Nutrition

Question 1

What is the equation used to calculate the energy requirements

Answer 1

(BW(kg) x 30)+ 70
Can use the above for patients weighing 2-20kg

RER= 70 x (bodyweight in kg) to the power of 0.75

Question 2

Name 3 electrolyte abnormalities seen in refeeding syndrome

Answer 2

Hypophosphataemia
Hypokalaemia
Hypomagnesaemia

Question 3

Why does hypophosphatemia cause haemolytic anaemia?

Answer 3

Rbc need glycolysis for ATP generation

Decrease phosphate limits ATP production

May cause malfunction of Na K pump-> osmotic lysis and failure of membrane-associated actin and myosin fibres which help to maintain rbc shape, plasticity,membrane integrity,deformability

Question 4

What comprises TPN

Answer 4

Lipid
Carbohydrates (Dextrose)
amino acids

Usually 50:50 lipid: Dextrose

+/- Vitamins
+/- Electrolytes
+/-Minerals

Question 5

What are the suggested protein requirements for cats and dogs?

Answer 5

Dogs
Standard 4-5g/100kcal
Decreased 2-3g/100kcal
Increased 5-6g/100kcal

Cats
Standard 6g/100kcal
Decreased 4-5g/100kcal
Increased 6-8g/100kcal

Question 6

What are the categories of TPN complications and give examples

Answer 6

Mechanical-chewed lines or catheter complications

Metabolic- hyperammonium, hypoglycaemia, changes to K/phos/Na

Septic- from catheter infex or technically infex of TPN bag because of high lipid content

Question 7

What are the proposed mechanisms glutamine improved outcomes

Answer 7

1. Tissue protection
2. Anti inflammatory and immune modulation (decreased cytokine production, inhibition of NFkB)
3. Preservation of metabolic function (improved insulin sensivity, ATP synthesis)
4. Antioxidant effects (enhanced glutathione generation)
5. Attenuation of iNOS activity