Nutrition Flashcards
(271 cards)
1
Q
Fat soluble vitamins?
A
Vitamins A, D, E, K
-Come in gelatin tablet with oil in center
2
Q
Vitamin A
A
Retinol
3
Q
Vitamin E
A
Tocopherol
“Toke-of-ethanol”
4
Q
Vitamin K
A
Phylloquinone
-“File-o-kanines”
File cabinet of dogs shaped like K
5
Q
Vitamin B1
A
Thiamine
6
Q
Vitamin B2
A
Riboflavin
7
Q
Vitamin B3
A
Niacin
8
Q
Vitamin B5
A
Pantothenic acid
Pentothenic acid
9
Q
Vitamin B6
A
Pyridoxine
Pyrido6ine
10
Q
Vitamin B9
A
Folate
Fool comes late it is benign
11
Q
Vitamin B12
A
Cyanocobalamin
12
Q
Weird B vitamin?
A
Biotin
13
Q
Ascorbic Acid
A
Vitamin C
14
Q
Most common cause of blindness in young children?
A
Vitamin A deficiency
Retinol is very similar to retina
15
Q
Xerophthalmia (dry eyes), nyctalopia (night blindness), complete blindness
A
Vitamin A deficiency
16
Q
What can cause intracranial hypertension (pseudotumor cerebri)?
A
Vitamin A intoxication
-Giant A causing intracranial pressure
17
Q
Large tongue and macrocytic anemia?
A
Vitamin B9 (folate) deficiency
18
Q
What can vitamin B9 (folate) toxicity cause?
A
Irritability
19
Q
If you give folate (B9) for macrocytic anemia, what can it mask?
A
B12 Deficiency
20
Q
B12 deficiency?
A
Macrocytic anemia
-Bowel disease can lead to pernicious anemia due to poor B12 absorption secondary to decreased intrinsic factor
21
Q
Can B12 in excess be toxic?
A
No
22
Q
Bleeding gums, scurvy, leg tenderness, poor wound healing
A
Vitamin C deficiency
23
Q
What can excessive mega doses of vitamin C cause?
A
Oxalate and cysteine nephrocalcinosis
Excreted through kidneys
24
Q
What vitamin can trigger a hemolytic crisis in someone with G6PD deficiency?
A
Vitamin C
25
Hemolytic anemia in preemies and neurological effects in older kids
Vitamin E deficiency
| Has to be a severely prolonged deficiency
-E is a fork puncturing red cells
26
Neuropathies, peripheral edema, thrombocytosis, muscle weakness
Vitamin E deficiency
27
Vitamin E toxicity?
Liver toxicity
28
Hemorrhagic disease of the newborn
Vitamin K deficiency
29
What vitamin doesn't cross the placenta well?
Vitamin K
30
Why can't a newborn produce vitamin K well?
Gut flora hasn't been established
31
Vitamin K dependent factors are only what % of normal in first 2-3 days of life?
30%
32
Are breast fed or formula fed babies babies more vulnerable to vitamin K deficiency?
Breast fed- Breast milk doesn't contain much vitamin K
33
Child born at home (did not get vitamin K at birth), exclusively breast fed, bleeding
Give vitamin K followed by FFP
K to make factors 10, 9, 7, 2
FFP for instant clotting factors (active bleeding)
34
What are the vitamin K dependent factors?
2, 7, 9, 10
35
Edema, erythrocyte explosion (hemolytic anemia), elevated platelet count
Triple E of vitamin E deficiency
36
What is isotretinoin an analog of?
Vitamin A
37
What is isotretinoin used to treat?
Acne
38
Which drug used for teens is a significant teratogen?
Isotretinoin
HAVE TO RULE OUT PREGANCY
39
Teen with symptoms of a brain tumor who takes isotretinoin
Vitamin A toxicity (pseudotumor cerebri)
40
Yellow toddler who eats lots of beta-carotene (carrots, sweet potatoes, apricots), but sclerae and oral mucosa aren't yellow
No further evaluation or change diet
NOT jaundice or icteric, don't get serum bili
41
What is common finding between B12 and B9 deficiency?
