By Mary Klingensmith
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Extra resources for The Washington Manual of Surgery, 6th Edition
Empiric antibiotic therapy should cover enteric pathogens and anaerobes. ⋅ Genitourinary infections. After the urine is cultured, simple lower-tract infections can be managed with oral antibiotics. Ill patients or those with pyelonephritis require more aggressive therapy. ⋅ Prosthetic-deviceâ related infections may present with fever, leukocytosis, and systemic bacteremia. Infection of prosthetic valves may present with a new murmur. Management may require removal of the infected device and the use of long-term antibiotics.
The brain preferentially uses this endogenously produced glucose, with the remainder consumed by red blood cells and leukocytes. Within approximately 10 days of starvation, the brain adapts and uses fat in the form of ketoacids as its fuel source. Produced by the liver from free fatty acids, the use of ketoacids has a protein-sparing effect. • Physiologic stress. The interaction of metabolic and endocrine responses that result from major operation, trauma, or sepsis can be divided into three phases.
For these patients, IV fluids with appropriate electrolytes and a minimum of 100 g glucose daily (to minimize protein catabolism) is adequate. However, even well-nourished patients can quickly become malnourished following a major operation or trauma (Curr Probl Surg. 1995;32(10):833â 917). Without nutritional intervention, these patients may suffer complications related to impaired immune function and poor wound healing from depleted visceral protein stores. Patients with a significant degree of preoperative malnutrition have less reserve, tolerate catabolic stress and starvation poorly, and are at higher risk for postoperative complications.
The Washington Manual of Surgery, 6th Edition by Mary Klingensmith