Chapter 10 - Nutrition Flashcards

1
Q

What is the approximate daily caloric need?

A

25 kcal/kg/day

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2
Q

How many kcal/gram of fat?

A

9

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3
Q

How many kcal/gram of protein?

A

4

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4
Q

How many kcal/gram of oral carbohydrates?

A

4

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5
Q

How many kcal/gram of Dextrose?

A

3.4

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6
Q

How many kcal/cc is there in a 10% lipid solution?

A

1.1

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7
Q

How many kcal/cc are there in a 20% lipid solution?

A

2

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8
Q

What are the nutritional requirements of a healthy adult male?

A

1g/kg/day protein (20% essential AA); 30% fat calories; rest as carbs

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9
Q

How much does trauma, surgery, or sepsis stress increase the k/cal requirements?

A

20-30%

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10
Q

How much does pregnancy increase the kcal requirements?

A

300 kcal/day

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11
Q

How much does lactation increase kcal requirements?

A

500kcal/day

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12
Q

How do you calculate the calories required in a burn?

A

25kcal/kg/day + (30 kcal/day x % of burn)

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13
Q

How do you calculate protein required in a burn?

A

1-1.5 g/kg/day + (3g x % of burn)

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14
Q

How much does the basal metabolic rate rise in fever?

A

10% for each degree above 38.0

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15
Q

Central line TPN is based on what?

A

glucose. Max glucose administration is 3g/kg/hr

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16
Q

Peripheral line parenteral nutrition is based on what?

A

fat

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17
Q

What is the fuel for colonocytes?

A

short chain fatty acids

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18
Q

What is the fuel for small bowel enterocytes?

A

Glutamine

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19
Q

What is the most common AA in bloodstream and tissue?

A

Glutamine

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20
Q

What does Glutamine do in kidney?

A

Releases NH4, helping with nitrogen excretion (can also be used for gluconeogenesis)

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21
Q

What is the primary fuel for neoplastic cells?

A

Glutamine

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22
Q

What is the half life of albumin?

A

20 days

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23
Q

What is the half life of Transferrin?

A

10 days

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24
Q

What is the half life of Pre-albumin?

A

2 days

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25
Q

What is the normal protein level?

A

6.0-8.5

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26
Q

What is the normal albumin level?

A

3.5-5.5

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27
Q

What are acute indicators of nutritional status?

A

retinal binding protein, pre-albumin, transferrin, total lymphocyte count

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28
Q

What is the Ideal Body Weight calculation?

A

Men: 106 + 6 for every inch over 5ft
Women: 100 + 5 for every inch over 5ft

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29
Q

What are 3 preoperative signs of poor nutrition?

A
  • Weight loss >10% in 6 months

- Weight <3.0 (strong M&M risk)

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30
Q

What is the respiratory quotient?

A

ratio of CO2 produced to O2 consumed

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31
Q

An RQ of >1 means what?

A

lipogenesis- overfeeding. decrease carbs and caloric intake. Can lead to ventilator problems for CO2 buildup

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32
Q

An RQ of <0.7 means what?

A

ketosis and fat oxidation (starving). Increase carbs and caloric intake

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33
Q

Pure fat metabolism has an RQ of?

A

0.7

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34
Q

Pure protein metabolism has an RQ of?

A

0.8

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35
Q

Pure carbohydrate metabolism has an RQ of?

A

1.0

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36
Q

Postoperative diuresis phase occurs when?

A

days 2-5

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37
Q

Postoperative catabolic phase occurs when?

A

days 0-3 (negative nitrogen balance)

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38
Q

Postoperative Anabolic phase occurs when?

A

days 3-6 (positive nitrogen balance)

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39
Q

How long before glycogen stores are depleted?

A

24-36 hours of starvation (2/3 in skeletal muscle, 1/3 in liver)

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40
Q

What do skeletal muscles lack that is found in the liver in regards to glycogen metabolism?

A

Glucose-6-phosphatase

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41
Q

What are the gluconeogenesis precursors?

A

AA (especially alanine), lactate, pyruvate, glycerol. Alanine is simpleist AA precursor for gluconeogenesis and is primary substrate.

42
Q

What AA increase during times of stress?

A

Alanine and Phenylalanine

43
Q

In late starvation, gluconeogenesis also occurs in what organ?

A

Kidney

44
Q

Why do protein conserving mechanisms not take place after trauma?

A

catecholamines and cortisol

45
Q

What is the main source of energy during trauma and starvation?

A

Fat (ketones)

46
Q

What percentage of weight loss can most patients tolerate without major complications?

A

15%

47
Q

How many days can patients tolerate without eating?

A

7 days. After that place dobbhoff or start TPN

48
Q

Why do you want to feed gut?

A

avoid bacterial translocation (enterocytes starved and allow bacterial leak)

49
Q

What is an elemental formula?

A

all protein given in the form of amino acids

50
Q

When to consider PEG?

A

when regular feeding not possible (CVA), or when feeding not to occur for >4 weeks

51
Q

What does the brain utilize with progressive starvation?

A

ketones

52
Q

What are the obligate glucose users?

A
  • Peripheral nerves
  • adrenal medulla
  • red blood cells
  • white blood cells
53
Q

What happens during refeeding syndrome?