Macrocytic anemia
42
What is beta carotene converted to in the body?
Vitamin A (retinol)
It's a precursor to vitamin A
43
Vitamin D2
Ergocalciferol (2 Cs, D2)
44
Vitamin D3
Cholecalciferol (3 Cs, D3)
45
25-Hydroxy Vitamin D
Calcidiol
46
Where is calcidiol (25-Hydroxy Vitamin D) hydroxylated?
Liver
47
1,25 Hydroxy Calciferol
1,25-Dihydroxycholecalciferol or calcitriol
-Calcitriol tries to help the body by increasing calcium absorption in the gut and releasing it into the blood from bone
48
Where is 1,25 Hydroxy-calciferol formed?
Kidney
49
What is the active metabolite of vitamin D?
1,25 Hydroxy-calciferol
50
What is the only vitamin known to be converted to hormone form?
Vitamin D
51
If I child is exposed to sufficient UV sunlight do they need any dietary vitamin D?
No
52
What is the primary storage form of vitamin D and the one you will measure?
25-Hydroxy Vitamin D
53
Who do you supplement vitamin D for?
Exclusively breast fed infants (by 2 weeks)
54
Low vitamin D causes?
Rickets
55
What electrolyte problems are from vitamin D excess?
Hypercalcemia and hyperphosphatemia
56
Symptoms of vitamin D excess?
Nausea, vomiting, weakness, polyuria, polydipsia, elevated BUN, nephrolothiasis, renal failure
It can be fatal
Similar symptoms to diabetes (both have D)
57
How to treat vitamin D toxicity
Hydration, lasix, correct sodium/potassium depletion
-It causes mobilization of calcium and phosphorous from bones and deposition into soft tissue
58
Calorie requirements
1500kcal for first 20kg, then 20kcal/kg for each additional kg
- 100kcal/kg for first 10kg
- 50kcal/kg for next 10kg
- 20kcal/kg for any more kg
59
What is caloric intake for children based on?
Body surface area
Which varies child to child
Recommended daily allowance (RDA) is starting point for estimating caloric requirements in kids.
60
Why can infants still lose weight even if they are receiving adequate nutrition, there are no increases insensible losses, and there is no evidence of renal failure?
Due to renal fluid loss as a result of increased solute load...infants kidneys can't handle the same osmotic load of an adult during times of stress (relationship with dietary protein and renal solute load)
61
What are calorie requirements for term/preterm infants?
100-120 kcal/kg/day
-Preemies closer to 120, large term closer to 100
62
How much protein for premature infants?
3.5 g/kg/day
63
Protein for full term infants?
2.0-2.5 g/kg/day for first 6 months
64
Why do premature infants have trouble maintaining appropriate body temperature?
Lower levels of fat storage
-Expend more energy in heat production than term babies
65
Premature babies require more energy for what 2 things?
Organogenesis and developing fat stores
-This all increases nutritional and energy requirements in comparison to term babies
66
When does catch up growth in preemies happen?
First 2 years (Should attain normal height at 2 and beyond)
67
Post-op infant not gaining weight... Cause?
Increased urine output secondary to increased renal solute load (Even is surgery was for big GI procedure like malrotation implying poor absorption or protein losing enteropathy)
68
What are 4 important components of renal solute load?
-Sodium, potassium, chloride, phosphorus
69
What electrolyte doesn't play a major role in renal solute load?
Calcium
70
If you are choosing an essential fatty acid, which one is it?
Linoleic Acid
71
No cow milk before...?
12 months
72
What milk from age 1-2?
Whole milk
73
Low fat milk when?
Overweight children after age 12 months
74
Does formula have adequate fluoride?
No, it needs to come from outside sources, like drinking water
75
What is the recommended concentration of iron in iron fortified formula?
12 mg/L
76
What can cause iron deficiency anemia in a toddler?
