Episode 49: Sepsis and How Your Gut Influences Your Diet
In this episode, we’ll be talking about the importance of gut genome and determining what diet is right for you. We will also be talking about sepsis, the disease process and the sepsis bundle.
What you should eat and gut genome³
Nutrition recommendations have focused on properties of food, debating whether focusing on calorie counts, carbohydrates, fats or proteins might be more important. But more studies are showing that people’s bodies can react very differently to the same foods, and standardized nutrition advice doesn’t fit everybody. Even identical twins can have varying responses to identical foods, new research finds, suggesting that the variety can’t be explained by genes alone.
With genetics being put on the back burner, researchers are searching for other explanations for why a diet one person swears by may cause another to gain weight. One big player may be the friendly bacteria and other microbes in people’s guts.
So instead of focusing on the food, we may have to look within our own gut microbes or other personal qualities to find the diet that works best for us, an approach known as personalized nutrition. But tailoring food regimens to individuals isn’t an easy feat.
Identical twins Julie Hodgson and Diane Portlock look like each other. Except Portlock, a firefighter in Worcester, England, weighs about 50 pounds more than her twin. The 46-year-old sisters always put their weight difference down to lifestyle. After all, Hodgson, of Ash Vale, England, is a competitive rower in the British Army who took a gold medal in the United Kingdom Invictus Games trials in July. She exercises more than her sister does and tends to go for salads, while Portlock admits “I like cheese. I like bread. I like a glass of wine.”
But now the sisters have discovered that their bodies handle food differently, too. In an extension of Spector’s study, Hodgson’s blood sugar after a meal would usually rise gradually then taper off “in a nice little rounded arch,” her sister says. But Portlock’s glucose levels spiked and quickly fell and then rose again in what she calls “a double dip.”
“My insulin response is really quite efficient,” Hodgson says. Her body handles carbohydrates well, and eating more carbs fills her up and gives her more energy to train. But not all carbs work for her. Spaghetti Bolognese is Hodgson’s worst food for triggering a glucose spike, even though pasta is considered a low glycemic index food. Now, she avoids pasta and eats other carbs, including mashed potatoes, her twin’s nemesis for causing blood sugar spikes.
Sepsis and Sepsis Protocol
What is sepsis?
Sepsis occurs when chemicals released in the bloodstream to fight an infection trigger inflammation throughout the body. This can cause a cascade of changes that damage multiple organ systems, leading them to fail, sometimes even resulting in death.
The risk of progressing to severe sepsis or septic shock was highest for those with bacteremia, followed by peritonitis and pneumonia.
Gram-positive cocci and Gram-negative bacilli bacteria in the blood increased the possibility of advancing to severe sepsis or septic shock within the first month in the ICU¹.
- Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus (MRSA)
- Escherichia coli, Klebsiella pneumoniae, Enterobacter species, and P. aeruginosa
3 stages of Sepsis
SIRS with a present infection
- SIRS criteriaBody is stressed resulting in a need to increase CO to increase oxygenation. Increased HR = increased CO
- Increased in respirations is associated with the need to increase CO and oxygenation usually resulting in a decrease in CO2 in the blood. Or it can be a signal of pneumonia or respiratory dysfunction.
- Body temperature less than 36 °C (96.8 °F) or greater than 38 °C (100.4 °F)
- Heart rate greater than 90 beats per minute.
- Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, arterial partial pressure of carbon dioxide (ABG PCO2) less than 4.3 kPa (32 mmHg)
- White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10% immature neutrophils (band forms).
- For SIRS to go into Sepsis: it would be considered sepsis if the patient has 2 SIRS criteria present plus an infection, positive blood cultures.
- Organ dysfunction is characterized by symptoms such as decreased urine output, sudden changes in mental state, decreased blood platelet count, difficulty breathing, abnormal heart pumping function, abdominal pain, and hypertension or hypoperfusion.
- Diagnosed when acute organ dysfunction begins.
- Septic shock has the highest chance of mortality, with estimates ranging from 30% to 50%.
- Septic shock is the most severe stage of sepsis. It is defined as the presence of hypotension, induced by sepsis, despite fluid resuscitation. In addition, perfusion abnormalities such as elevated lactate levels.
The Sepsis Bundle
- Serum lactate measured within 3 hours of presentation.
- Blood Cultures obtained prior to antibiotic administration to determine all potential sites and sources of infection.
- Early and appropriate broad-spectrum antibiotic administration. Timely re-evaluation of antibiotic therapy based on causative agent and susceptibilities is recommended.
- Initial fluid administration of 30 ml/kg crystalloid or colloid equivalent for hypotension or lactate >4 mmol/L (adults only). Initial fluid administration of 20 ml/kg crystalloid in children.
- Patient exhibits persistent hypotension despite fluid resuscitatio.
- The patient requires vasopressor therapy for hypotension
- Inability to obtain adequate peripheral access in patient for fluid resuscitation, blood products, or medications.
- Vasopressor therapy for persistent hypotension (MAP <65 in adults) despite initial fluid administration.
- Re-measure lactate if the initial value was elevated.
- A central venous catheter capable of hemodynamic measuring is inserted in a severely septic/septic shock patient if criteria are met
- The trending of lactate levels to gauge fluid response is used with critical value alerts for lactates resulting >4 mmol/L and suggested serial trending within 2 hours of this critical result.
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