Condition Specific Nutrition Support Flashcards
1
Q
The metabolic stress that occurs in burn injury generates a hypercatabolic state that increases ___ ___
A
energy expenditure
2
Q
What are the risks associated with overfeeding a burn patient?
A
Although patients with burns have increased needs, feeding in excess of energy expenditure may cause hyperglycemia, hepatic steatosis, and prolonged ventilator dependence.
3
Q
One study of critically ill burn patients showed that caloric delivery beyond ___ times measured resting energy expenditure did not conserve lean body mass but was associated with increased fat mass accumulation.
A
1.2
4
Q
Data on nutrition support in patients with obesity support the ___, high ___ feeding strategy
A
Hypocaloric, high protein
5
Q
High-protein hypocaloric feeding is thought to maintain ___ balance and lean body mass while facilitating the mobilization of ___ tissue for fuel utilization.
A
-Nitrogen
-Adipose
6
Q
What is a risk associated with hypercaloric feeding a critically ill patient?
A
Hypercaloric feeding would likely result in hyperglycemia and difficulty weaning from the ventilator.
7
Q
True or false: Low plasma glutamine levels at admission to the ICU is an independent risk factor for mortality.
A
True!
Despite this association studies of glutamine supplementation in critically ill patients either enterally or parenterally have yielded inconsistent results.
8
Q
Is glutamine recommended for EN/PN patients (based on SCCM/ASPEN guidelines)?
A
No. Based on current literature the SCCM/ASPEN 2016 critical care guidelines did not recommend glutamine routine use in either enteral or parenteral regimens.
9
Q
For the critically ill patient, blood glucose levels should be maintained between ___-___ mg/dL.
Lower glucose targets may be appropriate for selected patients, but targets <___mg/dL are not recommended.
A
-140-180 mg/dL
-110 mg/dL
10
Q
What does Octreotide do?
A
Octreotide reduces the production of a variety of gastrointestinal secretions and slows jejunal transit.
11
Q
Can Octreotide eleminate the need for PN?
A
No; its effects are often short lasting and have not been shown to improve absorption or lead to the elimination of the need for parenteral nutrition.
12
Q
What are some risks associated with Octreotide?
A
- Cholethiasis
- Expensive
- Potential for octreotide to inhibit bowel adaptation
13
Q
What kind of patient should Octreotide be reserved for?
A
Patients with large volume stool losses in whom fluid and electrolyte management is problematic
14
Q
When should Octreotide be avoided?
A
Should be avoided in the early adaptation stage (can inhibit bowel adaptation)
15
Q
What 6 nutritional deficiencies are common after gastric bypass surgery?
A
- Iron
- B12
- Folate
- Copper
- Thiamine
- Zinc
16
Q
What are some symptoms/outcomes of B12 deficiency?
A
- Anemia
- Neurological and psychiatric symptoms including paresthesia/tingling and memory loss
17
Q
What can thiamine deficiency lead to?
A
Neuropathy disorders such as beriberi or Wernicke ’s encephalopathy
18
Q
What can zinc deficiency lead to?
A
- Pica
- Dysgeusia
- Hair loss
- Skin lesions
19
Q
What can copper deficiency present with?
A
- Anemia (microcytic, normocytic or macrocytic)
- Neutropenia
- Myelopathy
- Peripheral neuropathy
20
Q
In the 1-3 months after transplant, energy needs are ___- ___ x basal energy expenditure (BEE), or approximately ___ to ___ kcal per kilogram using ___ weight .
A
-1.3 - 1.5
-30 to 35 kcal
-Ideal body weight
21
Q
How would you calculate energy needs in the 1-3 months after transplant?
A
1.5 - 2.0 g per kilogram IBW
22
Q
Refeeding syndrome is characterized by a serum depletion of ___, ___, and ___ as a result of aggressively refeeding malnourished patients.
A
-Phosphorus
-Magnesium
-Potassium
23
Q
What are the risks of hypophosphatemia?
