Nutrition

Question 1

What is the Fischer ratio?

Answer 1

BRAA:AAA

BRAA: valine + leucine + isoleucine
AAA: phenylalanine + tyrosine

Question 2

Canine SIRS criteria.

Answer 2

HR >120
RR>20
T102.5
WBC 16 K or greater than 3% bands

Question 3

Chan, JVIM, 2009. What AA were significantly lower in sick dogs?

Answer 3

alanine, arginine, citrulline, glyceine, methionine, proline, serine

Question 4

Chan, JVIM, 2009. What AA were significantly higher in sick dogs?

Answer 4

lysine, phenylalanine

Question 5

NICE SUGAR study results

Answer 5

increased mortality with intensive glucose control, increased hypoglycemia in intensive control, no diff in length of hospitalization, days of PPV or CRRT

Question 6

Chan, JVIM, 2009. What was findings from Fischer ratio? SPI2?

Answer 6

Fischer ratio * lower in sick dogs, SPI2 * higher in survivors

Question 7

What is a primary AA for enterocytes?

Answer 7

glutamine

Question 8

What AA is a precursor to NO?

Answer 8

arginine

Question 9

Early nutritional support in dogs with septic peritoniits is NOT associated with a shorter hospitalization length. T/F? Lui, JVECC, 2012

Answer 9

F - early nutrition IS associated with shorter hospitalization (by 1.6 days)

Question 10

Early (<24h) nutrition septic peritonitis dogs - study findings? Lui, JVECC, 2012

Answer 10

Early nutrition (regardless of route) shorter hospitalization by 1.6 days

No sig assc’n b/t route of nutrition and LOH

Concurrent illness and nutrition related metabolic complications assc’d with longer LOH (2.1 and 2.4 d, respectively)

Question 11

How do you make standard PN?

Answer 11

25% calories from AA, 50% calories from dextrose, 20% calories from intralipid, supplement zinc (1mcg/kcal), KPhos (8mM/1000 kcal), 2 ml vitamin B complex per liter

Question 12

Metabolic complications, Luis, JVECC, 2012, nutrition and septic peritonitis

Answer 12

42% - hypomagnesemia and hypokalemia most common

Question 13

Early vs late parenteral nutrition critically ill adults, findings? NEJM, 2011, Casaer

All used early enteral nutrition

Answer 13

5000 patients randomized; patients in LATE 6.3% increased likelihood being discharged alive from ICU and hospital, less ICU infections, lower incidence cholestasis, more hypoglycemia, higher CRP, less MV, less RRT, less cost of care.

Summary: LATE (8 d) better than EARLY (48h)