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Flashcards in CPS Nutrition 2 Deck (78)
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1

Which of the following statements is false?
a)the optimal glucose to sodium ratio to ensure sodium absorption by ORT is 2:1
b) the sodium-glucose cotransport system is destroyed in infective diarrhea caused by viruses or enteropathogenic bacteria
c)sodium-potassium-ATP pump on the basolateral membrane of the enterocyte provides the gradient that drives the process of glucose - sodium cotransport
d) glucose enhances sodium and water absorption

b) false, the cotranspot system is relatively intact in infective diarrhea caused by viruses and bacteria, whether invasive or enterotoxinegic, this is why ORT makes sense

ORT based on the glucose - sodium cotransport across the intestine membrane - sodium potassium ATP pump on the basolateral membrane of the enterocyte

the rest are true statements which explain the science behind ORT

2

Which of the following is not an effect of the reduced osmolality WHO recommended oral rehydration solution?
a) less IV solutions
b) lower stool volume
c) less emesis
d) hypernatremia

d) hypernatremia was reported with the use of the standard WHO solution with non cholera diarrhea

study comparing this standard solution to reduced osmolality ORS showed

less IV solutions (unplanned), lower stool volume, less emesis were advances of the oral rehydration solution with reduced osmolality

standard WHO solution: 90 mmol/L of sodium, 20 mmol/L of potassium, 80 mmol/L of chloride, 30 mmol/L of bicarbonate and 111 mmol/L of glucose, with an osmolarity of 311 mOsm/L.
revised WHO solution: reduced osmolarity (245 mOsm/L) ORS containing 75 mmol/L of sodium, 20 mmol/L of potassium, 65 mmol/L of chloride, 10 mmol/L of citrate and 75 mmol/L of glucose
**note that none of these have the 2:1 ratio shown in the last question; discuss; also, these have a lot less sodium that the body, does this work because the body is able to control the sodium (unlike with IV solutions?)

3

In which population has rice based oral rehydation therapy been shown to be especially effective?
a) children with cholera
b) children with non cholera diarrhea
c) children with E. coli
d) none of the above

a) has been shown to be especially effective in cholera, reduces stool output in these patients, not so much in other types of diarrhea
has been shown to reduce the need for unscheduled IV therapy

using starch from rice and other cereals helps reduce osmolarity while providing a favourable ratio of glucose to sodium, may also add calories without increasing osmolarity

4

Which of the following supplementations to oral rehydration solution has been shown to reduce the duration and severity of diarrhea?
a) glycine
b) alanine
c) zinc
d) glutamine

c) zinc fortified ORS can reduce the severity and duration of diarrhea; other substrates such as glycine, alanine and glutamine have not been shown to be superior to traditional ORS

because it is expensive, we don't give zinc fortified ORS routinely (instead recommend the supplement 20 mg for 10-14 days for children with acute diarrhea, 10 mg/day for infants <6 months of age

5

A 3 year old girl with gastroenteritis has decreased urine output, tachycardia and a sunken anterior fontanelle. How should you give rehydration?
a) IV normal saline or Ringer's Lactate 20 cc/kg - 40 cc/kg over 1 hour
b) oral rehydration solution 50 ml/kg over 4 hours and replace ongoing losses with ORS
c) oral rehydration solution 100 ml/kg over 4 hours then replace ongoing ORS
d) age appropriate diet

c) is the answer
this is moderate dehydration 5-10% dehydrated
(remember, that based on clinical signs is the best way to assess dehydration, weight isn't super accurate)
based on the algorithm should rehydrate with ORS 100 ml/kg over 4 hours, replace ongoing losses with oRS, age appropriate diet after rehydration

oral rehydration is as effective as, if not more effective, than IV treatment for moderate dehydration, less adverse effects and shooter hospital stay, should be the first choice for mild-moderate dehydration ; cheaper, less traumatic, can administer at home

6

A 2 year old boy weighing 16 kg with gastroenteritis has significantly reduced urine output, very sunken anterior fontanelle, tachycardia, and very low energy. His Na level is 150. What is the appropriate rate for rehydration ?
a) pedialyte 72 ml/hr
b) pedialyte 52 ml/hr
c) IV 0.45 NS @ 72 ml/hr
d) IV 0.45 NS @ 52 ml/hr

a) amount of maintenance fluid should be reduced by 25% because these children have higher ADH levels **check if this makes sense (since we are replacing losses plus maintenance
10% dehydration x 16000 kg = 1600 ml to replace
moderate hypernatremia, replace over 48 hours as per RCH guidelines, therefore rate will be 33cc/hr for replacement plus the maintenance rate - 25% (52 (-13) ml/hr) =72 ml/hr (looking at the guideline is a bit less because they use moderate 7% loss to replace), likely a few different ways of doing this
if doing IV then should do D5NS