A
The hypophosphatemia can intensify respiratory dysfunction, diaphragmatic weakness and decreased cellular energy production leading to difficulty in ventilator weaning.
24
Q
Azotemia is a sign of ___feeding.
A
Over
25
What is nephrolithiasis from calcium oxalate stones in SBS patients primarily due to?
Increased availability of oxalate for absorption in the colon
26
Normally, dietary oxalate binds to calcium and is excreted in the ___.
Stool
27
In the setting of steatorrhea, calcium binds to ___ ___, allowing excess and unbound oxalate to be absorbed from the colon and filtered by the kidneys.
Fatty acids
28
Oxalate stone formation in patients with SBS is facilitated by the ___ and leads to ___.
Facilitated in the kidneys of SBS patients by excess oxalates, dehydration, metabolic acidosis and hypomagnesemia
29
What is the most important intervention for preventing oxalate stone formation in patients with SBS?
Maintaining adequate hydration to support a urine output > 1200 mL/day is the most important intervention to prevent this complication.
30
What is the purpose and recommended dose for calcium supplements in patients with SBS?
To compete with fatty acids to bind oxalate in the colon
Calcium supplements of 800 to 1200 mg/day, in divided doses not exceeding 500 mg
31
In SBS patients, what is the benefit of limiting dietary fat to just 20-30% of macronutrients?
Minimizes steatorrhea, oxalate absorption and loss of calcium and magnesium
32
SBS patients with less than ___cm of terminal ileum resected are at lower risk of bile salt malabsorption and steatorrhea.
100
33
Intestinal resection involving removal of the terminal ileum and/or the ileocecal valve with the colon in continuity predisposes patients to ___
SIBO
34
What can patients with SBS develop due to colonic proliferation of D-lactic acid producing bacteria?
D-lactic acidosis and variable presentations of encephalopathy
35
What environmental condition do D-lactate producing bacteria thrive in?
Acidic environment
36
What causes the acidic environment commonly found in SBS?
Metabolism of unabsorbed carbohydrate leading to production of lactate and decreases in pH
37
What is a common cause of respiratory alkalosis?
Hyperventilation
38
What is a common cause of metabolic alkalosis?
Excess vomiting
39
What leads to reduced clearance of CO2 in respiratory acidosis?
Hypoventilation
40
What is cyclosporine or tacrolimus used for?
Commonly used after solid organ transplantation for immune suppression
41
What nutrient disorders can be caused by cyclosporine or tacrolimus?
-Hyperkalemia
-Hypomagnesemia
-Hyperglycemia
-Hypercholesterolemia
42
Cyclosporine or tacrolimus has a direct effect on the renin-angiotensin-aldosterone system contributing to altered ___ homeostasis.
Potassium
43
Tacrolimus and cyclosporine also affect the renal tubular excretion of ___.
Potassium
44
True or false: Zinc is an essential trace element.
True
45
What populations are at risk for zinc deficiency?
1. Older adults
2. Postoperative gastrointestinal surgery patients
3. Liver disease
4. Kidney disease
5. Malabsorptive conditions
46
Plasma and urinary zinc have been confirmed as the most reliable biomarkers of zinc status in healthy populations. However, plasma zinc should be interpreted with caution in patients with low ___, inflammation or hemodilution.
Albumin
47
Zinc's role in ___ ___ is due to its function as a cofactor for collagen and protein.
Wound healing
48
What type of patient (with a wound) would benefit from zinc supplementation?
Patients with wounds who are deficient or shown to be losing zinc in wound exudates (negative pressure therapy) may benefit from supplementation
49
Why should prophylactic zinc supplementation be avoided?
Supplementation for all patients with wounds is not recommended due to the risks of copper deficiency and adverse effects on wound healing with zinc toxicity.
50
Clinical manifestations of zinc deficiency are evident at plasma levels <___ mcg/dL.
33
51
What are the manifestations of zinc deficiency?