Drinking too much milk
77
Who needs iron supplementation at birth?
Only those at high risk (LBW or preterm, even if breastfed)
-Full term babies have adequate iron stores
78
When should all babies (even breast fed infants) get iron supplementation in their food (iron-fortified cereals)?
Start around 4-6 months of age
79
What blood problem is associated with obesity in children?
Iron deficiency anemia
80
When do you use low iron formula (1.5 mg/L)?
NEVER
81
Does iron fortified formula cause constipation?
No
82
Kid in iron fortified formula has constipation... What do you do?
Add fruit juice to increase osmotic load
-Don't use low iron formula, dilute the formula, switch to whole milk, or add more cereal
83
Which is IgE mediated, milk protein allergy or milk intolerance?
Milk protein allergy
84
Which two formula intolerance can cause rash, vomiting, and irritability?
Milk protein allergy and milk intolerance
85
Due to IgE mediated response, presents with rash, vomiting, and irritability
Milk protein allergy
86
What formula intolerance causes irritability, but no rash or vomiting?
Lactose intolerance
87
When can a secondary lactase deficiency causing lactose intolerance in kids develop?
After GI infection (like rotavirus)
88
With true milk allergy what is there significant cross reactivity with?
Soy-based formula, use elemental formula
89
Infant with bloating and worsening diarrhea after formula is reintroduced into diet following episode of viral gastroenteritis?
Lactose intolerance due to secondary lactase deficiency (usually doesn't happen, but it can)
-You can hold off on lactose-containing formula in young infant until diarrhea resolves, but DONT hold hold off on breastfeeding
90
Vomiting, rash, diarrhea, irritability
Milk protein allergy/intolerance
91
Flatulence, bloating, diarrhea, irritability
Lactose intolerance
92
Where are 3 places lactose is found?
Human milk, cow based formula, evaporated cow milk
93
Infants fed "non-traditional" formula will suffer from what?
Nutritional deficiencies
94
Who do you give protein hydrolysate formula to?
Infants with allergy to intact milk protein or allergy or soy protein
95
Non IgE mediated severe cow milk protein intolerance
FPIES: Food protein induced enterocolitis syndrome
96
How does FPIES present?
In first 3 months with either heme positive stools or hematochezia along with normal abdominal exam
97
Can FPIES affect breast fed infants?
Yes, cow milk protein ingested by mom can get into breast milk, (this is primarily due to cow milk intolerance)
98
What do you do for a kid with FPIES?
Switch to protein hydrolysate formula or completely eliminate implicated protein from Moms diet
Do not switch to soy formula (symptoms frequently continue with this)
99
Scaly dermatitis, alopecia, thrombocytopenia
Essential fatty acid deficiency
-Thin fish with scales coming off (scaly rash), that turn into platelets (low platelet count), fish is bald (alopecia)
100
Treatment for essential fatty acid deficiency
IV lipids (focus on linoleic acid)
101
Mineral deficiency presenting with dermatitis and alopecia?
Acrodermatitis enteropathica (Inherited condition where zinc isn't absorbed well)
102
Infant with dermatitis and alopecia who was recently weaned from breast milk...
Zinc deficiency
| Breast milk contains a protein which facilitates zinc absorption
103
Typical presentation of zinc deficiency?
Infant with extensive eczematous eruption, growing poorly, lesions around mouth, sometimes in perianal area
104
What is inheritance of acrodermatitis enteropathica?
AR
105
What differentiates eczema from acrodermatitis enteropathica?
Acrodermatitis enteropathica has no lichenification
106
Low serum copper, low serum ceruloplasmin, high tissue copper, twisted hairs (pili torti)
Menkes kinky hair syndrome
107
Inheritance of menkes kinky hair syndrome
X-linked
108
"Liver deterioration" ( jaundice, large liver), acute neurological deterioration, Kayser Fletcher rings, low ceruloplasmin
Wilson's disease
109
What causes Wilson's disease?