A

drop in K+, Mg+, and PO4. causes cardiac dysfunction and fluid shifts. Start refeeding at low rate (10-15kcal/kg/day)

54
Q

What is thought to mediate cachexia?

A

TNF alpha

55
Q

What is kwashiorkor?

A

protein deficiency

56
Q

What is Marasmus?

A

starvation

57
Q

How many grams of protein contains 1 gram of Nitrogen?

A

6.25

58
Q

How do you calculate Nitrogen balance?

A

(protein in/6.25) - (24 hour Urine N + 4 grams)

  • positive # = anabolism
  • negative # = catabolism
59
Q

What is the total protein synthesis for a healthy, normal, 70kg male?

A

250 g/day

60
Q

What is the function of Urea production?

A

get rid of ammonia from amino acid breakdown

61
Q

What is AA is produced in the majority of skeletal muscle breakdown?

A

glutamine and alanine

62
Q

In digestion, what breaks down triacylglycerides, cholesterol, and lipids?

A

Pancreatic lipase, cholesterol esterase, phospholipas; broken down to micelles and free fatty acids

63
Q

What are Micelles?

A

Aggregates of bile salts, long chain fatty acids, and monoacylglycerides

64
Q

How do micelles enter enterocytes?

A

they fuse with the membrane

65
Q

What are the fat soluble vitamins?

A

A, D, E, K

66
Q

How do medium and short chain fatty acids enter enterocytes?

A

simple diffusion

67
Q

After micelles and other fatty acids enter enterocytes, how are they transported out?

A

chylomicrons are formed. they are 90% TAG’s, 10% phospholipids/proteins/cholesterol. Chylomicrons enter lymphatics to thoracic duct. (medium & short chain FA’s enter portal system) long chain FA’s enter lympatics like chylomicrons

68
Q

Where is lipoprotein lipase found and what does it do?

A

liver endothelium; clears chylomicrons and TAG’s from blood breaking them down to FA’s and glycerol. Then taken up by hepatocytes

69
Q

Where is free fatty acid binding protein found and what does it do?

A

Liver endothelium; binds short and medium chain FA’s

70
Q

What is the most important route of entry for dietary cholesterol?

A

VLDL; synthesized in liver

71
Q

What are saturated fatty acids used for?

A

Fuel for cardiac and skeletal muscles

72
Q

What are unsaturated fatty acids used for?

A

structural components of cells

73
Q

Where is Hormone sensitive lipase found, what does it do, and what stimulates it?

A

found in fat cells; breaks down TAG’s to fatty acids and glycerol; stimulated by growth hormone, catecholamines, and glucocorticoids

74
Q

What are essential fatty acids?

A

linolenic, linoleic

75
Q

Omega-3 fatty acids are needed for what?

A

PGI3, TXA3, LTB5 (all even)

76
Q

Omega-6 fatty acids are needed for what?

A

PGE2, TXA2, LTB4 (all even)

77
Q

Glucose and Galactose use what process for absorption?

A

secondary active transport

78
Q

Fructose uses what process for absorption?

A

Facilitated diffusion

79
Q

Sucrose is made up of what?

A

fructose + glucose

80
Q

Lactose is made up of what?

A

galactose + glucose

81
Q

Maltose is made up of what?

A

glucose + glucose

82
Q

Trypsinogen is released from where and activated by what?

A

pancreas; activated by enterokinase from duodenum (can also be autoactivated by trypsin)

83
Q

What are the branched chain amino acids?

A

leucine, isoleucine, valine (LIV)

84
Q

Chromium deficiency?

A

hyperglycemia, encephalopathy, neuropathy

85
Q

Selenium deficiency?

A

Cardiomyopathy, Weakness, Hair loss

86
Q

Copper deficiency?

A

Pancytopenia

87
Q

Zinc deficiency?

A

Hair loss, poor healing, rash

88
Q

Trace element deficiency?

A

poor wound healing

89
Q

Phosphate deficiency?

A

Weakness, failure to wean off Vent (hyporesponsive diaphragm) encephalopathy, decreased phagocytosis

90
Q

Thamine B1 deficiency?

A

Wernicke’s, cardiomyopathy, peripheral neuropathy

91
Q

Pyridoxine deficiency?

A

Sideroblastic anemia, glossitis, peripheral neuropathy

92
Q

Cobalamin B12 deficiency?

A

Megaloblasic anemia, peripheral neuropathy, Beefy assed tongue

93
Q

Folate deficiency?

A

megaloblastic anemia, glossitis

94
Q

Niacin deficiency?

A

Pellagra (diarrhea, dermatitis, dementia)

95
Q

essential fatty acid deficiency?

A

dermatitis, hair loss, thrombocytopenia

96
Q

Vitamin A deficiency?

A

Night blindness

97
Q

Vitamin K deficiency?

A

coagulopathy

98
Q

Vitamin D deficiency?

A

Rickets, osteomalacia

99
Q

Vitamin E deficiency?

A

Neuropathy

100
Q

Briefly describe steps of Cori cycle

A

Glucose used in muscle, broken down to lactate, lactate to liver, lactate converted to pyruvate, pyruvate to glucose via gluconeogenesis, glucose back to muscle