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Nutrition, Fluid Flashcards

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1
Q

what key nutrients do cow milk lacking?

A

Cow milk inadequate in Fe, Zinc, Vit E, essential FA’s, LCPUFA’s

early introduction of cow’s milk can increase blood loss from GI tract and contribute to Fe-deficiency anemia

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2
Q

Preterm infants fed standard infant formulas gain a higher proportion of their weight as FAT when compared with a fetus of the same maturity

True or False

A

True

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3
Q

The use of special preterm formulas and preterm HMF results in a composition of weight gain and bone mineralization closer to that of the reference fetus when compared to infants fed standard term formulas or straight human milk.

True or False

A

True

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4
Q

RCT’s of specially formulated preterm formulas have shown significant improvements in growth and cognitive development compared with standard formulas or unfortified EBM.

True or False

A

True

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5
Q

how much calories is needed (enterally) to balance energy expenditure and to allow for proper growth in low birth weight infant?

A

105-130 kcal/kg/day

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6
Q

Give the estimate energy need for each of the following (kcal/kg/day)
Energy expended:
Synthesis:
Energy Stored:
Energy Excreted:

A

Energy expended
(40-60. resting metabolic rate: 40-50, activity: 0-5, thermoregulation: 0-5)
Synthesis: 15
Energy Stored: 20-30
Energy Excreted: 15

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7
Q

is Z-score important?

A

Yes.
Be sure to not only use wt/length/FOC curves… also look at growth Z-score at appropriate frequent intervals

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8
Q

which position has lower energy expenditure?
prone or supine

A

Prone position has lower energy expenditure
10% lower than supine.

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9
Q

infant’s 1600g vs. 1800g wean from incubator to crib earlier or later

A

similar outcome

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10
Q

what is the estimate protein need for preterm infant

A

3.5 - 4.5 g/kg/day

American Academy of Pediatrics– 3.5 - 4.5 g/kg/day
European Society for Paediatric Gastroenterology, Hepatology, and Nutrition
– <1000 g: 4.0 - 4.5 g/kg/day
– 1000 – 1800 g: 3.5 - 4.0 g/kg/day
Nutrition of Preterm Infants– 3.5-4.5 g/kg/day

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11
Q

What enteral protein intake (g/kg/day) is literature supported to be non-toxic in the preterm infant?

A

3.0 - 4.0 g/kg/day

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12
Q

what happens if energy intake is adequate but protein intake is limited

A

protein retention will plateaus.
energy excess is used for fat deposition

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13
Q

what happens if energy intake is limited but protein intake is adequate

A

protein is used for energy

then if increasing energy intake, it will spare protein and improve nitrogen retention

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14
Q

whey to casein ratio in clostrum vs. mature milk

whey to casein ratio in predominantly casein frormula vs. predominantly whey formula

A

80:20 in colostrum

55:45 in mature milk

WHEY is WAY BETTER

predominant casein formula: 20: 80
predominant whey formula (i.e. enfamil premature): 80:20 or 60:40

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15
Q

compare the concentration of the following in foremilk vs. hindmilk
protein, carbohydrate, fat

A

protein concentration similar
foremilk has higher lactose
hindmilk has more fat

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16
Q

how much energy do you need to growth? (enteral vs. parenteral)

A

enteral: 115 - 130 (kcal/kg/day)
parenteral: 100-115

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17
Q

In formulas, approximately 40-50% of energy is provided by fat.

T or F

A

True

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18
Q

how much energy is provided by fat in human milk

A

50%

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19
Q

Oils rich in mixtures of MCT and ___ chain polyunsaturated triglycerides are in special formulas for preterm infants to help aid fat absorption.

A

Long

MCT and Long chain

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20
Q

What are DHA and ARA?