Deposition of copper in liver and brain
Also affects eyes and kidney
110
Does Wilson's disease have visual deficits?
No
111
How to diagnose Wilson's disease?
Liver biopsy
Ceruloplasmin levels low, not diagnostic
112
When do you consider mineral deficiencies (magnesium and chromium)?
Hospitalized patients with increased metabolic demands and underlying conditions (malnutrition, malabsorption, short bowel, burns, TPN)
113
What to do if mom wants to breast feed a preemie?
Have mom pump so milk is there for infant, then begin breast feeding when baby ready
114
Who has higher vitamin D requirements?
Premature infants
115
Non fat-soluble vitamins?
B & C
116
What do preterm infants taking formula high in polyunsaturated fatty acids have to have supplemented?
Vitamin E (to avoid hemolysis)
117
Why do premature infants have a difficult time absorbing long chain triglycerides and fat-soluble vitamins?
They have decreased amounts of bile acids
118
Premature babies can lose up to what % of ingested fat through the stool?
20%
-Fat is absorbed less efficiently in premature babies
119
What triglycerides are absorbed best by premature babies?
Medium chain triglycerides (they don't require bile salts)
120
What % of total fat in preemie formula is from medium chain triglycerides?
50%
121
What % of total fat in mature breast milk if from medium chain triglycerides?
12%
122
Why doesn't breast milk contain or need a high amount of medium chain triglycerides?
It has high absorptive abilities...breast milk has sufficient linoleic and linolenic acid (these are both essential long chain fatty acids)
123
Are medium chain triglycerides sufficient to provide the essential fatty acids?
No, they enhance lipid absorption in formulas, but aren't sufficient to provide essential fatty acids
124
What can lead to osteopenia and rickets in premature infants?
Poor calcium and phosphorous intake
Preemies require supplementation in large amounts (both are poorly absorbed in gut of preemies)
125
What can cause demineralization of bone in a very low birthweight preterm infant?
Inadequate phosphorous (often secondary to prolonged parenteral nutrition)
126
Inadequate calcium can lead to...
Bone demineralization
127
When will you see bone demineralization and what are the initial lab finding?
Can occur after 1 month of TPN, normal serum calcium and phosphorous, elevated alkaline phosphatase
128
Too much phosphorous given to a very low birthweight infant can lead to...
Hypocalcemia, tetany, seizures
129
Exclusive breast feeding until?
At least 6 months
130
Continued use of breast milk up until...
12 months
131
When breastfeeding, what milk is higher in calories?
Hind milk (at end of breastfeeding session)
132
Do you ever supplement with water?
No
133
What 2 acids decrease in mature milk?
Arachidonic acid (AA) and Docosahexaenoic acid (DHA)
This is true for Moms of preemies too
134
What are AA and DHA important for?
Neurological development
135
What along with AA is needed in preemies to help prevent skin lesions, poor wound healing, and decreased immune function?
Zinc
136
What has low levels in colostrum and thus increases the risk for rickets?
Ergo-cholecalciferol
137
Hind milk is higher in what?
Fat (milk at end of feeding)
138
What is colostrum over the first few days postpartum higher in?
Protein
139
What makes colostrum over first few days postpartum higher in protein?
High levels of immune globulins (secretory IgA)
140
What does high levels of immune globulins including secretory IgA provide?
Initial protection against infection
141
Why is colostrum yellow?
High in carotene
142
What does colostrum do to the gut?
Gives a dose of enzymes that stimulate gut maturation and facilitates digestion (especially fats)
Stimulates gut to mass meconium
143
Does colostrum or mature milk have more...
1. Protein
2. Fat
3. Lactose
4. Energy content
5. Minerals
1. Colostrum (2.3g/dL v. 1.2g/dL)
2. Mature milk (4g/dL v. 1.7g/dL)
3. Mature milk (7g/dL v. 6g/dL)
4. Mature milk (69kcal/dL v. 49kcal/dL)
5. Both constant throughout lactation
144
Which is sweeter, breast or cow milk, and why?
