Nutrition Flashcards
(93 cards)
1
Q
Baseline daily calorie requirement
A
20-25 kcal/kg/d
2
Q
Baseline daily protein requirement
A
1g/kg/d
3
Q
Fat % of caloric intake
A
30%
4
Q
Protein % of caloric intake
A
20%
5
Q
Carb % of caloric intake
A
50%
6
Q
kcal of protein per gram
A
4kcal/g
7
Q
kcal of fat per gram
A
9kcal/g
8
Q
kcal of carb per gram
A
4kcal/g
9
Q
Harris-Benedict equation for BMR (basal metabolic rate)
A
M: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age) + 5
W: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age) - 161
10
Q
Caloric requirement after trauma, surgery, or sepsis
A
25-30 kcal/kg/d
11
Q
Caloric requirements after burns
A
25 kcal/kg/d + (30 kcal/d x % burn)
12
Q
Protein requirement after burns
A
1 g/kg/d + (3 g/d x % burn)
13
Q
Predicted increase in caloric requirements due to elective surgery
A
1.2x
14
Q
Predicted increase in caloric requirements due to multisystem trauma
A
1.3-1.5x
15
Q
Predicted increase in caloric requirements due to sepsis
A
1.5-1.8x
16
Q
Predicted increase in caloric requirements due to burns
A
1.5-2.0x
17
Q
What is body’s state after surgery or critical illness
A
Catabolic state
Proteolysis, inadequate intake results in body turning to protein sources
18
Q
Protein requirement for critically ill patient
A
1.5 g/kg/d
19
Q
Protein requirement for head injury or burn patient
A
2 g/kg/d
20
Q
Protein sparing effect
A
Delivery of small amount of carbs or fat (~400kcal/d) decreases proteolysis
21
Q
Cause of insulin resistant during starvation
A
Inhibition of glucose oxidation. Increased gluconeogenesis causing hyperglycemia
22
Q
Blood glucose goal during surgery
A
140-180 mg/dL
23
Q
Benefits of enteral nutrition
A
stimulates IgA, prevents bacterial translocation, preserves upper respiratory tract, lessens inflammatory response
24
Q
Timing for enteral feeding after admission/surgery
A
24-48 hours
25
Situations where enteral feeding is contraindicated
1. Bowel perf
2. obstruction
3. Discontinuity
4. Significant HD instability on pressors
26
When to start parenteral nutrition
after 7 days without nutrition and inability to tolerated enteral nutrition
27
Respiratory quotient
if elevated, makes weaning off the vent more challenging due to extra carbon dioxide made that must be expired (increased respiratory rate)
ratio of CO2 produced and oxygen consumed
measure of energy expenditure
28
Complications with parenteral nutrition
1. Electrolyte disturbances (refeeding syndrome)
2. Liver dysfunction (steatosis, cholestasis)
3. Line infection
4. GI dysfunction (mucosal atrophy from disuse, loss of brush border enzymes, bacterial overgrowth, decreased gut immunity)
29
Nitrogen balance
helps determine balance of anabolism and catabolism. Positive nitrogen balance is ideal --> pt getting enough protein
(Protein intake / 6.25) - (UUN + 4)
6.25g of protein in 1g nitrogen
UUN = 24-h urine urea nitrogen
30
Fat utilization respiratory quotient
0.7
31
protein utilization respiratory quotient
0.8
32
carb utilization respiratory quotient
1.0
33
RQ > 1
Overfeeding/Lipogenesis
| Excess carbs
34
RQ < 0.7
Starvation/Ketosis & fat oxidation
35
Markers for long-term nutrition
Albumin
| Transferrin
36
Markers for short-term nutrition
Prealbumin
| Retinol-binding protein
37
Half life of albumin
20 days
38
Half life of prealbumin
2 days
39
Half life of transferrin
10 days
40
Half life of retinol-binding protein
12 hours
41
Most accurate marker of nutritional status in stable patients
Albumin
42
Respiratory quotient
CO2 produced / O2 consumed
43
Nitrogen balance equation
Total protein intake (g) / 6.25 - UUN + 4g
44
Urinary urea nitrogen (UUN)
Nitrogen lost in urine in 24 hours
45
Upper esophageal sphincter
Open/relaxes w/ swallowing, allows entry of food bolus into esophagus
46
Lower esophageal sphincter
Open/relaxes w/ swallowing, allows entry of food bolus into stomach
47
Mechanics above food bolus
contraction of circular smooth muscle layer squeezes bolus forward
48
Mechanics below food bolus
contraction of longitudinal smooth muscle layer widens lumen to receive bolus
49
Stomach wall mechanics
```
Muscularis externa (3 layers: circular, longitudinal, oblique) contraction helps break food into smaller bits
Inner lining: simple columnar epithelium with goblet cells, secrete mucus
longitudinal folds (rugae): allows stomach to increase storage capacity
```
50
Vent volumes decrease after placement of NGT placed to suction
Means NGT was placed nasotracheal position.