1, Alopecia
2. Skin rash
3. Cheilosis
4. Glossitis
5. Nail dystrophy
52
Treatment for zinc deficiency in adults is typically 220 mg zinc sulfate (___ mg elemental zinc) twice daily for a total of ___ mg elemental zinc per day. Oral replacement will generally alleviate all clinical manifestations within 1-2 weeks.
-50
-100
53
Blood product support, hyper-transfusion, is usually required before, during and after HSCT, thus leading to ___ overload.
Iron
54
What are the risks of iron overload in HSCT?
-Increased likelihood for graft versus host disease
-Blood and fungal infections
-Sinusoidal obstruction syndrome (veno-occlusion) of the liver
55
Where can Crohn's disease occur in the GI tract?
Can appear anywhere from the mouth to the most distal bowel
As a result, patients with Crohn's disease can become deficient in a whole host of nutrients.
56
Where are iron and calcium absorbed?
Duodenum
57
Where is folic acid absorbed
Jejunum
58
Where is vitamin B12 absorbed?
Distal ileum
59
What does low muscle mass or sarcopenia reflect?
Poor nutritional status and can reflect inflammation
60
What does low fat mass reflects?
Low body stores of energy.
61
What are elevated CRP levels in HD associated with?
Greater weight loss, decreased albumin and decreased appetite.
62
What BMI range in HD patients is considered protective?
30-34.9
63
A BMI less than 23 and hypoalbuminemia (< 3.2g/dL) are strong predictors of ___ in HD patients.
Mortality
64
What does serum cholesterol indicate in HD patients?
While generally, high serum cholesterol is linked to increased cardiovascular disease risk, in dialysis patients, lower cholesterol levels may be associated with increased mortality
Serum cholesterol level is inversely correlated with the risk for death. It has been noted that serum cholesterol concentration is elevated in the long-term dialysis survivors.
65
Loop diuretics are known to cause electrolyte abnormalities as a result of increased ___ ___.
Urine output
66
What specific electrolyte disturbances can occur with loop diuretics?
Excess potassium and magnesium excretion
67
Azotemia can occur related to volume ___.
Depletion
68
The metabolic response to sepsis and stress is characterized by an increase in ___ production and a decrease in ___ uptake.
-Glucose
-Glucose
69
Stress hormones induce ___ resistance therefore hyperglycemia is commonly observed in stressed patients.
Insulin
70
What are the risks of untreated high glucose?
Polyuria, electrolyte disturbances, and infectious complications.
71
What is the ERAS protocol?
Pre and postoperative care program
72
What are the objectives of the ERAS protocol?
1. Avoid starvation
2. Decrease the stress of surgery
3. Limit postoperative IV fluids
4. Optimizing pain control
5. Optimizing GI function and mobilization
6. Decrease insulin resistance
73
Why is nutrition an important part of the ERAS protocol?
ERAS identifies nutrition status as a modifier of surgical outcomes, so nutrition-related interventions are integrated into several elements.
74
What are the nutrition components of ERAS?
1. Preoperative nutrition risk screening
2. Avoidance of preoperative fasting with carbohydrate loading
3. Early resumption of oral nutrition postoperatively
75
What does ERAS preoperative counseling include?
Education regarding the importance of nutrition after surgery
76
In a French study, prevalence of malnutrition was ___ in patients with prostate and breast cancers. An ___ prevalence was found in patients with hematologic, colorectal, ovarian/uterine, and head/neck cancers. The ___ prevalence of malnutrition was seen in patients with esophageal, stomach, and pancreatic cancers.
-Lowest
-Intermediate
-Highest
77
Should patients with advanced liver disease be protein restricted?
NO! The long-standing tradition of protein restriction for patients with advanced liver disease has no solid scientific basis and recent studies do not support this approach, as it may result in loss of muscle mass
78
What is type of protein has been beneficial in reducing encephalopathy?