Breast, contains more lactose
145
Which has more phosphorous, cow or human milk?
Cow
146
What can occur if an infant starts cow's milk before age 1?
Hypocalcemia
Infant kidney can get rid of phosphorous in cow milk fast enough...increased phosphorous causes decreased calcium
"Hypo-cow-lcemia"
147
What antibiotic is contraindicated with breast feeding?
Metronidazole (Flagyl) for Trichomonas vaginalis
148
What can diazepam do to baby if Mom is taking it while breastfeeding?
Sedate them...diazepam is sufficiently concentrated and absorbed by a breast-feeding infant so it is contraindicated
Any medications with sedative effects can make its way into breast milk
149
What vitamin deficiency are breast fed infants at risk for?
Vitamin D
150
What vitamin does breast milk contain a small amount of that can contribute to hemorrhagic disease of the newborn?
Vitamin K (especially if they haven't received IM vitamin K at birth)
151
How long do you stop breastfeeding for if you received technetium-99?
24-48 hours
Half life is only 6 hours
This is an exception to radioactive contraindication to breast feeding rule
152
What's the BAD BREAST pneumonic for contraindications to breast feeding?
B: Bad bugs (CMV, HIV, TB)
A: Anti-thyroid meds
D: Diseases/STDs (HSV lesions on breast)
B: Bad bugs (CMV, HIV, TB)
R: Radioactive and other chemicals (radioactive meds and chemotherapy)
E: Errors of metabolism, galactosemia, PKU, urea cycle defects (in the baby)
A: Antibiotics and anti-seizures (Flagyl and diazepam)
S: Sulfonamides
T: Tetracycline
153
Can you keep breast feeding with things like candidiasis, contact dermatitis, fibrocystic breast disease, or mastitis?
Yes, if properly managed
154
What problem with mom can cause unsuccessful breast feeding?
Inverted nipples
155
What is the protein concentration in human milk, cow milk, and modified cow formula?
Human: 0.9g/dL
Cow: 3.5g/dL
Modified cow: 1.4g/dL
156
What is the whey:casein ratio in human milk, cow milk, and modified cow formula?
Human: 70% whey, 30% casein (human milk is WHEY better)
Cow: 20% whey, 80% casein
Modified cow: Variable
157
What is the type of whey protein in human milk?
Alpha lactalbumin
158
What milk contains beta lactalbumin as its whey protein?
Cow milk
159
What does the whey protein in human milk contain that makes it easier to digest and promotes gastric emptying?
Larger amounts of lactoferrin, lysozyme, and IgA?
160
What does modified cow formula have higher amounts of than human milk?
Minerals (calcium, phosphorous, iron)
161
What is the calcium:phosphorous ratio in human milk?
2:1
162
What is the calcium phosphorous ratio in modified cow formula?
1.5:1
163
What has better iron absorption, human milk or modified cow formula?
Human milk
164
Which has higher amounts of vitamins A, B, and C, human milk or modified cow formula?
They are the same
165
What has higher amounts of vitamins D, E, and K, human milk or modified cow formula?
Modified cow formula (but this is clinically insignificant in mothers with an adequate diet who get sunlight exposure)
166
What has a lower renal solute load, human milk or modified cow formula?
Human milk
167
Which has more lipase, human milk or modified cow formula?
Human milk
168
Even though breast milk is lower in iron, it has higher bioavailability (iron in breast milk is absorbed better than iron I'm formula) for how many months?
First 4
169
During the first four months, is the iron stored during fetal life compensate for an iron deficiency in breast milk?
Yes
170
Which contains more iron, formula or breast milk?
Formula
171
What is the better source, or results in better absorption of iron, formula or breast milk?
Breast milk
172
Standard formula and breast milk are both what-based?
Lactose
173
What is the calorie content of breast milk and standard formula?
20 kcal/oz = 20 kcal/30cc = 0.67 kcal/cc
174
What has higher protein content, formula or cow milk?