| Remove NGT
51
Obstruction after feeding tube placement
Balloons migrate distally to obstruction
52
Buried Bumper Syndrome
Complication after PEG placement, bumper is overgrown by hypertrophic gastric mucosa, embedded into gastric wall
Likely secondary to enforced tightening of PEG causing an ulcer
Can't see bumper endoscopically
53
Indications of Buried Bumper Syndrome
PEG tube can't be mobilized, secretion along tube, upper ABD pain
54
MC causes of new-onset feeding intolerance
Gastroparesis (assoc w/ DM, PNA, sepsis)
Ileus
Sepsis/Infections
55
Tx of gastroparesis
```
prokinetic agents (metoclopramide, erythromycin)
NJ tube feeds
```
56
Results of excessive protein
azotemia, hypertonic dehydration, hyperammonemia, metabolic acidosis
57
MC assoc w/ undernutrition
Enteral feeding
58
MC assoc w/ overfeeding
TPN
59
Components of TPN
amino acids, lipids, dextrose, trace elements, vitamins, electrolytes
60
Risk of DVT w/ CVC placement
Fem > IJ > SC
61
Dx of Hyperosmolar hyperglycemia state (HHS)
```
Glucose > 600mg/dL
Osmolality >320 mOsm/kg
Profound dehydration
pH > 7.4
Bicarb > 15 mEq/L
Ketonuria and Low ketonemia
BUN > 30 mg/dL
Creat > 1.5 mg/dL
```
Relative insulin deficiency but no ketosis due to presence of insulin inhibiting hormone-sensitive lipase mediated fat tissue breakdown
62
NUTRIC Score
```
APACHE II score
SOFA score
Comorbidities
IL-2
# ICU admissions
```
Score >6 assoc w/ higher mortality, acquire more aggressive therapy
63
Immunonutrients
```
Arginine
Glutamine
Branched-chain amino acids
omega-3 fatty acids
nucleotides
```
64
Arginine
Precursor of polyamides, nucleic acids, amino acids involved in connective tissue synthesis, nitric oxide
Secretagogue for growth hormone, prolactin, insulin
Increases # T cells, enhances T-cell function
Improves wound healing
Increases mortality in septic elderly men
decreases risk of postop infxn, improves wound healing in pts with GI malignancy undergoing elective surgery
65
Glutamine
Most prevalent AA in human body
Made in skeletal muscle
Precursor of purines, pyrimidines, nucleotides, amino sugars, glutathione
Most important substrate for renal ammoniagenesis
Protects structural and functional integrity of intestinal mucosa
Maintains, augments cell immune functions
66
Branched-chain amino acids
Precursor of glutamine
67
Omega-3 fatty acids
Antagonize production of inflammatory eicosanoids from arachidonic acid
precursor of alternative family of eicosanoids
Anti-inflammatory
prevents immunosuppression
68
Nucleotides
impair de novo synthesis in catabolic states
precursors of RNA/DNA
Protects structural and functional integrity of intestinal mucosa
Maintains or augments cell immune functions, especially those assoc w/ cell-mediated immunity
69
how many kcal in gram of carb
4. 0 kcal/g (enteral)
| 3. 4 kcal/g (parenteral)
70
Gold standard for determining resting energy expenditure in hospitalized patients
Indirect calorimetry
71
Long-chain fatty acids (LCFAs)
12+ carbons
| Undergo esterification inside enterocytes, enter circulation through lymphatics as chylomicrons
72
Short-chain fatty acids (SCFAs)
Enter directly into portal circulation, transported into liver by albumin carriers
Made in colon by action of bacteria.
Substrates for colonocytes
Pts w/ colostomy and distal rectal pouches might develop diversion colitis in distal rectal pouch b/c lack of SCFAs as nutrition in mucosa. Tx w/ SCFAs enemas
73
Fuel source for stomach, enterocytes, pancreas, spleen
glutamine
74
fuel source for hepatocytes
amino acids
75
fuel source for colonocytes
SCFA (butyrate, acetate)
76
fuel source for cardiac myocytes
SCFA
77
fuel source for skeletal myocytes, brain, kidney
glucose
78
Fuel source for peripheral nerves, adrenal medulla, RBCs, PMNs
glucose
79
Fuel source for neoplastic cells
Glutamine, glucose
80
Omega 3 FAs
Found in fish
Modulate leukocyte function, regulate cytokine release via nuclear signaling and gene expression
```
Eicosapentanoid acid (EPA)
Docosahexaenoic acid (DHA)
```
metabolized into prostaglandins called resolvins and neuroprotectins
81
Omega 6 FAs
Found in safflower oil, corn, cottonseed, soybean oil
assoc w/ higher inflammatory response
precursors to leukotrienes, thromboxane, prostaglandins (vasoconstrictive, induce platelet aggregation)
82
Vit A deficiency
Xerophthalmia, rashes
83
Vit A excess
Nausea, vomiting, brain edema, hepatomegaly
84
Vit D Deficiency
Hypocalcemia, hypophosphatemia
85
Vit D excess
Confusion, polyuria, polydipsia, vomiting, muscle weakness
86
Vit E deficiency
hemolytic anemia, neuromuscular disorders
87
Vit E excess
possible platelet dysfunction, inhibit wound healing
88
Vit K deficiency
Elevated INR, coagulopathy
89
Vit K excess
hemolytic anemia, kernicterus
90
Refeeding syndrome
D/t conversion of fat -> carb metabolism
| hypophosphatemia
91
Beneficial for wound healing in malnourished or immunosuppressed patients
Vit A - stimulates fibroplasia, collagen cross-linking, epithelialization. may reverse inhibitory effects of glucocorticoids on inflammatory phase of wound healing
92
Vit C
essential for wound healing, hydroxylation of lysine and proline in collagen synthesis
93
Vit C deficiency
Scurvy
| Impaired wound healing