Although protein restriction is not recommended, substitution of vegetable and dairy protein for animal protein sources has been shown to be beneficial in reducing encephalopathy.
79
Patients with advanced liver disease enter into a starvation mode with decreased ___ oxidation and increased ___ and ___ catabolism, resulting in sarcopenia with subsequent hepatic ___.
-Glucose
-Fat
-Protein
-Encephalopathy
80
What deficiencies are common in patients with liver disease?
B complex vitamins including thiamine, folic acid, vitamin B12, and vitamin B6, as well as zinc, and vitamin D
81
Zinc is a cofactor in the conversion of ___ to ___ which improves excretion of this neurotoxin.
Ammonia to urea
82
Lactulose, a nonabsorbable disaccharide, and rifaximin, a non-absorbable antibiotic both reduce encephalopathy by promoting ___ elimination.
Ammonia
83
What is hyperemesis gravidarum?
Severe, intractable nausea and vomiting complicated by dehydration, electrolyte imbalance, nutrition deficiencies and weight loss
84
How should an enteral formula be selected in the pregnant patient?
The process for selecting an enteral formula for the pregnant patient requiring EN is similar to the process for nonpregnant patients. Polymeric formula is appropriate for patients with adequate digestive and absorptive process.
85
What EN formula should be considered in pregnant patients with constipation?
Because constipation is often a problem in pregnancy (25 – 45 % of pregnant women experience this complication), a fiber – containing formula should be considered.
86
Is thiamine more or less common in patients with heart failure?
Thiamin deficiency is more common in heart failure patients than the general population.
87
Why is thiamine deficiency more common in patients with heart failure?
1. Decreased intake
2. Poor absorption (due to cardiac cachexia and splanchnic congestion)
3. Increased urinary excretion with diuretics
4. Altered thiamin metabolism
88
What is the largest contributing factor to thiamine deficiency in heart failure?
High dose loop diuretics (such as furosemide) are thought to be the most important factor contributing to thiamin deficiency in heart failure.
89
How does furosemide cause thiamien deficiency?
Furosemide therapy causes thiamin deficiency due to increased urinary thiamin excretion.
90
What are the benefits of supplementing thiamin for heart failure patients?
1. Improved left ventricular ejection fraction (LVEF)
2. New York Heart Association (NYHA) functional class and QOL.
3. Thiamin also acts as a vasodilator and reduces the afterload on the heart
4. Improving cardiac function.
5. Increases systolic, diastolic and central venous pressures
6. Decline in heart rate
7. Increase in LVEF
91
Protein losses through the ___ take place routinely while on PD.
Peritoneum
92
How much protein per day should be given to a patient on PD?
KDOQI guidelines recommend 1.0 - 1.2 grams per kilogram per day in clinically stable patients.
93
What happens to the output and risk of metabolic derangements as the fistula occurs higher in the gastrointestinal tract?
The output increases and the risk of metabolic derangements also increases.
94
What must be managed and replaced carefully in patients with proximal high output fistulas?
Fluids and electrolytes.
95
In which type of fistulas may fiber-containing enteral nutrition be possible?
Low output (< 500mL/d) esophageal, gastric, duodenal, or proximal jejunal fistulas with distal enteral access.
96
What type of formula should be used to minimize fistula output in distal ileal or colonic fistulas?
A fiber-free or low fiber formula.
97
To increase the surface area for absorption in distal ileal or colonic fistulas, where should the EN access site site be placed?
As high up as possible.
98
Why is the delivery of adequate protein to acutely ill patients requiring CRRT?
Due to hypercatabolism, obligatory use of protein as a preferred fuel source during the stress response, and likelihood of significant protein losses in CRRT effluent.
99
What is the range of protein losses into CRRT effluent (fluid)?
10-15 g per day.
100
What is the maximum dose of protein that has been advocated to promote positive nitrogen balance in CRRT patients?
2.5 g protein/kg per day.
101
What are some disadvantages of high-protein delivery in CRRT?