b) does not do replacement

**according to the algorithm once the patient is stable, can give ORS for severe dehydration, but this patient is still not totally stable so should continue IV

for hypernatremia, should give fluids so that Na is normalized over 48-72 hours
amount of maintenance fluid should be reduced by 25% because these children have higher ADH levels
http://www.rch.org.au/clinicalguide/guideline_index/Hypernatraemia/ (how to deal with hypernatremic dehydration *also clarify what type of fluid to use)

fluid therapy should always include: rehydration, replace losses, maintenance

7

Which is the best type of oral rehydration solution to use?
a) powder package
b) premixed
c) homemade
d) none of the above

b) premixed are recommended over the others even though the pre-packaged powders are easier to store, have longer shelf life and are less expensive, can easily lead o an imbalance of electrolytes with incorrect mixing

8

Which of the following is not true of carbonated beverages?
a) can cause diarrhea
b) low electrolytes
c) high carbohydrate
d) low osmolarity

d) actually has high osmolarity, can cause diarrhea if given in high quantities

free water can lead to hyponatremia or hypoglycaemia

9

All but which of the following is not a contraindication to oral rehydration therapy?
a) protracted vomiting despite small, frequent feeding
b) severe dehydration with shock like state
c) impaired consciousness
d) ongoing stool losses of >10 ml/kg/hr
e) paralytic ileus
f) monosaccharide malabsorption

d) these children should not be denied ORT despite the intense pooping because the majority of these children will respond to ORT

the others are contraindications to ORT
ORT successful in 95% of cases

10

Which of the following is not the appropriate advice to give a parent with a dehydrated baby?
a) stop breastfeeding while baby is dehydrated
b) can give regular formula to non breastfed babies who are dehydrated
c) early referring has both nutritional and clinical benefits
d) children with dehydration should be rehydrated then fed an age-appropriate diet

a) false - should continue breastfeeding throughout, even in the initial phases

the rest are true
nutritional and clinical benefits of early referring: induce digestive enzymes, improve absorption, enhance enterocyte regeneration, promotee recovery of disaccharidases, reduce duration of diarrhea, maintain growth and improve nutritional outcomes

11

How much of baby baby's nutritional needs can be met by breast milk between the ages of 6-12 months?
a) 25%
b) 50% or more
c) 100%
d)none of the above

b) 50% or more between 6 -12 months (starts off lower, see below)
prior to this, all nutrition from breast milk (firsts 6 months)

12-24 months - 1/3 from breast milk, the rest from food

the energy contribution from complementary feedings is approximately one fifth of the total requirement (WHO, 2009; PAHO, 2003). By nine to 11 months, complementary feedings contribute just under half of the estimated total energy requirement.

12

Which of the following has not been associated with breastfeeding past 6 months?
a) increased risk of obesity and overweight
b) protect against infections, especially GI and resp
c) protect mother against breast cancer and ovarian cancer
d) improved sensitivity and bonding

a) opposite, decreases this risk

the others are based on limited evidence

13

Of Canadian mothers who breastfeed, how many breastfeed past 6 months of age?

57.4% continue breastfeeding, only 18% past one year
reasons for stopping: lack of milk; infant ready for food/self-weaned
closet nursing, not always socially acceptable to continue so people do it in secret

14

True or false -baby friendly initiatives help to improve the duration of breastfeeding

true - BFI initiative are known to improve the initiation, exclusivity and duration of breastfeeding
Breastfeeding protection, promotion and support increases the percentage of mothers who breastfeed their child beyond six months. offering breastfeeding support at all visits up to 9 months helps increase BF
need to educate dads and other social supporters about appropriate length of breastfeeding

15

What is the maximum tolerable daily level of vitamin D?

2500 IU
therefore should continue to supplement baby with 400 IU daily as long as they are receiving breastmilk, unlikely to over-reach the level
formula and cow's milk contain vitamin D so babies that get this don't need a supplement (see separate statement on vitamin D also)
after 2 years, no longer recommended supplement (at this point follow the food guide)3-8 year olds have the lowest levels of deficiency amongst any age group

16

True or false? breastmilk should be given before complementary foods at every meal

false - does not matter which you give first

17

Which of the following is not a good initial choice for a family starting their 6 month old on solid foods?
a) iron fortified cereal
b) meat
c) yogourt
d)meat alternatives

c) yogourt - not iron rich , should start with iron rich foods
then, between 6-9 months should give vegetables, fruit and milk products and yogourt

best to give food from family meals that has been mashed up to an appropriate consistency , don't need commercial foods (may be high in sugar); if babies get used to eating nutritious foods, more likely to keep doing so when older

18

True are false - babies must have teeth to eat crackers

false - the older infant develops up and down munching abilities that allow them to munch on food, regardless of whether or not they have teeth (i.e. crackers, toast, breakfast cereal). starting at 6 months should give a
variety of soft textures (such as lumpy, and tender-cooked and finely minced, pureed, mashed or ground) and finger foods from six months of age. Safe finger foods include: pieces of soft-cooked vegetables and fruits; soft, ripe fruit such as banana; finely minced, ground or mashed cooked meat, deboned fish, and poultry; grated cheese; and bread crusts or toasts.

