Hospital-Based Nutrition

Question 1

It is irrelevant to this lecture, but Dr. Bessesen brought up an interesting point: where do the pyrimidine pathway and urea cycle meet?

Answer 1

Orotic acid

Question 2

After how many days of fasting does nutritional depletion occur?

Answer 2

Not sick or undernourished (e.g., unconscious due to a stroke): 10-14 days
Sick but not previously undernourished: 5-7 days
Sick and previously undernourished: 3-5 days

Question 3

What things should you ask about to assess for possible nutritional depletion?

Answer 3

• Weight trajectory (has the patient recently lost weight?)
• Social factors (alcoholism or homelessness)
• Chronic medical problems
• Thenar wasting
• BMI less than 19
• Albumin level
• Lymphocyte level

Question 4

Why is enteral feeding better?

Answer 4

Because gut feeding improves the lining of the gut, leading to improved health of the gut wall. Most people die from Gram-negative infection from gut bacteria, so preserving gut wall health is vital!

Question 5

What is D5?

Answer 5

5 grams of dextrose per 100 mL saline

Question 6

Reduce the flow rate of nasogastric feeding when the residual volume in the stomach is ______________.

Answer 6

greater than 100 mL

Question 7

Many times, glycogen stores take ______ days to fill. Because of this, check glucose after this much time has passed.

Answer 7

~2

Question 8

What is deficient in beri beri?

Answer 8

Thiamine

Question 9

Why is arginine special?

Answer 9

The body can make it, but production is limited. Also, arginine is needed for NO production.

Question 10

Another “special” amino acid is ______________.

Answer 10

glutamine; it can be made by the body, but production is limited. Also, it is needed for gut epithelium

Question 11

What nutritional considerations are important for those in respiratory failure?

Answer 11

Because the body needs to work to breathe off carbon, it will have to work harder when given nutrients that produce more carbon per calorie –such as carbohydrates. As such, many protocols give higher fat diets to those in respiratory failure.

For the same reason, it is better to avoid overfeeding someone in respiratory failure.

Question 12

Hepatic dietary formulas have lower __________, which can act as false neurotransmitters that worsen encephalopathy.

Answer 12

aromatic amino acids

Question 13

What is the energy density of most TPN fluids?

Answer 13

1 kcal/mL

Question 14

Why should you start low and titrate up for enteric feeding?

Answer 14

Because most people can’t tolerate much in their stomachs via enteric feeding, so start in a safe range and work up.

Question 15

How much protein do we typically need?

Answer 15

Normal conditions: 0.5 - 0.8 g/kg/day

During illness: 1.0 - 1.8 g/kg/day

Question 16

____________ deficiency has been shown to cause insulin resistance.

Answer 16

Chromium

Question 17

Deficiency of ___________ can cause CHF.

Answer 17

selenium

Question 18

Arginine is not stable in ____________.

Answer 18

enteric formulations

Question 19

How can you avoid refeeding syndrome?

Answer 19

Feed slowly, then start with vitamins, folate, and thiamin

Question 20

Cardiac diets must have _______ or less of sodium. Additionally, they’re also low in ______________.

Answer 20

2 grams; triglycerides and saturated fat

Question 21

In what situations should you order a nutrition consult?

Answer 21

• When the patient has a disorder with nutritional implications
• When you can’t get a patient to consume an adequate diet
• When patients receive enteral feeding
• When swallowing therapy is needed