-Exacerbation of uremia
- Increased demand on hepatic and renal function
- Increased costs
102
What is the best insulin administration method in the critical care setting?
Continuous intravenous insulin infusion has been shown to be the best method for achieving glycemic targets and allows for off cycles during the 24-hour period when enteral feeding is held or discontinued.
103
What is megestrol acetate?
A synthetic progestational agent that promotes weight gain and helps to stimulate appetite.
104
What is the primary reason for the change in weight associated with megestrol acetate?
Increased adipose tissue and edema.
105
How can megestrol acetate affect diabetes mellitus?
It can exacerbate underlying diabetes mellitus.
106
What is a rare side effect of megestrol acetate?
Adrenal suppression.
107
What risk may be associated with megestrol acetate?
A small increase in the risk of deep venous thrombosis.
108
Megastrol acetate works as progestagens induce the release of neuropeptide Y from the hypothalamus and downregulate the synthesis and release of ___ ___
Proinflammatory cytokines
109
What percentage of complex carbohydrates is recommended for a diet in SBS patients?
50% to 60%
## Footnote
This range is associated with increased overall energy absorption and SCFA production.
110
What is the recommended fat percentage in the diet for SBS patients?
20% to 30%
## Footnote
A lower fat intake helps reduce steatorrhea and fecal wet weight.
111
In SBS patients, what is the result of a diet high in complex carbohydrates?
Reduces losses of magnesium and calcium
## Footnote
This dietary approach helps maintain mineral balance in SBS patients.
112
What effect does fat malabsorption have on oxalate absorption?
Fat malabsorption increases oxalate absorption
## Footnote
In fat malabsorption, calcium binds to free fatty acids, leaving oxalate free to be absorbed.
113
What dietary changes should SBS patients with a colon in continuity make to reduce the risk of oxalate nephrolithiasis?
Restrict dietary oxalate intake and consume high calcium foods or calcium citrate supplements
## Footnote
These measures help manage oxalate levels in the body.
114
What is the preferred type of carbohydrates in the diet of SBS patients?
Complex carbohydrates
## Footnote
They help reduce osmotic load and may aid in the adaptation process.
115
Why should concentrated sugars be avoided in the diet of SBS patients?
They generate a high osmotic load and potentiate stool output
## Footnote
This can worsen symptoms and lead to further complications.
116
Mid-arm circumference and hand grip strength appear to be sensitive markers of ___ ___ ___ ___
Body cell mass depletion
117
Malnutrition has been reported in ___% of patients with compensated cirrhosis and in more than ___% of patients with decompensated disease.
-20%
-50%
118
What are some reasons for malnutrition in liver disease?
Inadequate oral intake (anorexia)
1. Nausea
2. Bloating/distention
3. Ascites
4. Encephalopathy
5. Delayed gastric emptying
6. Restrictive diet
7. Increased leptin levels
Metabolic disturbances
1. Catabolism
2. Malabsorption
3. Decreased capacity of the liver to store nutrients
119
Why is malnutrition difficult to diagnose with NFPE in patients with liver disease?
Ascites and fluid weight gain masks muscle and fat losses
120
Why is EN preferred over PN in patients with acute pancreatitis?
1. Less likely to develop infectious complications
2. Maintained equal nitrogen balance
3. Reduced incidence of hyperglycemia 4. Enteral feedings were well tolerated without adverse effects on the disease course.
121
Name the catabolic stress hormones
Epinephrine, glucagon, and cortisol
## Footnote
These hormones play a critical role in the body's response to trauma.
122
What metabolic processes are stimulated by the release of catabolic hormones after an injury?
- Glycogenolysis (glycogen breakdown)
- Gluconeogenesis (glucose from non-carbohydrate sources like lactate, amino acids, and glycerol)
- Proteolysis
- Free fatty acid release
## Footnote
These processes help to mobilize energy stores for survival and recovery.
123
What is the top priority in the resuscitation of trauma patients?