Cows milk (3% versus 1%)
Cow milk has more protein than human milk, but it is a quality over quantity thing...protein quality is different between cow and human milk
175
What is the protein requirement of a newborn?
2-3 g/kg/day
176
What is the protein requirement of a preemie?
3-4 g/kg/day
177
What do you want to prevent in very low birthweight infants since it causes weight loss, and how do you do this?
Negative nitrogen balance, give them lots of non-protein calories
178
Why do you not add more powder than indicated when mixing formula?
This increases the protein load, which stresses the kidneys (lipid and carbohydrate supplements are available to enhance calorie content of formula)
179
Adding carbohydrate supplement to milk can lead to what?
Diarrhea
180
Adding lipid supplement to milk can increase the risk for what?
Diarrhea or delayed gastric emptying
181
What amount do you never increase calorie content beyond in formula?
30 kcal/oz
182
What form of protein is better for infants and has a higher content of protein in human milk?
Whey
"Whey is way better for infants and weighs heavier in the protein content of human milk"
183
What % of cow milk and human milk fat?
3-4% for cow milk, human milk varies with Mom diet but is similar to cow's milk
184
High concentrations of what in breast milk protect against infectious disease (including local GI immunity)?
IgA and other antibodies
185
What inhibits bacterial adhesions to mucosal surfaces and reduces the risk of bacterial infection?
Lactose-derived oligosaccharides (case with both colostrum and mature milk)
Bacteria lack toes (lactose) to adhere to mucosal surfaces
186
Average full term newborns will gain how much weight per day?
20-30 g/day (after initial weight loss during first few days of life)
187
What is the caloric requirement for a newborn?
Close to 100 kcal/kg/day
188
Conversion of pounds to kg?
Divide by 2.2
189
What is the caloric requirement for a preemie?
120 kcal/kg/day
190
How much is a preemie expected to gain each day?
15-20g/day
191
What is the optimal whey/casein ratio for a preemie?
60:40
192
What is absorbed better than lactose in preemies?
Glucose polymers
193
Since preemies absorb glucose polymers better than lactose, what is needed in preemie formula?
Medium chain triglycerides
194
Preemie formula has higher amounts of what 2 electrolytes?
Calcium and phosphorous
195
Preemie formula contains how many kcal/oz?
24 kcal/oz
196
Preemie breast milk contains higher amounts of everything except for what when compared to full term breast milk?
Carbohydrates
197
Feeding solid foods like cereals to breastfed infants before 4-6 months of age increases the likelihood of what?
GI infection
198
Infants have low levels of what in the gut that make it more difficult to digest solid foods?
Amylase
199
Does the introduction of solid foods help an infant sleep through the night?
No
200
Introducing solids early increases the chances of developing what? (This is now considered controversial)
Food allergies and obesity
201
Do artificial flavor and colors have any role in the development of ADHD?
No
202
Artificial flavors and colors may have a role in causing what 2 things?
Urticaria and angioedema
203
What are 4 things to remember for home-prepared foods?
1. Foods need to be cleaned and puréed so there are no solid chunks inadvertently left behind
2. Food should be fully cooked
3. Serve fresh or freeze for later
4. No salt seasoning and no honey
204
Do home prepared foods reduce the risk for food allergies?
No
205
What is overweight defined as for children?
BMI between 85 and 95 percentiles for age and gender
206
What is obesity defined as for kids?
BMI greater than 95 percentile for age and gender
207
A child who is obese at age 6 has what % chance of being obese as an adult?
25%
208
A child who is obese at age 12 has what % chance of being obese as an adult?
75%
209
Is the teen tall/short and delayed/advanced bone age with obesity due to exogenous (overeating) sources?
Tall and advanced bone age
210
If a child is overweight due to hormonal/genetic (endogenous) reasons what is their height and bone age?
Short with delayed bone age
211
A work up is not warranted for obesity in a child who is obese with what 3 features?