19

When do babies peak in their ability to eat purees?
a) 6 months
b) 8 months
c) 10 months
d) 24 months

c) ability to eat purees peaks at 10 months, ability to eat other foods continue to develop until 24 months, may take longer to eat varied textures but should continue to do so
infant 8 months -12 months - lateral movements of the tongue, can move food to the teeth

20

True or false - there are no long term consequences to delaying the introduction of lumpy foods

false - delaying the intro of lumpy foods beyond 9 months of age associated with feeding difficulties in older children and lower intake of nutritions foods
By 12 months of age, young children should be offered a variety of family foods with modified textures, such as ground, mashed, or chopped foods, with a tender consistency (Morris & Klein, 2000). Between 12 and 18 months, young children will acquire full chewing movements (WHO, 1998).

21

True or false - it is good to encourage children to clean their plate

false -making children clean their plate can lead to negative attitudes about feeding and eating habits and excessive weight gain; however restricting high calory foods is also bad because it might lead kids to eat too much of them when they are offered them
young infant - parents offer milk, baby decides everything else

22

Who should decide how much a kid should eat?

the kid should always decide how much
infant - they should decide how much and what they want to eat (when/where/how much) other than milk
older kid>12 months - parent should decide when and where they eat, again, the kid should decide how much

23

When should self-feeding first be offered?

can start from when first complementary foods are introduced, helps capture the window for learning these oromotor skills

24

True or false - sippy cups support the development of mature drinking skills

false - these don't support the development of mature drinking skills, should give fluids other than breastmilk from open cup. using cup can reduce the chance of prolonged bottle feeding.
Use of bottles among young children has been associated with the consumption of excess calories and may contribute to the risk of obesity in childhood

25

True or false - symptoms of iron deficiency should be apparent as soon as iron deficiency begins

false - classical symptoms such as pallor, poor appetite, irritability and slowed growth and development may not happen until the deficiency is severe
iron deficiency-leads to iron deficiency anemia, leads to irreversible cognitive defects
iron stores last until 6 months - between 6-12 months kids grow a lot, leads to iron deficiency, continues 12-24 months

26

Which of the following infants is not at risk of having low iron stores?
a) birth weight >3000 g
b) iron deficiency mother
c) mother with diabetes
d) mother with excessive alcohol intake
e) babies who eat evaporated milk or cow milk

a) in fact, BW

27

How often should a 6 month old baby be offered iron rich foods?

2x/day - should get offered 2x per day from 6-12 months, from 12-24 months should be offered at every meal

28

True or false - iron from cereals is equally bioavailable to iron from meat

false - from non meat sources( cereals, legumes, egg, tofu) is less bioavailable that from meat; even small servings of poultry, meat or fish contribute to intake because the iron is in the heme form
meat can also help to improve the availability of non heme iron by 150% (i.e. eating meat and plant together)
vitamin C also helps improve the absorption of non-heme iron
fish to avoid because of mercury: fresh or frozen tuna, shark, swordfish, marlin, orange roughy and escolar.avoid luncheon/processed meats (lots of salt)

29

What is not a true of cow's milk ?
a) low in iron
b) improves iron absorption
c) excessive consumption can lead to iron deficiency
d) can cause GI bleeding and occult blood loss in babies

b) false - in fact, can inhibit iron absorption

the rest are true
the milk itself leads to trouble with iron (as mentioned) when it is the main milk source
should be delayed till 9-12 months; once babies are eating lots of different iron rich foods, less concern about iron deficiency associated - however, excessive consumption can lead to severe anemia (likely because not eating enough other iron rich foods)

30

What should be the maximum cow's milk intake for young kids?
a) 300 ml
b) 400 ml
c) 550 ml
d) 750 ml

750 ml: if more, can displace other foods that give nutrients, also may lead to less fibre intake and constipation as a result. open cup may help reduce excess consumption
goat milk may lead to iron deficiency the same way as cow's milk when introduced too soon
should get at least 500 ml of milk to maintain bone health