Nutrition Flashcards
(166 cards)
1
Q
Daily amount of calcium gluconate
A
0.25-0.5 mEq/kg
2
Q
What can inadequate protein intake lead to?
A
- Failure to thrive
- Hypoalbuminemia
- Edema.
3
Q
Normal Lab Values for Children Glucose
A
70-110
4
Q
How much Folic Acid?
A
140 mcg
5
Q
What does enteral nutrition improve?
A
- Epithelial structure and function
- Enhance mucosal immunity
- Reduce the risk of bacterial translocation
6
Q
How much of endogenous protein can low birth weight infant lose daily?
A
1%
7
Q
Short term complications related to excess protein administration
A
- Azotemia
2. Hyperammonemia
8
Q
Hypernatremia Treatment
A
Treatment will involve replacement of BOTH water and electrolyte defecits
9
Q
Holliday-Segar Method
ml/kg/day
Each Additional kg
A
20 ml/kg/day
10
Q
What should be monitored on TPN?
A
- Weight
- CBC
- Electrolytes
- BUN
- Plasma glucose
- Accurate I and O
- Liver function
- Calcium
- Magnesium
- Phosphorus
11
Q
How can burns affect energy requirements?
A
Up to 100% more
12
Q
Why are carbohydrates initiated like they are?
A
To allow an appropriate response to endogenous insulin and prevent hyperglycemia and osmotic diuresis
13
Q
Normal Lab Values for Children WBC
A
5,000-10,000
14
Q
How to initiate enteral feeding while weaning TPN?
A
Enteral feedings can be tolerating initially with slow continuous drips with age appropriate elemental formula
15
Q
Administration of Resuscitative Fluids
A
Warmed crystalloid fluids (Lactated Ringers or 0.9% Normal Saline)
16
Q
Severe Volume Depletion Symptoms
A
- Near shock presentation
- Decrease peripheral perfusion with capillary refill >3 seconds
- Cool and mottled extremities
- Lethargy
- Increased respiratory rate
17
Q
Goal and max of (GIR)
A
5 – 8 mg/kg/min
Maximum: 13 mg/kg/min
18
Q
What to use for greater than 6 weeks of parenteral nutrition?
A
- Hickman
2. Broviac
19
Q
Holliday-Segar Method
ml/kg/day
Second 10 kg
A
50 ml/kg/day
20
Q
Normal Lab Values for Children Creatinine
A
0.7-1.3 (Kidney)
21
Q
Holliday-Segar Method
Electrolytes (mEq/100 ml H2)
First 10 kg
A
Na+ 3
22
Q
Normal Lab Values for Children RBC
A
- 7-6.1 (M)
4. 2-5.4 (F)
23
Q
Hypokalemia Treatment
A
- Potassium supplement
- Potassium sparing diuretics
- IV potassium
(Do not use Dextrose base solution because it stimulates the release of insulin, which drives extracellular potassium into the cells)
24
Q
How much Selenium?
Recommended/Protocol Dose/Maximum
A
Recommended: 2 mcg/kg/day
Protocol Dose: none
Maximum: 30 mcg/day
25
Hypokalemia
Serum or plasma levels <3.5 mEq/L
26
Daily Energy Requirements
(Non-protein kcal/kg)
13-18 years
30-60 kcal/kg/day
27
Normal Lab Values for Children Hgb
14-18 (M)
| 12-16 (F)
28
Holliday-Segar Method
ml/kg/hr
Each Additional kg
1 ml/kg/hr
29
Normal Lab Values for Children Hct
42-52 (M)
| 37-47 (F)
30
* Placement requires surgical or interventional radiology procedures
* Used for long term use of TPN
Implanted Ports
31
What do you do if additional losses need to be replaced in addition to daily maintenance?
Use non-TPN fluid and piggyback into line
32
Types of Catheters used for TPN
1. Percutaneous nontunneled central catheters
2. Tunneled cuff central catheters
3. Peripherally Inserted Central Catheters (PICC)
4. Implanted Ports
5. Peripheral catheters
33
What to monitor with fat infusion?
Monitor tolerance closely with triglyceride (TG) levels.
34
Daily protein requirements (g/kg)
| Infants
2-2.5 gm/kg
35
Types of Fluid Therapies
1. Maintenance Therapy
2. Repletion Therapy
3. Administration of Resuscitative Fluids
36
Maximum dextrose concentration in peripheral?
10-12% (Greater than 12% is associated with increased phlebitis)
37
How much Vitamin E?
7 mg equals 7 USP units
38
Holliday-Segar Method
Electrolytes (mEq/100 ml H2)
Each Additional kg
K+2
39
Normal Lab Values for Children BUN
10-20 (Kidney)
40
Daily amount of potassium
2-5 mEq/kg
41
Long term complications related to excess protein administration
1. Abnormal plasma aminograms
| 2. Cholestolic jaundice
42
MVI dosing for greater than 3 kg and less than 11 years
5 ml daily
43
How many kcal/gram does dextrose provide?
