Fiser Chapter 10 NUTRITION

Question 1

Caloric need

Answer 1

20-25 calories/kg/day

Question 2

Calories in different forms

Answer 2

Fat 9 calories/g
Protein 4 calories/g
Oral carbohydrates 4 calories/g
Dextrose 3.4 calories/g

Question 3

Nutritional requirements

Answer 3

20% protein
30% fat
50% carbohydrates

Question 4

Trauma, surgery, sepsis increase kcal requirement

Answer 4

20-40% increase

Question 5

Caloric need equation if overweight

Answer 5

weight = [(actual weight - ideal body weight) x 0.25] + IBW

Question 6

Colonocyte fuel

Answer 6

Short-chain fatty acids (butyric acid)

Question 7

Small bowel enterocyte fuel

Answer 7

Glutamine
Releases NH4 in kidney, helping with nitrogen excretion
Can be used for gluconeogenesis

Question 8

Neoplastic cells fuel

Answer 8

glutamine

Question 9

Albumin half life

Answer 9

18 days

Question 10

Transferrin half life

Answer 10

10 days

Question 11

Prealbumin half life

Answer 11

2 days

Question 12

Acute indicators of nutrition

Answer 12

Retinal binding protein
Prealbumin
Transferrin

Question 13

IBW

Answer 13

Men: 106 lb + 6 lb for each inch over 5ft

Women = 100 lb + 5 lb for each inch over 5 ft

Question 14

Preop signs of poor nutrition

Answer 14

Acute weight loss > 10% in 6 months
Weight
Albumin < 3.0 (strong risk factor for M&M after surgery)

Question 15

RQ ratio

Answer 15

CO2 produced : O2 consumed

Question 16

RQ > 1

Answer 16

Lipogenesis (overfeeding)

Question 17

RQ < 0.7

Answer 17

ketosis and fat oxidation (starvation)

Question 18

RQ 0.7 exactly

Answer 18

Pure fat utilization

Question 19

RQ 0.8 exactly

Answer 19

Pure protein utilization

Question 20

RQ 1 exactly

Answer 20

Pure carbohydrate utilization

Question 21

Postoperative phases

Answer 21

0-3 catabolic (negative nitrogen balance)
2-5 diuresis
3-6 anabolic (positive nitrogen balance)

Question 22

Glycogen stores

Answer 22

Muscle and liver
Depleted after 24-36 hours, then fat
Muscle lacks G6Pase

Question 23

Gluconeogensis precursors

Answer 23

AAs (alanine)
Lactate
Pyruvate
Glycerol

Question 24

Do protein conserving mechanisms occur after trauma or surgery?

Answer 24

No due to catecholamines and cortisol

Question 25

Do protein conserving mechanisms occur with starvation?

Answer 25

yes

Question 26

Main source of energy in starvation and trauma

Answer 26

Fat (ketones) Trauma: more mixed (fat and protein) than starvation

Question 27

T/F most patients can tolerate a 15% weight loss without major cx?

Answer 27

True

Question 28

How long can patients tolerate without eating, after which should start tube feeds or TPN?

Answer 28

7 days

Question 29

Why is enteral feeding important?

Answer 29

To avoid bacterial translocation (bacterial overgrowth, increased permeability due to starved enterocytes, bacteremia) and TPN complications

Question 30

What does brain use for energy?

Answer 30

Normally glucose --> ketones during starvation

Question 31

What are the obligate glucose users?

Answer 31

Peripheral nerves Adrenal medulla RBCs WBCs

Question 32

Refeeding syndrome symptoms

Answer 32

Low K, Mg, PO4 Cardiac dysfunction Weakness Encephalopathy Prevent by starting at low rate (10-15 kcal/kg/day)

Question 33

Cachexia is mediated by what?

Answer 33

TNF-alpha Glycogen breakdown, lipolysis, protein catabolism

Question 34

Kwashiorkor versus Marasmus

Answer 34

Kwashiorkor: protein deficiency Marasmus: starvation

Question 35

How much nitrogen does 6.25 g of protein contain?

Answer 35

1 g nitrogen

Question 36

Nitrogen balance equation

Answer 36

N in - N out = (protein/6.25) - (24hr urine N + 4 g)

Question 37

Positive N balance versus Negative N balance

Answer 37

Positive = anabolism Negative = catabolism

Question 38

Total protein synthesis for a healthy 70kg male is what?

Answer 38

250 g / day

Question 39

What organ is responsible for amino acid production and breakdown?

Answer 39

Liver

Question 40

Urea production is used for what?

Answer 40

To get rid of ammonia from amino acid breakdown

Question 41

Majority of protein breakdown from skeletal muscle is what amino acids?

Answer 41

Glutamine Alanine

Question 42

How do short, medium, and long chain fatty acids enter enterocytes?

Answer 42

Short and medium: simple diffusion, into portal system, like amino acids and carbs Long: enter lymphatics along with chylomicrons

Question 43

Vitamin deficiency causing hyperglycemia, encephalopathy, neuropathy?

Answer 43

Chromium deficiency

Question 44

Vitamin deficiency causing cardiomyopathy and weakness?

Answer 44

Selenium

Question 45

Vitamin deficiency causing pancytopenia?

Answer 45

Copper

Question 46

Vitamin deficiency causing poor wound healing?

Answer 46

Zinc

Question 47

Vitamin deficiency causing weakness (failure to wean off vent), encephalopathy, decreased phagocytosis?

Answer 47

Phosphate

Question 48

Vitamin deficiency causing Wernicke's encephalopathy, cardiomyopathy?

Answer 48

Thiamine (B1)

Question 49

Vitamin deficiency causing sideroblastic anemia, glossitis, peripheral neuropathy?

Answer 49

Pyridoxine (B6)

Question 50

Vitamin deficiency causing megaloblastic anemia, peripheral neuropathy, beefy tongue?

Answer 50

Cobalamin (B12)

Question 51

Vitamin deficiency causing megaloblastic anemia, glossitis?

Answer 51

Folate

Question 52

Vitamin deficiency causing diarrhea, dermatitis, dementia?

Answer 52

Niacin (pellagra)

Question 53

Vitamin deficiency causing dermatitis, hair loss, thrombocytopenia?

Answer 53

Essential fatty acids (leucine, isoleucine, valine, arginine, histidine, lysine, methionine, phenylalanine, threonine, tryptophan)

Question 54

Vitamin deficiency causing night blindness?

Answer 54

Vitamin A

Question 55

Vitamin deficiency causing coagulopathy?

Answer 55

Vitamin K

Question 56

Vitamin deficiency causing rickets, osteomalacia, osteoporosis?

Answer 56

Vitamin D

Question 57

Vitamin deficiency causing neuropathy?

Answer 57

Vitamin E