A

fatty acids.
DHA and ARA are transferred across the placenta to the developing fetus.
small amount in BM.
Term and preterm infant can synthesize them. but not enough.

docohexanoic acid (DHA) and arachidonic acid (ARA)

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21
Q

Most common fatty acids

A

Stearic acid (C18, fully saturated)
Oleic acid (C18, 1 double bond)
Palmitic acid (C16, fully satured)

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22
Q

Which fatty acids are essential in neonates

A

Linoleic Acid
Linolenic Acid
(aka alpha linolenic acid)

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23
Q

Length of fatty acids

A

Very Long chain: >/= 22 carbons

Long chain: > 12-20

Medium chain: 6-12 C

Short chain: < 6

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24
Q

most common fatty acid in human milk

A

palmitic
oleic

(P O)

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25
side effect of fatty acid deficiency
SKIN: * hemorrhagic dermatitis * skin atrophy * scaly dermatitis OTHER: * weakness * impaired vision * Edema * high blood pressure * impaired growth
26
what is Triene:Tetraene ratio
T/T ratio is the marker used to diagnose essential fatty acid deficiency. (Mead acid : Arachidonic acid) **Triene/Tetraene **ratio is also called: **Holman Index ** Triene : Tetraene ratio of **is considered EFAD (or use > 0.2)
27
how many kcal/gram of the following Carbohydrate Protein Fat For 20% Intralipid emulsion, what is ___ kcals/ml?
Carbohydrate: 3.4 kcal/g Protein: 4 kcal/g Fat: 10 kcal/g IL: 2 kcal/ml if D10, it means 10g glucose / 100ml.
28
infant's requirement for carbonhydrate is estimated at __ % of calories
40-50%
29
Benefits of lactose Content of lactose in premature formula
- enhance absorption of **Ca and Magnesium.** - promote intestinal growth of **lactobacilli** - premature formula often replace some of the lactose with corn syrup and short chain glucose polymers. (But still has *40-50% lactose* and then 50-60% glucose polymers) - short-chain glucose polymers are absorbed more easily than long-chain glucose polymers.
30
What is the predominant carbohydrate in breast milk and many standard formulas ?
Lactose
31
For positive nitrogen balance, how many __ g of glucose should be provided for each gram of protein
**6 g glucose** for 1 g of protein.
32
How to calculate Nitrogen balance
Nitrogen balance = nitrogen intake - nitrogen lost. Nitrogen intake = **protein g/day x 0.16** (each gram of protein has 16% nitrogen) Nitrogen lost: urine loss (urinary urea concentration) + estimated stool losses (4g)
33
compare lactase activity in 34 week vs. term infant
34 week is 30% of term infants lactase level reach adult level by 36 week
34
Preterm of formula have a higher fat content. which triglyceride is in greater proportion
medium chain triglyceride
35
To achieve optimal nutrition via Parenteral nutrition, what % of total daily calories should each of the follow macro-nutrient provide? Fat CHO Protein
- 30-50% as Fat (not > 60%, stay around 40%, 3-4g/kg/day) - 35 - 65% as CHO (9.7- 17 g/kg/day) - 7-15% as Protein (3 - 4.2 g/kg/day)
36
As gestational age and body weight increases, What decrease? What increases?
Decrease (v): Total body H2O, extracellular H2O, Na, Cl Increase ^: intracellular H2O, Protein, Fat, Ca, Ph, Mg, Fe
37
primary fetal energy source
maternal glucose transferred across the placenta by **facilitated diffusion** (no ATP required)
38
what role does placental lactate play in fetal energy
Placental lactate is 1/4 of fetal energy source (Glucose is 2/3 energy source)
39
what role does maternal amino acid place in fetal energy
- Remainder of fetal energy source (after glucose and placental lactate) - active transport across placenta - important for tissue growth (metabolic fuel). Source of gluconeogenic substrates (pyruvate)
40
What amino acids are NOT gluconeogenic substrates in fetus
