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Clin Med 2 > Nutrition > Flashcards

Flashcards in Nutrition Deck (58):
1

Energy comes from

o Carbohydrate
o Fiber
o Nitrogen
o Water

2

Energy supports

normal functions and activity, growth and repair of damaged tissues

3

Three factors for Energy Expenditure

o Basal energy expenditure (BEE)
o Thermic effect of food (TEF)
o Physical activity

4

Basal energy expenditure (BEE)

amount of energy required to maintain basic physiologic functions

5

Thermic effect of food (TEF)

amount of energy expended during and following the ingestion of food

6

Of the energy expenditures, which has the largest effect

physical activity

7

Why do we need protein

growth and maintenance of body structure and function

8

How much protein a day

56g/day for men and 45g/day women

9

Carbs include

o Simple sugars
o Complex carbohydrates (starches)
o Indigestible carbohydrates (dietary fiber)

10

What is the most concentrated source of food energy

fat

11

What is major part of cell membranes

cholesterol

12

Patient populations at risk of nutritional deficiencies

o Elderly
o Adolescent
o Pregnant or lactating women
o Low socioeconomic status

13

BMI

body weight in relation to height

14

Most important lab in evaluation of protein-calorie undernutrition

albumin

15

2 distinct syndromes of protein- energy malnutrition

Kwashiorkor
Marasmus

16

Kwashiorkor

- deficiency of protein in presence of adequate energy
- Sufficient caloric intake, insufficient protein consumption

17

Marasmus

- combined protein and energy deficiency
- Severe malnutrition, emaciated appearance

18

In developing countries where is Kwashiorkor found

- where foods containing protein are insufficient
- Occurs in areas of famine or poor food supply

19

In developing countries where is Marasmus found

seen where adequate quantities of food are not available

20

In developed countries where is Kwashiorkor found

associated with illnesses where the body is in a hypermetabolic state, i.e. trauma, sepsis, burns

21

In developed countries where is Marasmus found

results from chronic diseases like heart failure, cancer, COPD, AIDS 
Protein-Energy Malnutrition

22

Tx protein energy malnutrition

Call your nutrition colleagues ASAP
Should be followed daily by nutrition consultant
o Help manage dietary requirements
o Correct electrolyte abnormalities
o Replace vitamins and minerals
o Supplements with enteral or parenteral nutrition

23

obesity is

excess adipose tissue

24

Tx obesity

- Close follow-up is essential
- Identify and refer those patients who are motivated to active 
treatment programs
- Programs are multifactorial and emphasize maintenance of weight loss
o Dietary instruction and education
o Behavior modification
o Exercise
o Medications
o Bariatric surgery

25

Def anorexia

a disturbance in body image and intense fear of weight gain

26

Clinical anorexia

- Weight loss leading to body weight 15% below expected
- In female patients, amenorrhea is almost always present
- Other clinical signs and symptoms:
o Constipation
o Cold intolerance
o Bradycardia
o Hypotension
o Loss of body fat
o Dry and scaly skin 


27

Dx anorexia

- Behavioral features such as distorted body image, fear of weight gain and refusal to maintain normal body weight in setting of weight loss to a body weight 15% below expected
- In female, absence of at least 3 menstrual cycles

28

Tx anorexia

- Goal is restoration of normal body weight and elimination of psychological features
- Inpatient treatment programs are available but may also be necessary in severe cases for management of volume status and electrolytes
- Referral to psychiatrist is essential 


29

Def bulimia nervosa

Episodic, uncontrolled ingestion of large quantities of food followed by recurrent inappropriate compensatory behavior to avoid weight gain
o Self-induced vomiting
o Diuretics
o Cathartics
o Strict dieting
o Vigorous exercise

30

Clinical bulimia nervosa

- Body weight fluctuations but generally within 20% of normal body weight
- Commonly describe family and psychological issues
- Impulsive or antisocial behavior may be present
- Menstruation is typically preserved
- Medical complications such as:
o Gastric dilatation, pancreatitis after binges
o Poor dentition, esophagitis secondary to vomiting
o Electrolyte abnormalities, dehydration secondary to diuretics and cathartics
o Constipation

31

Tx bulimia

- Supportive care to include psychotherapy
- Antidepressants may be helpful
- All patients should be referred to psychiatrist
- Long term psychiatric prognosis is worse with bulimia nervosa

32

Serum ferritin levels in iron deficiency

Serum ferritin value <12 ng/mL without anemia or <30 ng/mL with anemia

33

Stage of iron deficient anemia

1. Depletion of iron stores without anemia
2. Anemia with a normal red blood size (MCV)
3. Anemia with low MCV (microcytic), low reticulocyte count , low serum ferritin

34

Clinical iron deficient anemia

- Fatigue
- Tachycardia
- Palpitations
- Dyspnea on exertion
- Skin and mucosal changes
- Smooth tongue
- Brittle nails
- Spooning of nails
- Cheilosis
- pica

35

Tx iron deficient anemia

- Identify cause of iron deficiency anemia as often this can be a result of occult blood loss
- Oral iron
o Ferrous sulfate 325 mg PO one-three times daily
o Continue 3-6 months after restoration of normal labs

36

Who get parenteral iron

Refractory to PO iron

GI disease
Hemodialysis

37

Thiamine deficiency due to

chronic alcoholism

38

Clinical thiamine deficiency

- Anorexia
- Muscle cramps
- Paresthesias
- Irritability
- Cardiovascular dysfunction – wet beriberi
- Neurological dysfunction – dry beriberi

39

Wet beriberi

- Marked peripheral vasodilation caused high output heart failure
- Dyspnea, tachycardia, cardiomegaly, edema

40

Dry beriberi

- Peripheral nerve involvement causing motor and sensory neuropathy, 
paresthesias and loss of reflexes
-Wernicke - Korsakoff Syndrome

41

Tx thiamine deficiency

replace thiamine, initially IV followed by PO

42

Where is B12 from?

animal sources

43

How is B12 absorbed

intrinsic factor in the intestine and stored in liver

44

B12 deficiency in

vegans, alcoholics, elderly

45

Pernicious anemia

autoimmune disease where there are autoantibodies against gastric parietal cells that produce intrinsic factor

46

What surgery eliminates intrinsic factor

Gastrectomy

47

B12 anemia

- elevated MCV (MCV >100) (macrocytic)
- megaloblastic and hypersegmented neutrophils

48

Tx B12

IM or subcutaneous injections of 100 mcg
• Daily for first week
• Weekly for first month
• Monthly for life

49

Folic acid found

fruit and vegetable

50

Folic acid deficiency due to

lack of intake

51

Clinical B12 and folate

- GI symptoms

- Swollen, painful tongue
- Neurologic symptoms such as cognitive impairment, dementia, depression

52

Diagnostic level folic acid

less than 150

53

Tx folic acid deficiency

folic acid 1mg PO daily

54

Vit D found

ultraviolet B light, plants, animals, fish

55

Vit D converted into

Hormone 1,25- dihydroxyvitamin D

56

Hormone 1,25- dihydroxyvitamin D does what

increases absorption of dietary calcium and stimulate osteoclast to release calcium

57

MC manifestation of Vit D deficiency

osteomalacia

58

Tx Vit D

o Ergocalciferol (D2) 50,000 units once weekly x8 weeks
o Cholecalciferol (D3) 2,000 units daily