1. Why does metabolic stress increase the body’s use of protein as a fuel source? Caitlyn Whiteside, Sierra Terrel-Perez, Michayla Robertson

2. Metabolic Stress Stressors Sepsis/Burns Major surgery/Disease Acute injury Cancer/Inflammation Hormones Glucagon Cortisol Sympathetic Stimulation: Epinephrine Norepinephrine

3. Hormone Spotlight Cortisol Inhibition of glucose uptake by tissues (except brain) Stimulates protein degradation while hindering protein synthesis Glucagon Increases gluconeogenesis process

4. Amino Acids Alanine o Primary substrate required for gluconeogenesis, made available to the liver via catabolism of skeletal muscles. o Activated by Cortisol Glutamine o Goes to GI tract for immunity response

5. Goal: Glucose Availability

6. References Biolo, G., Toigo, G., Ciocchi, B., Situlin, R., Iscra, F., Gullo, A., & Guarnieri, G. (2010). Metabolic response to injury and sepsis: Changes in protein metabolism. Nutrition (Burbank, Los Angeles County, Calif.), 13(9 Suppl), 52S-57. doi:10.1016/S0899-9007(97)83044-4 Kim, H. (2011). Glutamine as an immunonutrient. Yonsei Medical Journal, 52(6), 892-897. doi:10.3349/ymj.2011.52.6.892 Nelms, Marcia N, et al. (2011) Metabolic Stress and the Critically Ill: Nutrition Therapy and Pathophysiology. 2nd ed. Belmont: Wadsworth, Cengage Learning. 683+. Print.