1. Unremarkable PE
2. Normal linear growth
3. Normal developmental milestones
212
What is the most common metabolic explanation for an overweight child?
Hypothyroidism
| Overweight kids who have a normal physical exam and normal linear growth don't need routine testing
213
Child who is obese with small hands, hypogonadism, delayed developmental milestones, and/or cognitive deficits?
Prader-Willi syndrome or Bardet-Biedel syndrome
214
Does genetics play a role in obesity?
Yes (correlation in adopted kids, identical twins end up with similar weights, even if raised in different homes/locations)
215
Parental obesity makes it how much more likely that a child younger than 10 will be obese as an adult?
Twice as likely
| Even if the child isn't obese, but obesity in childhood increases the risk
216
What is the most common cause of obesity?
Excessive food intake
217
What is needed to treat obesity?
Child and family have to recognize problem and want to change
1. Changing diet (without impacting growth)
2. Increase exercise (most effective when combined with dietary changes)
3. Modify behavior (support inside and outside family)
218
What should you eliminate first in a kid trying to lose weight so you don't impact growth?
Snacks and sugary drinks
219
What is the best obesity therapy available for children?
Prevention... Behavior modification that encourages a healthy diet and appropriate exercise (since roots of obesity are found in childhood)
220
Vegetarian teenage girl with low hemoglobin, SMR of 5, what other physical findings?
NONE...vegetarians have low iron stores (a mild iron deficiency anemia will have no other physical findings)
Don't be tempted by tachycardia, pallor, weakness, and oral lesions
221
What are some health risks involved in obesity in kids?
1. Depression (unclear if obesity causes depression or depression causes obesity)
2. Avascular necrosis of the hip
3. Diabetes
4. HTN
5. Cardiac disease
6. Osteoarthritis (secondary to strain on joints, especially LE)
222
A kid who drinks lots of diet sodas (with high phosphoric acid content) is at high risk for what?
Osteopenia (risk is even higher if kid has been treated with steroids)
223
What is the best way to reduce risk for fractures in a kid with osteopenia?
Vitamin D and calcium supplements
224
What 2 places make you think kwashiorkor or marasmus?
Refugee camps or communes
225
What vitamin deficiency are kids who eat vegan diets at risk for?
B12
226
If a kid is drinking goat's milk, what will they be at risk for?
Folate deficiency
227
A vegan breastfeeding mom needs to take prenatal vitamins with what in them?
B12
228
Non-breastfed vegan infants should get what type of formula?
Iron fortified soy formula
229
Kwashiorkor is a deficiency of what?
Protein
230
Kid with a pot belly from starvation, pitting edema, rash, thin/frail hair, pallor, overall thin appearance?
Kwashiorkor
231
Low protein causes less what, that causes edema?
Intravascular osmotic pressure
232
Marasmus is a deficiency of what?
General nutrition
233
Muscle wasting without edema and normal hair?
Marasmus
234
Can there be a combination of marasmus and kwashiorkor?
Yes
235
Which is preferred, enteral or parenteral?
Enteral if possible
If gut functions, use it...enteral trumps parenteral wherever possible
236
When are parenteral feedings via central line indicated?
1. When enteral or oral feedings cannot be administered for 7 days or more
2. When partial oral feedings and standard peripheral IV either can't meet nutritional requirements or will be needed for prolonged periods of time
237
Why do you want to maintain some enteral feedings in an infant whenever possible?
If you don't, infants may lose the will and/or ability to feed orally
238
What can prolonged periods without enteral nutrition do to the GI tract?
Leave the GI mucosa more vulnerable to infection
239
Kid with diarrhea and vomiting, tolerating minimal fluids, intermittent vomiting, pasty mouth, good bounding pulses, good HR...most appropriate management?
Oral rehydration and D/C with regular diet as soon as tolerated
No BRAT diet, it lacks adequate nutrition
Do not dilute formula
Do not get serum bilk
240
What is the most common complication of NG feeding?