3.4 kcal/gram
44
How much Vitamin B12?
1 mcg
45
Normal Lab Values for Children Cl+
98-106
46
Repletion Therapy
Corrects water and acute electrolyte deficits caused by illness or physiologic abnormality
47
How much Niacin?
17 mg
48
Daily protein requirements (g/kg)
| Adolescents
0.8-2 gm/kg
49
Daily amount of phosphorus
1-2 mmol/kg
50
Normal Lab Values for Children PTT
60-70 (Heparin)
51
Why is the osmolality of fats important?
Low osmolality makes them useful in peripheral TPN
52
How often should liver function, calcium, magnesium, and phosphorus be monitored during TPN?
Twice weekly
53
How much should carbohydrates provide in total non-protein calories?
50-60%
54
How much Vitamin B6?
1.0 mg
55
Normal Lab Values for Children Platelets
150,000-400,00 (ASA)
56
How often should plasma glucose be monitored during TPN?
Every 6-8 hours until patients and glucose levels are stable
57
Fluid requirements per day for body weight greater than 20 kg
1500ml plus 20 ml/kg for each kg greater than 20 kg
58
What does the administration of fats prevent?
Fatty acid deficiency
59
Normal Lab Values for Children PT
11-12.5
60
Holliday-Segar Method
ml/kg/day
First 10 kg
100 ml/kg/day
61
How much Vitamin D?
400 USP units
62
Hyperkalemia
Serum or plasma levels > 5.5 mEq/L
63
Nutritional assessment in considering TPN
1. Goals for calories, protein, fat, non-protein calories to nitrogen ratio
2. Plot growth history on growth curve
64
Recommended non-protein nitrogen ratio
150-100:1
65
Normal Lab Values for Children INR
0.9-1.2 (Coumadin)
66
How to infuse fats?
Start infusing fat over 20-24 hours to improve clearance
67
How can fever affect energy requirements?
12% increase for each degree about 37
68
Moderate Volume Depletion Symptoms
1. Tachycardia
2. Orthostatic hypotension
3. Dry mucous membranes
4. Irritability
5. Delay in capillary refill
6. Increase respiratory rate
7. Decrease urine output
8. Open fontanelle will be sunken on infants
69
How much Biotin?
20 mcg
70
Maintenance Therapy
Normalizes and preserves homeostasis through replacing normal daily losses of water and electrolytes (urine, sweat, respiration, & stool)
71
Daily Energy Requirements
(Non-protein kcal/kg)
7-12 years
60-75 kcal/kg/day
72
How to maintain calories while weaning TPN?
Maintain calories by calculating adjusts of enteral and parenteral fluids
73
How can cardiac failure affect energy requirements?
5-25% increase
74
Daily Energy Requirements
(Non-protein kcal/kg)
Less than 6 months
90-120 kcal/kg/day
75
Hyponatremia Treatment
Treatment choices (oral or IV)
1. Hypertonic saline 3% for symptomatic patients
2. Fluid restriction for patients with ADH release
3. Treatment of the underlying disease
76
Hypervolemia
Decrease in water loss leading to water retention. These patients will have decrease serum sodium levels, postive net volume balance, and increase body weight
77
How many kcal/gram do fats provide?
9 kcal/gram
78
Protein administration
Begin with 2 gm amino acids (except children with renal insufficiency)
79
Euvolemia
No change in serum sodium levels or body weight and the patients will have a neutral net volume balance
80
How can protein calorie malnutrition affect energy requirements?
50-100% more
81
Estimation of duration of parenteral nutrition in considering TPN
1. Peripheral access for short term use
| 2. Central access for long term use
82
Hypernatremia
Serum or plasma >150 mEq/L
83
Daily amount of magnesium
0.25-0.5 mEq/kg
84
What are maintenance requirements for fluids based on?
Weight
85
Identification of primary objective for parenteral nutrition in considering TPN
1. Supplemental
2. Maintenance of present body stores
3. Repletion of malnourished patient
4. Promotion of catch up growth
86
Normal Lab Values for Children Na+
136-145
87
Fluid requirements per day for body weight 11-20 kg
1000 ml plus 50 ml/kg for each kg greater 10 kg
88
Prolonged period of time for children and adolescents unable to meet nutritional requirements
4-5 days
89
How much Dexpanthenol?
5.0 mg
90
Prolonged period of time for infants unable to meet nutritional requirements
1-3 days
91
Who should receive pediatric multi-vitamins?
Infants and children up to 11 years of age
92
Normal Lab Values for Children Ca+
9.0-10.5
93
* Inserted peripherally but more commonly in the antecubital
| * Used for medium term use of TPN (several months)
Peripherally Inserted Central Catheters (PICC)
94
How much Vitamin A?