Fetus: Glycine (cannot be converted to pyruvate in fetus) Leucine (give rise to acetylCoA and acetoacetyle CoA -> ketogenic) In neonates: Some say it is: *Leucine and Lysine* Ketogenic amino acid
41
which amino acid is the primary fuel of enterocytes in the newborn
Glutamine Glutamine is the largest amino acid concentration in human milk.
42
Essential / Indispensable Amino Acid
Lysine Histidine Threonine Tryptophan Methionine Phenylalanine **Branched chain: Valine, Leucine, Isoleucine** "Try THIS VIP MaLL" Tryptophan Threonine Histidine Valine Isoleucine Phenylalanine Methaionine Leucine Lysine
43
Conditionally Essential Amino Acid (in Preterm infant)
**Arginine (precursor to nitric oxide) Cysteine Taurine Tyrosine ** **Glutamine Glycine Proline** *draw the conditional essential AA picture with the person*
44
what is casein protein
- beta-casein in human milk - human milk proteases (plasmin): increase infant capacity for protein digestion
45
what is whey protein
- alpha-lactalbumin - lactoferrin - **secretory IgA** - serum albumin (*IgA and lactoferrin = 30% of milk protein*)
46
Preterm infant glucose utilization rate vs. Term infant
Preterm: 5-8 mg/kg/min (after 5-7 days, can tolerate 11-12 mg/kg/min) Term: 3-5 mg/kg/min Preterm infant has increased brain-body weight ratio, decrease fat stores, increased total energy req.
47
20% lipid vs. 10% lipid
10% has lower TG content and lower calories per ml. > higher phospholipid/TG ratio > this ratio impairs lipid lipase activities in preterm infant > not using 10%
48
Most important amino acid that assists in metabolism of fat
CARNITINE preterm infant's blood and tissue carnitine are low. add carnitine in TPN (up to 10mg/kg/day)
49
what lipid is used in PN associated liver disease
Omegaven (100% Fish oil)
50
Intravenous lipids increase serum free fatty acid concentrations that can displace bilirubin from albumin binding sites T or F
True BUT: Studies have demonstrated that if parenteral lipids are provided up to 2-3.5 g/kg/day continuously over 24 hours, free bilirubin is NOT affected and therefore IV lipids might need to be discontinued in jaundiced infants
51
lipids and fatty acids are highly bioactive and essential for what?
neurodevelopment (myelin is fat) cell membrane structure/function cell signaling
52
lipids are alternative fuel for gluconeogenesis T or F
True
53
1 gram of protein is ___ g of nitrogen
0.16 g of Nitrogen (4kcal)
54
If cholestatic, which trace element must be reduced and what to keep
Reduce Mn and Cu Keep Selenium (Se) and Chromium (Cr)
55
If renal dysfunction, what trace element to omit
Selenium (Se) and Chromium (Cr) to omit.
56
fat in human milk
- Fat provide 50% of calories in human milk - > 98% of fat in human milk is TG - made in mammary glands from **medium chain fatty acid and LCFA** - Oleic acid and Palmitic acid (most abundant FA) - High proportions of the essential FA’s (linoleic and linolenic acid) and of other LCPUFA’s (ARA, DHA) are also present (LCPUFA’s are constituents of brain and neural tissue and are needed early in life for mental and visual development) - human milk has more LCFA compares to cow's milk
57
what other CHO is contained in human milk
**oligosaccharides** growth factors for intestinal microflora (B. bifidum, etc) may alter cellular bacterial adhesion to intestinal epithelial cells.
58
What pass placenta by simple diffusion?
O2, CO2, lipid fat soluable multivitamin Na, Cl H2O most medications
59
What pass placenta by facilitated diffusion?
Glucose Cephalexin
60
What pass placenta by active transport ?
Amino Acids Ca, Phos, Mg, Fe, Iodine H2O soluble Vitamin
61
What pass placenta by Pinocytosis/endocytosis
IgG some other proteins
62
What pass placenta by Bulk flow
H2O, dissolved electrolytes ? importance
63
Other components of human milk are
- Hormones (cortisol, epidermal GF) - Colostrum - Lmphocytes, macrophages, IgA, - limited cholesterol, phospholipids, lots of TG - enzyme (bile salt-dependent lipase) - cholesterol (precursor of bile salts and steroid hormones) - carnitine