Diarrhea
241
What is the second most common complication of NG feeding?
GE reflux
242
What can reduce the risk of GE reflux with NG feeding?
Using elemental formula
243
Is the diarrhea from NG feedings severe enough to cause dehydration?
Rarely
244
What is the most severe complication of NG feeding?
Vomiting with aspiration
245
What type of feedings can result in wound infections?
Ostomy feedings
246
Infants who have gastroesophageal reflux might respond better to what type of feeds and gain weight better?
Continuous
After a short period of continuous feeds, the vomiting and reflux may stop (they can then tolerate regular PO feedings)
247
What kind of feeds could a child with Crohn's disease may need that could be helpful in reversing growth failure and inducing remission?
Continuous NG feedings
248
What type of feeds for children with malabsorption syndrome?
Continuous
249
Why do you use continuous feeds for infants with congenital heart disease?
Increased nutritional demands...they often have delayed gastric emptying and early satiety. Bolus feeds can lead to malnourishment and delay of corrective surgery...need to fatten them up ASAP.
250
What type of feeds for infants with oral motor discoordination?
Bolus (as long as there are no gut responses, gastric residuals, or evidence of malabsorption or dumping syndrome)
251
Patients with liver disease have decreased delivery of bile acids which results in what?
Malabsorption of fat soluble vitamins (A, D, E, K)
252
Cholestatic disease results in what nutrition wise?
Malabsorption of fat soluble vitamins (A, D, E, K) due to decreased delivery of bile acids
253
Kids with cholestatic disease (liver disease) have an increased risk for what because they can't absorb fat soluble vitamins?
Rickets
254
For a kid with ascites or portal hypertension , what do you do and how does this affect formula?
Fluid restriction, need to use a more concentrated formula
Concentrated formulas are gross... So sometimes you have to do NG or gastrostomy feedings
Have to maintain adequate calorie intake to reduce risk for growth failure
255
What do you do with nutrition for kids with heart failure?
Increased caloric intake with restricted fluids
Increase concentration of formula (increases caloric density without increasing fluid causing appropriate weight gain)
These kids are also often on diuretics (balance tendency for fluid overload)
256
What acute organ failure kids tend to be malnourished?
Acute renal failure
257
In children in acute renal failure, what % of calories should come from carbohydrates?
70%
258
In kids with acute renal failure lipids should comprise less than what % of calories?
20%
259
Kids with acute renal failure can have what protein intake?
0.5-2 g/kg/day
260
Infants in renal failure require what type of formula?
Low phosphorous formula
261
Kids with adequate nutrition at the onset of treatment for malignancy may have reduced risk for what?
Infection and reduced severity of chemo side effects
262
Neurologically impaired kids are at a higher risk for what GI issue?
GERD
Also more prone to ill effects when fundoplication surgery is done
263
What is essential to wound healing from a nutritional standpoint?
Adequate caloric intake (especially protein), vitamin C, vitamin A, zinc, iron
264
Is severe diet restriction in response to multiple food allergies ever the right answer?
No, because of the nutritional hazards of diet restriction
265
If you substitute rice milk for standard formula in an infant, you can get what deficiencies?
Vitamin D, calcium, protein, fatty acid
266
Older kids who restrict dairy intake due to lactose intolerance can have what?
Calcium and vitamin D deficiency
267
Kids with cystic fibrosis have poor pancreatic function that leads to malabsorption of what?
Intestinal protein and fat (at risk for deficiency of vitamins A, D, E, K)
268
Kids with CF almost always need what to maintain adequate growth during childhood?
Supplementation of calories
Better nutritional status in these patients correlates to better lung function
269
What can be done to minimize protein catabolism and weight loss in burn patients?
Early and aggressive nutritional support to reduce resting energy expenditure
270
Burn patients need lots of what in their diet?
High carbohydrates (due to relative inability to use fat)
271
Burn patients need lots of what electrolytes to maintain normal serum levels?
Calcium and magnesium