2300 USP units
95
How much Vitamin C?
80 mg
96
When should iron not be used?
Patients with gastrointestinal problems
97
How much Thiamine?
1.2 mg
98
Severe Volume Depletion
>/= 10% volume loss
99
Goal of weaning TPN?
Goal is maintenance of optimal nutrition while progressing from parenteral to enteral feeding
100
How much Chromium?
| Recommended/Protocol Dose/Maximum
Recommended: 0.14 to 0.25 mcg/kg/day
Protocol Dose: 0.17 mcg/kg/day
Maximum: 5 mcg/day
101
Normal Lab Values for Children AST
12-31 (Liver)
102
How much Zinc?
| Recommended/Protocol Dose/Maximum
Recommended: 100-400 mcg/kg/day
Protocol Dose: 100 mcg/kg/day
Maximum: 5000 mcg/day
103
What can early use of proteins stimulate?
Endogenous insulin secretion
104
How are carbohydrates initiated?
In a slow stepwise manner
105
Who should receive adult dosage of vitamins for IV use?
Children above age 11
106
MVI dosing for less than 3 kg
3.25 ml daily
107
Mild Volume Depletion
3-5% volume loss, minimal changes in clinical findings
108
How many cal/ml does 20% Intralipids provide?
2 cal/ml
109
Glucose Infusion Rate (GIR) Formula
1. Glucose concentration (as a decimal) x Volume (mL/kg/d) ÷ 1.44
2. (IVR × % Dextrose solution) ÷ (6 × Weight)
3. IV rate (mL/hr) x Dextrose concentration (g/dL) x 0.167 Weight (kg)
110
Preliminary factors in considering TPN
1. Nutritional assessment
2. Identification of primary objective for parenteral nutrition
3. Estimation of duration of parenteral nutrition
111
How much of total calories as fat are recommended?
20-30%
112
Maximum dextrose concentration in central?
30%
113
How should dextrose be increased?
Increase dextrose 2-5 gm/100ml per day as tolerated
114
Fat administration rates for older children
| Initial/Daily increase/Maximum
Initial: 1gm/kg/day (5ml/kg/day)
Daily increase: 1 gm/kg/day (5ml/kg/day)
Maximum: 2 gm/kg/day (10 ml/kg/day)
115
Normal Lab Values for Children K+
3.5-5.0
116
Hyponatremia
Serum or plasma sodium levels <135 mEq/L
117
Normal Lab Values for Children ALT
10-40 (M)
7-35 (F)
(Liver)
118
How can major surgery affect energy requirements?
20-30% increase
119
Normal Lab Values for Children Albumin
3.5-5.0 (Liver)
120
How much Copper?
| Recommended/Protocol Dose/Maximum
Recommended: 20 mcg/kg/day
Protocol Dose: 20 mcg/kg/day
Maximum: 300 mcg/day
121
Daily Energy Requirements
(Non-protein kcal/kg)
1-7 years
75-90 kcal/kg/day
122
Fluid requirements per day for body weight 1-10 kg
100 ml/kg
123
Holliday-Segar Method
ml/kg/hr
First 10 kg
4 ml/kg/hr
124
When should you further investigate glucose needs?
In excess of 24g/kg/day
125
Daily Energy Requirements
(Non-protein kcal/kg)
Preterm
120-140 kcal/kg/day
126
Holliday-Segar Method
Electrolytes (mEq/100 ml H2)
Second 10 kg
Cl- 2
127
Hypovolemia
Unreplaced water losses leads to volume depletion. These patients will have increase serum sodium levels, negative net volume balance, and decrease body weight
128
How much Manganese?
| Recommended/Protocol Dose/Maximum
Recommended: 1-10 mcg/kg/day
Protocol Dose: 5 mcg/kg/day
Maximum: 50 mcg/day
129
Hyperkalemia Treatment
Therapies removing potassium from the body:
1. Diurectics
2. Enteral cation exchange resins
3. Dialysis
130
Who should be given fats cautiously?
Patients with elevated bilirubin levels.
| There is competitive binding between bilirubin and fats to albumin. Watch those indirect bilirubin levels.
131
Daily protein requirements (g/kg)
| Critically ill child
1.5-2 gm/kg
132
What kind of osmolality is fats?
Low osmolality
133
How can long term growth failure affect energy requirements?
50-100% increase
134
* Only appropriate for TPN use with osmolarity between 900-1000
* Needs to be replaced frequently (days to 1 week)
* Limits the use of how much TPN can be given
Peripheral Catheters
135
How much Riboflavin?
1.4 mg
136
* Inserted through the subclavian, jugular, or femoral veins
| * Used for short term TPN (1-2 weeks)
Percutaneous Nontunneled Central Catheters
137
Why are fats essential?
