce catabolism (unlike the adaptive reduction in protein metabolism that occurs in starvation)
- Mechanisms not clearly understood
- Pre-existing malnutrition / malabsorption.
- Cytokine-induced up-regulation of muscle protein degradation Neuro-endocrine – stimulation of hypothalamic-pituitary-adrenal axis Reduced circulating anabolic hormones
- Immobility and prolonged length of stay
- Corticosteroid therapy
- Increased risk of death
- Prolonged time on ventilator
- Increased ICU and hospital length of stay Increased risk of nosocomial infections
- Poor wound healing
- Malnutrition and nutritional deficiency syndromes