General Nutrition

Question 1

How much unintentional weight loss is a red flag?

Answer 1

5-10% in 6 months

Question 2

Someone with decreased ABW, normal lean body mass, and decreased total body water is considered what?

Answer 2

dehydrated

Question 3

What is the estimated average requirement?

Answer 3

meets vitamin and trace element needs of 50% of persons

Question 4

What is the caloric recommended daily intake for carbohydrates?

Answer 4

4kcal/g

Question 5

What is the caloric recommended daily intake for protein?

Answer 5

4 kcal/g

Question 6

What is the caloric recommended daily intake for fat?

Answer 6

9 kcal/g

Question 7

What affects albumin/ protein assessment?

Answer 7

1. dehydration
2. decreased hepatic function
3. abnormal renal function loss
4. abnormal GI function loss

Question 8

What would cause increased levels of albumin?

Answer 8

1. dehydration
2. anabolic steroid use

Question 9

What would cause a decrease in albumin?

Answer 9

1. fluid overload
2. malnutrition
3. burns
4. nephrotic syndrome
5. cirrhosis

Question 10

How often do albumin levels need to be checked? Why?

Answer 10

every 2-3 weeks;
half-life= 2-3 weeks, chronic marker

Question 11

How often do pre-albumin levels need to be checked? Why?

Answer 11

every 2-3 days;
half-life= 2-3 days, acute marker

Question 12

Is a baseline value more important for albumin or pre-albumin?

Answer 12

albumin

Question 13

What types of underlying pathologies can contribute to nutritional problems?

Answer 13

1. neoplastic diseases
2. digestive/ absorptive diseases
3. COPD
4. cirrhosis

Question 14

What is marasmus?

Answer 14

severe malnutrition where the body digests its organs leads to kwashiorkor

Question 15

What is kwashiorkor?

Answer 15

acities due to severe protein/ albumin depletion

Question 16

What are early signs of malnutrition?

Answer 16

1. dermatitis
2. glossitis
3. cheilosis (crust around lips from fat deficiency)
4. jaundice

Question 17

What are the consequences of underfeeding?

Answer 17

metabolic abnormalities and nutrient deficiency –> infection, wound healing, arrhythmias

Question 18

What are the consequences of starvation?

Answer 18

changes in metabolic process –> digestion of organs/ muscle –> inability to clear fluids around the heart and lungs –> pneumonia –> death

Question 19

What medications are recommended for underweight/malnourished and able to tolerate oral intake safely?

Answer 19

1. Mirtazapine
2. Testosterone
3. Megestrol Acetate
4. Dronabinol

Question 20

What patients would Mirtazapine (Remeron) work best in?

Answer 20

weight loss due to depression

Question 21

What patients would Megestrol acetate (MEGACE) work best in?

Answer 21

1. cancer
2. AIDS
3. end of life
4. palliative care

Question 22

What is the MOA of Megestrol acetate?

Answer 22

synthetic progestin; anti-estrogenic properties

Question 23

What are SEs with Megestrol acetate (MEGACE)?

Answer 23

1. Thromboembolic events
2. diabetes

Question 24

What patients would Dronabinol (MARINOL) work best in?

Answer 24

AIDS patients

Question 25

What are SEs with Dronabinol (MARINOL) ?

Answer 25

1. CNS depression 2. exacerbation of mental illness

Question 26

How is Dronabinol (MARINOL) administered?

Answer 26

1 hour before lunch and dinner

Question 27

What patients would Testosterone work best in?

Answer 27

malnourished males with low testosterone

Question 28

Why is testosterone rarely used?

Answer 28

SE profile, fluid retention

Question 29

What happens during initial onset of starvation?

Answer 29

Decreased insulin and glucose utilization Increased catecholamines and gluconeogenesis (fight/flight response)

Question 30

What happens as starvation progresses?

Answer 30

Fatty acid utilization becomes main source of energy --> vital organs (heart/respiratory muscles) used as caloric source

Question 31

What is hypermetabolism?

Answer 31

Neuroendocrine (sympathetic) response to maintain homeostasis due to injury

Question 32

What is acute hypermetabolism?

Answer 32

lasts 24-36 hours after injury; promotion of hyperglycemia and protein catabolism

Question 33

How should acute hypermetabolism be managed?

Answer 33

increase calories 1.5-2 times BEE

Question 34

Why is nutritional support vital during adaptive hypermetabolism?

Answer 34

increased metabolic rate, protein consumption, glucose flow, and hyperthermia

Question 35

What are indications to recieve chronic nutritional support?

Answer 35

1. inability to absorb nutrients using GI tract (small bowel resection, small intestine diseases, radiation) 2. inadequate nutritional intake (inability to swallow due to aspiration risk, lack of appetite)

Question 36

When should acute nutritional support be given?

Answer 36

nutrition cannot be provided for 5-7 days