1. For normal body growth and development
2. Cell structure and function
3. Retinal and brain development
138
Fat administration rates for full-term AGA infant
| Initial/Daily increase/Maximum
Initial: 1gm/kg/day (5ml/kg/day)
Daily increase: 0.5 gm/kg/day (2.5ml/kg/day)
Maximum: 4 gm/kg/day (20 ml/kg/day)
139
How much Vitamin K?
200 mcg
140
What does early enteral nutrition lead to?
1. Quicker advancements in feedings
2. Fewer infections
3. Lower costs
4. Decreased hospital stays
141
Fat administration rates for premature SGA infant
| Initial/Daily increase/Maximum
Initial: 0.5 gm/kg/day (2.5ml/kg/day)
Daily increase: 0.25 gm/kg/day (1.25ml/kg/day)
Maximum: 3 gm/kg/day (15 ml/kg/day)
142
How to calculate neonatal daily fluids?
Based on birth weight until back to birth weight or 7-10 days
(There are exceptions to this rule)
143
When to wean TPN and why?
Wean TPN as soon as possible to minimize cholestatic liver disease
144
Daily Energy Requirements
(Non-protein kcal/kg)
6-12 months
80-100 kcal/kg/day
145
Daily protein requirements (g/kg)
| Neonates
2.5-4 gm/kg
146
Moderate Volume Depletion
6-9% volume loss
147
Indications for TPN
1. Severe chronic intestinal failure
2. Neonates who cannot be fed enterally because of necrotizing enterocolitis
3 Stages of Crohn’s disease or ulcerative colitis
4. Bowel Obstruction
5. Short bowel syndrome due to surgery
6. Congenital gastrointestinal anomalies
7. Prolonged diarrhea
8. Prematurity
148
How to give dextrose centrally?
1. Usually begin with 15% dextrose
2. Check blood sugars to evaluate tolerance of dextrose increase
3. Increase dextrose 2-5 gm/100ml per day as tolerated
149
* Inserted surgically, commonly in the jugular or cephalic veins
* Used for long term TPN
Tunneled Cuff Central Catheters
150
How to calculate daily fluid allowance?
Based on maintenance requirements
151
When should fat infusions be adjusted?
If triglyceride levels are greater than 400 IL
152
Benefits of fats
A great source of concentrated calories, especially during times of fluid restriction
153
Holliday-Segar Method
ml/kg/hr
Second 10 kg
2 ml/kg/hr
154
Daily amount of chloride
2-5 mEq/kg
155
Daily protein requirements (g/kg)
| Children
1.5-2 gm/kg
156
What to use for less than or equal to 6 weeks of parenteral nutrition?
PICC line
157
Daily amount of sodium
2-5 mEq/kg
158
When to increase protein?
1. Stress events
2. Sepsis
3. Thermal injury
4. Surgery
5. Trauma
6. Stomal loss
7. Urinary excretion of nitrogen related to steroids, diuretics, or primary renal disease
159
When to decrease protein?
1. Renal disease
2. Hepatic failure
3. Metabolism issues
160
Intralipids and infants with jaundice
Icteric premature newborns should be started on 0.5 g/kg/day doses, increasing after bilirubin levels fall or on determination of free fatty acid levels
Due to increased risk of kernicterus, as fatty acids compete with bilirubin for binding sites on albumin
161
Osmolarity limits peripheral lines
1. For peripheral vein tolerance, total osmolarity per liter is limited to 700 to 900 mOsm.
2. Solutions with osmolarity > 600 mOsm/L should be administered in a central vein to lower risk of plebitis
162
Indications for TPN
1. Nonfunctional or inaccessible GI tract
2. Cannot meet their nutritional requirements by enteral intake alone
3. Intestinal disorders for which PN has been proven effective
163
Examples of nonfunctional or inaccessible GI tract
1. Intestinal failure (short gut)
2. Severe malabsorption
3. Obstruction or ileum
4. Intractable vomiting or diarrhea
5. Necrotizing enterocolitis
6. Congenital anomalies of the GI tract
7. Bowel ischemia
164
Extra-intestinal Disorders/Therapy for TPN
1. Malignancies
2. Body surface burns
3. Cardiac failure
4. Kidney failure
5. Chylothorax
6. ECMO
165
How to treat hypernatremia?
150 to 170 mEq/L: correct over a 48-hour period.
Greater than 170 mEq/L: correct over a 72-hour period.
Greater than 200 mEq/L: consider dialysis.
The goal in treatment is to avoid cerebral edema or herniation by decreasing serum sodium slowly, by 1 mEq/L/h with acute hypernatremia or by 0.5 mEq/L/h with chronic hypernatremia.
Administration of free water
166
Free water formula
(Current Na+ − Desired Na+) × 4 mL/kg × Patient weight (in kg)
