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Flashcards in Fiser Chapter 10 NUTRITION Deck (57):
1

Caloric need

20-25 calories/kg/day

2

Calories in different forms

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

3

Nutritional requirements

20% protein
30% fat
50% carbohydrates

4

Trauma, surgery, sepsis increase kcal requirement

20-40% increase

5

Caloric need equation if overweight

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

6

Colonocyte fuel

Short-chain fatty acids (butyric acid)

7

Small bowel enterocyte fuel

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

8

Neoplastic cells fuel

glutamine

9

Albumin half life

18 days

10

Transferrin half life

10 days

11

Prealbumin half life

2 days

12

Acute indicators of nutrition

Retinal binding protein
Prealbumin
Transferrin

13

IBW

Men: 106 lb + 6 lb for each inch over 5ft
Women = 100 lb + 5 lb for each inch over 5 ft

14

Preop signs of poor nutrition

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

15

RQ ratio

CO2 produced : O2 consumed

16

RQ > 1

Lipogenesis (overfeeding)

17

RQ < 0.7

ketosis and fat oxidation (starvation)

18

RQ 0.7 exactly

Pure fat utilization

19

RQ 0.8 exactly

Pure protein utilization

20

RQ 1 exactly

Pure carbohydrate utilization

21

Postoperative phases

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

22

Glycogen stores

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

23

Gluconeogensis precursors

AAs (alanine)
Lactate
Pyruvate
Glycerol

24

Do protein conserving mechanisms occur after trauma or surgery?

No due to catecholamines and cortisol

25

Do protein conserving mechanisms occur with starvation?

yes

26

Main source of energy in starvation and trauma

Fat (ketones)

Trauma: more mixed (fat and protein) than starvation

27

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

True

28

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

7 days

29

Why is enteral feeding important?

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

30

What does brain use for energy?

Normally glucose --> ketones during starvation

31

What are the obligate glucose users?

Peripheral nerves

Adrenal medulla

RBCs

WBCs

32

Refeeding syndrome symptoms

Low K, Mg, PO4

Cardiac dysfunction

Weakness

Encephalopathy

Prevent by starting at low rate (10-15 kcal/kg/day)

33

Cachexia is mediated by what?

TNF-alpha

Glycogen breakdown, lipolysis, protein catabolism

34

Kwashiorkor versus Marasmus

Kwashiorkor: protein deficiency

Marasmus: starvation

35

How much nitrogen does 6.25 g of protein contain?

1 g nitrogen

36

Nitrogen balance equation

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

37

Positive N balance versus Negative N balance

Positive = anabolism

Negative = catabolism

38

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

250 g / day

39

What organ is responsible for amino acid production and breakdown?

Liver

40

Urea production is used for what?

To get rid of ammonia from amino acid breakdown

41

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

Glutamine

Alanine

42

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

Short and medium: simple diffusion, into portal system, like amino acids and carbs

Long: enter lymphatics along with chylomicrons

43

Vitamin deficiency causing hyperglycemia, encephalopathy, neuropathy?

Chromium deficiency

44

Vitamin deficiency causing cardiomyopathy and weakness?

Selenium

45

Vitamin deficiency causing pancytopenia?

Copper

46

Vitamin deficiency causing poor wound healing?

Zinc

47

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

Phosphate

48

Vitamin deficiency causing Wernicke's encephalopathy, cardiomyopathy?

Thiamine (B1)

49

Vitamin deficiency causing sideroblastic anemia, glossitis, peripheral neuropathy?

Pyridoxine (B6)

50

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

Cobalamin (B12)

51

Vitamin deficiency causing megaloblastic anemia, glossitis?

Folate

52

Vitamin deficiency causing diarrhea, dermatitis, dementia?

Niacin (pellagra)

53

Vitamin deficiency causing dermatitis, hair loss, thrombocytopenia?

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

54

Vitamin deficiency causing night blindness?

Vitamin A

55

Vitamin deficiency causing coagulopathy?

Vitamin K

56

Vitamin deficiency causing rickets, osteomalacia, osteoporosis?

Vitamin D

57

Vitamin deficiency causing neuropathy?

Vitamin E