Restoration of perfusion, oxygenation, and hemodynamic stability
## Footnote
Ensuring adequate blood flow and oxygen delivery is essential for survival.
124
Why is hypoglycemia common in acute liver failure?
-Glycogen stores are rapidly depleted
-Iinsulin metabolism is impaired and leads to increased serum insulin levels
-Gluconeogenesis is reduced
-Oral intake is also generally diminished
125
How is hypoglycemia managed in patients with acute liver failure?
Typically managed with continuous dextrose infusions
126
What is the association between underfeeding and COPD?
Prolonged underfeeding of patients with chronic respiratory disease may lead to deficits in lean body mass that may increase mortality.
127
Do patients with COPD have a higher or lower REE, on average?
Patients with COPD frequently have an increased REE secondary to their disease, although the exact etiology of this hypermetabolism is not fully understood
128
What does accumulation of an energy deficit lead to, in patients with COPD?
Increased:
-Length of stay
-Complications
-Infections
-Days on antibiotics
-Time on mechanical ventilation
129
What are the reasons human milk is preferred over formula?
Human milk is the optimal choice over standard formula for any infant due to multiple beneficial components including immunologic properties, growth factors, and both prebiotics and probiotics.
130
What type of feeding is recommended for a baby with CF?
Human milk or standard infant formula with appropriate enzyme dosing is recommended.
131
Protein hydrolysate or free amino acid formulas containing MCT are not indicated for infants with CF unless there is another medical reason. Name 2 examples of a case where these formulas would be appropriate?
1. Bowel resection resulting in malabsorption
2. Liver abnormalities
132
What are the 3 reasons for malnutrition in liver disease?
1. Reduced caloric intake from anorexia and early satiety
2. Fat malabsorption from altered bile acid circulation
3. Increased protein and fat oxidation (main etiologies)
133
What is the main etiology for malnutrition in liver disease?
Increased protein and fat oxidation
134
Energy expenditure may be ___ in those liver-disease patients with infections and ascites.
Increased
135
What are the metabolic bone disease complications associated with inflammatory bowel disease?
Osteopenia and osteoporosis
## Footnote
These conditions are significant complications that can arise in patients with inflammatory bowel disease.
136
What interventions can reduce osteopenia in patients on long-term steroids?
Supplementation of calcium and vitamin D
## Footnote
These supplements are recommended to mitigate the effects of long-term steroid use.
137
List 5 factors associated with the development of metabolic bone disease in patients with IBD.
1. Malnutrition
2. Vitamin D deficiency
3. Corticosteroid therapy
4. Magnesium deficiency
5. Chronic inflammation
## Footnote
These factors commonly coexist in patients suffering from inflammatory bowel disease.
138
What 3 conditions may be associated with parenteral nutrition-associated metabolic bone disease?
1. Hypercalciuria
2. Aluminum toxicity
3. Magnesium deficiency
## Footnote
These conditions could impact patients with inflammatory bowel disease requiring long-term parenteral nutrition.
139
What is a potential risk of administering antidiarrheals to patients with inflammatory bowel disease?
Development of toxic megacolon
140
What medication can be used with antidiarrheal agents for patients who have undergone extensive bowel resection?
Cholestyramine
141
What is the stool output threshold that should prompt evaluation for diarrhea treatment?
Greater than 500 mL/day for 2 consecutive days
To reduce the risk of volume depletion and electrolyte deficiencies
142
Are there evidence-based recommendations for using prebiotics and probiotics as standard therapy for diarrhea?
No
143
Several reviews have indicated that in the United States, ___ ___ is the preferred modality for nutrition rehabilitation.
Oral refeeding
144
What is the impact of reduced hepatic glycogen stores in cirrhotic patients?
Increased use of muscle glycogen, free fatty acid oxidation, and production of ketone bodies
## Footnote
This leads to a higher reliance on alternative fuel sources.
