Flashcards in Hospital-Based Nutrition Deck (21):
It is irrelevant to this lecture, but Dr. Bessesen brought up an interesting point: where do the pyrimidine pathway and urea cycle meet?
After how many days of fasting does nutritional depletion occur?
Not sick or undernourished (e.g., unconscious due to a stroke): 10-14 days
Sick but not previously undernourished: 5-7 days
Sick and previously undernourished: 3-5 days
What things should you ask about to assess for possible nutritional depletion?
- Weight trajectory (has the patient recently lost weight?)
- Social factors (alcoholism or homelessness)
- Chronic medical problems
- Thenar wasting
- BMI less than 19
- Albumin level
- Lymphocyte level
Why is enteral feeding better?
Because gut feeding improves the lining of the gut, leading to improved health of the gut wall. Most people die from Gram-negative infection from gut bacteria, so preserving gut wall health is vital!
What is D5?
5 grams of dextrose per 100 mL saline
Reduce the flow rate of nasogastric feeding when the residual volume in the stomach is ______________.
greater than 100 mL
Many times, glycogen stores take ______ days to fill. Because of this, check glucose after this much time has passed.
What is deficient in beri beri?
Why is arginine special?
The body can make it, but production is limited. Also, arginine is needed for NO production.
Another "special" amino acid is ______________.
glutamine; it can be made by the body, but production is limited. Also, it is needed for gut epithelium
What nutritional considerations are important for those in respiratory failure?
Because the body needs to work to breathe off carbon, it will have to work harder when given nutrients that produce more carbon per calorie – such as carbohydrates. As such, many protocols give higher fat diets to those in respiratory failure.
For the same reason, it is better to avoid overfeeding someone in respiratory failure.
Hepatic dietary formulas have lower __________, which can act as false neurotransmitters that worsen encephalopathy.
aromatic amino acids
What is the energy density of most TPN fluids?
Why should you start low and titrate up for enteric feeding?
Because most people can't tolerate much in their stomachs via enteric feeding, so start in a safe range and work up.
How much protein do we typically need?
Normal conditions: 0.5 - 0.8 g/kg/day
During illness: 1.0 - 1.8 g/kg/day
____________ deficiency has been shown to cause insulin resistance.
Deficiency of ___________ can cause CHF.
Arginine is not stable in ____________.
How can you avoid refeeding syndrome?
Feed slowly, then start with vitamins, folate, and thiamin
Cardiac diets must have _______ or less of sodium. Additionally, they're also low in ______________.
2 grams; triglycerides and saturated fat