Hands helg high/Crawling
natt
Ännu en nattjoursvecka. Hade mitt första pass natten mellan måndag-tisdag och laddar just nu inför ett pass från klockan åtta till imorgon bitti. Första natten var relativt lugn, 10 opåtittade patienter när jag anlände vilket ändå får anses vara lite en måndag. Inga larm under hela natten heller. Hoppas på att även denna natt ska bli lugn.
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Bjuppar på denna, något skeva, bild.
refeding syndrome
Refeeding syndrome är ett tillstånd som kan drabba en individ som utsatts för svält under en tid, och som sedan åter får näring tillförd.
Vid ett icke-svälttillstånd står glukos för den största delen av energibidraget. Glukos i blodbanan stimulerar hormonet insulin, som hjälper glukoset in i cellerna och lagrar det som glykogen. Insulin hämmar även nedbrytningen av fett (lipolys), då kroppen ju redan har mycket energisubstrat i form av glukos, samt ökar upptaget av kalium in i cellerna. När glykogendepåerna är fyllda går kroppen även till lipogenes, dvs glukos konverteras till fett och lagras som triglycerider i fettväv. Detta leder till att glukosnivåerna går ned och därmed även insulinutsöndringen.
Vid svält sjunker glukosnivåerna. Detta leder till att hormonet glukagon frisätts, vilket i princip är insulinets motsats. Insulinfrisättningen hämmas. Glukosnivån i blodet uppehålls av nedbrytningen av glykogen (lagrat glukos), men dessa lager räcker sällan mer än 72 timmar. För att ändå få tillgång till energi börjar kroppen bryta ned protein och fett.
I levern oxideras fettsyror och bildar ketoner (aceton, acetoacetat, beta-hydroxibutyrat). Dessa konverteras till acetyl-CoA och genererar energi via lemonadhojjen. Energi fås även från laktat och pyruvat, samt aminosyror.
I dessa processer går kalium, fosfat och magnesium åt. Lagren som finns utanför cellerna töms och för att bibehålla en normal koncentration utanför cellerna av dessa elektrolyter töms de intracellulära lagren. När man sedan börjar äta (eller får näring på andra sätt) så kommer insulinnivåerna stiga. Detta hämmar ovan nämnda processer. Insulin stimulerar upptag av kalium, fosfat och magnesium till cellerna vilket leder till ett snabbt fall i den extracellulära koncentrastionen.
Fosfat krävs för bildandet av ATP från ADP och AMP vilket det blir brist på vid "refeeding". Näringstillförsel ökar även metabolismen i kroppen vilket även denna kräver energi.
När elektrolyter går in i cellen kommer vatten följa med och vi får en redistribution av kroppens vätskebalans. Allt detta leder till sk refeeding syndrome och kan ge upphov till kardiell svikt (hjärtsvikt, arrytmier), respiratorisk svikt, hypotension, rabdomylos, koma, död.
Where'd you go?
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
She said somedays I feel like shit
Somedays I wanna quit and just be normal for a bit
I don't understand why you have to always be gone
I get along but your trips always feel so long
And I find myself trying to stay by the phone
'Cause your voice always helps me to not feel so alone
But I feel like an idiot, working my day around a call
And when I pick up I don't have much to say, so
I want you to know its a little fucked up that
I'm stuck here waiting, at times debatin
Telling you that I've had it with you and your career
Me and the rest of the family here singing
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Please Come back home
You know, the place where you used to live
Used to barbeque with burgers and ribs
Used to have a little party every halloween
with candy by the pile but now
you only stop by every once in a while
Shit
I find myself just filling my time
With anything to keep the thought of you from my mind
I'm doing fine and I'm plannin' to keep it that way
You can call me if you find that you have something to say
And I'll tell you
I want you to know its a little fucked up that
I'm stuck here waiting, at times debating
Telling you that I've had it with you and your career
Me and the rest of the family here singing
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Please Come back home
I want you to know its a little fucked up that
I'm stuck here waiting, no longer debatin'
Tired of sittin and hatin' and making these excuses
For why you're not around, and feeling sorta useless
It seems that one thing has been true all along
You don't really know what you've got till its gone
I guess I've had it with you and your career
When you come back I won't be here and you can sing it
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Please Come back home
I miss you so
Seems like its been forever that you've been gone
She said somedays I feel like shit
Somedays I wanna quit and just be normal for a bit
I don't understand why you have to always be gone
I get along but your trips always feel so long
And I find myself trying to stay by the phone
'Cause your voice always helps me to not feel so alone
But I feel like an idiot, working my day around a call
And when I pick up I don't have much to say, so
I want you to know its a little fucked up that
I'm stuck here waiting, at times debatin
Telling you that I've had it with you and your career
Me and the rest of the family here singing
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Please Come back home
You know, the place where you used to live
Used to barbeque with burgers and ribs
Used to have a little party every halloween
with candy by the pile but now
you only stop by every once in a while
Shit
I find myself just filling my time
With anything to keep the thought of you from my mind
I'm doing fine and I'm plannin' to keep it that way
You can call me if you find that you have something to say
And I'll tell you
I want you to know its a little fucked up that
I'm stuck here waiting, at times debating
Telling you that I've had it with you and your career
Me and the rest of the family here singing
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Please Come back home
I want you to know its a little fucked up that
I'm stuck here waiting, no longer debatin'
Tired of sittin and hatin' and making these excuses
For why you're not around, and feeling sorta useless
It seems that one thing has been true all along
You don't really know what you've got till its gone
I guess I've had it with you and your career
When you come back I won't be here and you can sing it
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Where'd you go?
I miss you so
Seems like its been forever that you've been gone
Please Come back home
Vaccination
Audio Technica ATH M50x
Har länge (så länge jag kan minnas..) använt mig av olika "standard-iphonehörlurar", dvs sådana där vita in-ear som man får med när man köper en iphone. Nu kände jag att det var dags att gå vidare och testa ett par riktiga lurar. Det finns få saker som kan förgylla ett träningspass som musik, så med siktet inställt på ett par rejälra lurar med grymt ljud bökade jag mig ned i hörlursdjungeln. Resultatet efter alldeles för lång tid av recensions- och testläsande fastnade jag för ovanstående hörlurar, och idag kom leveransen. Det blev ett benpass och jäklar vilket drag det blev! Galet bra investering!