64
Comparing to cow's milk, mature human milk is low in what electrolytes/other? is high in what?
Low in Na, Ca, K, Cl, Mg, Phos. low in protein Human milk is high in Fe, Lactalbumin, Whey protein. Colostrum is in higher protein than mature BM.
65
two major forms of iron
functional vs. stored Functional: heme iron (hemoglobin and myoglobin) Stored: ferritin and hemosiderin --> can mobilize when iron intake is low.
66
Four factors determine Fe requirement
1. expansion of RBC mass with growth 2. ^ in tissue Fe for enzymatic process 3. expansion of Fe storage pool (not until 7-18 m PMA) 4. Compensation of Fe losses in stool
67
% of Fe absorption from human milk
50% (perterm infant 33%) content of Fe in human milk = same as non-Fe-fortified formula. But human milk Fe much better absorbed.
68
Vitamin K deficiency
Hemorrhagic disease of newborn.
69
Vitamin A deficiency Vitamin A's other name
Retinol BPD, abnormal epiphyseal formation and tooth enamel photophobia and conjunctivitis generalized scaling
70
Vitamin B1 deficiency (also B1's other name)
Thiamine Assoc w/ Pyruvate Dehydrogenase complex deficiency, MSUD, beriberi (fatigue, irritablity, constipation, cardiac failure)
71
Vitamin B2 deficiency (B2's other name)
Riboflavin FTT, dermatitis, mucositis, photophobia, blurred vision Assoc w/ Glutaric aciduria Type I
72
Vitamin B6 deficiency (B6's other name)
Pyridoxine Dermatitis, mucositis, seizures; hypochromic anemia Assoc w/ homocysteinuria
73
Vitamin C deficiency (C's other name)
Ascorbic acid Poor wound healing, Assoc w/ transient tyrosinemia
74
Vitamin D deficiency
Osteopenia/rickets, FTT, tetany
75
Biotin Deficiency
Dermatitis, scaling, dermatitis, seborrhea Assoc w/ biotinidase def., propionic acidemia, pyruvate dehydrogenase complex def., B-methylcrotonyl glycinuria
76
Vitamin B12 and Folic acid (folate) deficiency (B12 is aka)
B12 = Cobalamin - Folate deficiency in infant fed goat's milk or evaporated milk - B12 deficiency in breast fed infants of vegetarian mother who don't ingest egg or diary. megaloblastic macrocytic anemia Assoc w/ methylmalonic acidemia & homocystinuria co-exist with iron deficiency
77
Vitamin E deficiency (E is aka)
Alpha-tocopherol Vitamin E is an anti-oxidant, given with iron administration to prevent iron-induced hemolysis increased sensitivity of RBC to H2O2 and hemolysis anemia, reticulocytosis, thrombocytosis, acanthocytosis neurological deficits
78
Chromium
insulin metabolism. (remove from TPN if poor renal fxn, but keep if TPN cholestasis)
79
Copper
RBC production and Hb formation. in deficiency: **anemia, neutropenia**, osteoporosis Depigmentation of hair and skin poor weight gain, hypotonia, ataxia later in life
80
Manganese
enzyme activation, important for normal bone structure. CHO metabolism. clinical effect of deficiency is unknown.
81
Selenium
cofactor in glutathione peroxidase (rbc membrane stabilization versus oxidative stress) in deficiency: cardiomyopathy
82
Zinc
enzyme component, important for growth Deficient in **acrodermatitis enteropathica** (AR). Deficiency causes **FTT, alopecia, diarrhea, perianal dermatitis**, nail hypoplasia. Preterm with poor wt. gain, malabsorption, poor wound healing. Maternal deficiency can cause IUGR/anomalies or preterm infant receiving inadequate zinc.
83
Schwartz equation
= k x Height (cm) / Serum Cr = GFR (ml/min/1.73 m2) Term k=0.45 Preterm k=0.33
84
Plasma Osmolality
2 [Na] + [Glucose] / 18 + [ BUN ] / 2.8
85
Creatinine clearance
Urine Cr x V (ml/min) / Plasma Cr
86
Tubular reabsorption of phosphorus (TRP)
1 - [(Urine Ph x Plasma Cr) / (Urine Cr x Plasma Ph)] x 100
87
colostrum is high
high in **protein, whey protein, fat**, Also high in (but less critical/tested) lactalbumin Na, K, Cl. Fe (not too much) low in Ca (slightly)
88
Na deficit calculation
0.6 x wt (kg) x (desired Na - current Na)
89
Free water deficient calculation
4ml/kg x weight (kg) x (Na now - desire Na)

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