145
What dietary strategy should cirrhotic patients follow to mitigate hepatic glycogen depletion?
Eating small, frequent meals, including a nighttime snack
## Footnote
This helps to prevent prolonged fasting and subsequent breakdown of endogenous protein.
146
What effect does a bedtime or late evening nutrient-dense snack have on patients with cirrhosis?
It has been shown to increase total body protein levels and lean muscle mass
## Footnote
This is particularly important for maintaining muscle mass in cirrhotic patients.
147
Studies comparing full EN and trophic feeds during the first week of critical illness found:
No differences in ventilator days, 60 day mortality or infectious complications.
148
Studies indicated that early, short-term trophic EN may result in less ___ ___ than full feeding in patients with ALI or ARDS who are not at nutrition risk.
GI intolerance
149
What stage or renal disease requires dialysis or transplant?
A diagnosis of ESRD may include GFR < 15 mL/min or need for dialysis or kidney transplant
150
Stage 1 CKD GFR
Normal or high GFR (GFR > 90 mL/min)
151
Stage 2 CKD GFR
Mild CKD (GFR 60-89 mL/min)
152
Stage 3 CKD GFR
Moderate CKD (GFR 45-59 mL/min)
153
Stage 3b CKD GFR
Moderate CKD (GFR 30-44 mL/min)
154
Stage 4 CKD GFR
Severe CKD (GFR 15-29 mL/min)
155
Stage 5 CKD GFR
End Stage CKD (GFR < 15 mL/min)
156
Can histamine 2-receptor antagonists be added to PN?
Yes
157
Can octreotide be added to PN solutions?
Yes
158
Octreotide may impair small intestinal ___ if used in the early phase following significant resection of the bowel.
Adaptation
159
What causes TLS
TLS is caused by massive tumor cell lysis
160
What is released with TLS?
Large amounts of:
1. Potassium (hyperkalemia)
2. Phosphate (hyperphosphatemia)
3. Nucleic acids
161
TLS most often occurs after the initiation of ___ ___
Cytotoxic therapy
162
Respiratory acidosis results from what disorders?
Those producing alterations in ventilatory control, increased production of CO2, and respiratory muscle weakness
163
The increased CO2 production is greatest when overfeeding occurs (___x BEE) due to an excess generation of CO2 relative to O2 consumption during ___ metabolism.
-2
-Carbohydrate
164
What types of malabsorption can occur with decreased pancreatic function in CF patients?
1. Fat
2. Protein
3. Fat soluble vitamins
165
How does EFA affect patients with CF?
Essential fatty acid deficiency may contribute to inflammatory pathways resulting in pulmonary and gastrointestinal symptoms associated with CF.
166
What are usual signs of EFA deficiency?
Scaly dermatitis, alopecia, thrombocytopenia, and growth failure
167
Do "normal" signs of EFA deficiency show up in patients with CF?
The overt signs of EFAD (scaly dermatitis, alopecia, thrombocytopenia, and growth failure) are uncommon in patients with CF.
168
EFAD correlates with poor ___ and ___ status in patients with CF
EFAD correlates with poor growth and pulmonary status.
169
EFA status is usually evaluated by measuring the triene: tetraene ratio. A ratio > ___ (some suggest > ___) is diagnostic of EFAD.
-0.2
-0.4
170
How is EFAD treated in patients with CF?
Although supplementation with omega-3 fatty acids is sometimes used in the management of CF, results from clinical trials have shown mixed results and further trials are needed to determine the efficacy of routine EFA supplementation in the management of CF.
171
In patients with refeeding risk, 100mg thiamine is recommended before intimating ___ and for ___-___ days thereafter
-Before feeding / dextrose IVF
-5-7 days
172
Decreased thiamine levels are frequently seen in pregnancy due to increased ___ and increased demand for ___ metabolism, increasing the risk for ___ ___, a potentially fatal neurologic syndrome.
-Losses
-Glucose
-Wernicke's encephalopathy
