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Flashcards in nutrition/fluids Deck (187):
1

What is the other name for vitamin E?

Tocopherol

2

What is the other name for vitamin K?

Phylloquinone

3

What is the other name for vitamin b1?

Thiamine

4

What is the other name for vitamin B2?

Riboflavin

5

What is the other name for vitamin B3?

Niacin

6

What is pantothenic acid?

Vitamin B5

7

What is pyridoxine ?

Vitamin B6

8

What is the vitamin name for folate?

Vitamin B9

9

What is another name for vitamin B12?

Cyanocobalamin

10

What is the formal name for vitamin C?

Ascorbic acid

11

What can intoxication of vitamin A cause?

Pseudo tumor cerebri

12

What is the most common cause of blindness in young children worldwide?

Vitamin A deficiency

13

What can retinol deficiency cause?

Xerophthalmia (dry eyes)
Nyctalopia (night blindness)
Complete blindness

14

What is the cause of beri beri?

B1 deficiency

15

What are the symptoms of beri beri?

Mental confusion
Peripheral paralysis
Muscle weakness
Tachycardia
Cardiomegaly

16

Who is at risk for riboflavin deficiency?

Premies on phototherapy

17

What are the 3 typically symptoms of vitamin B2 deficiency?

Anemia, angular stomatitis, seborrheic dermatitis

18

What can occur with niacin toxicity?

Vasodilation

19

What are the symptoms of vitamin B3 deficiency?

Dermatitis, diarrhea and dementia = pellagra

20

What symptom is associated with vitamin b6 toxicity?

Neuropathy

21

What are symptoms of vitamins b6 deficiency?

Swelling if tongue and rash

22

What are symptoms of vitamin b9 deficiency?

Larger tongue and macrocytic anemia

23

What is one symptom of vitamin B9 toxicity?

Irritability

24

What are symptoms of vitamin b12 deficiency ?

Macrocytic anemia

25

What symptoms occur with vitamin c deficiency?

Leg tenderness
Poor wound healing
Bleeding gums

26

What type of crisis can be triggered by calcium toxicity?

Hemolytic crisis in a patient with G6PD deficiency

27

What are symptoms of vitamin E deficiency in premies?

Hemolytic anemia

28

What are symptoms of vitamin E deficiency?

Neuropathy
Muscle weakness
Peripheral edema
Thromocytosis

29

What are the vitamin K dependent factors?

2,7,9 and 10

30

What increases risk of hemorrhagic disease in a newborn?

Vitamin k not given
Breast feeding

31

What treatment is appropriate in a patient with hemorrhagic disease of the newborn if bleeding actively?

Vitamin K + FFP

32

What is the physiological effect of vitamin D toxicity?

Mobilization of calcium and phosphorus from bones and deposition into soft tissue

33

How is vitamin d toxicity managed?

Hydration
Corrections of Na and K depletion
LASIX

34

What metabolic disturbances occur Due to excessive vitamin D?

Hypercalcemia
Hyperphosphatemia

35

What are some symptoms of vitamin D toxicity?

Polyuria
Poly displays
Elevated BUN
Kidney stones
Renal failure

36

What is the other name for ergocalciferol?

Vitamin D2

37

What is the other name for cholecalciferol ?

Vitamin D3

38

What is the other name for activated calcitriol?

1,25 hydroxycalciferol

39

What are the lab findings used to diagnose rickets?

Low 25OH vitamin D
High PTH
Alkaline phosphatase elevated
Calcium and phosphorus may be normal

40

What are the findings in the physical exam of the head in a patient with rickets?

Craniotabes (delayed fontanel closure, skull thickening, frontal bossing, poor tooth enamel)

41

What occurs in the extremities secondary to rickets?

Wide physes of wrists and ankles
Femoral / tibial bowing

42

What occurs on the trunk in patients with rickets?

Pigeon chest, rachitic rosary

43

Other than lack of adequate sunlight, what could cause rickets?

Chronic liver disease causes decreased vitamin D absorption due to low bile salts

44

What is caused from zinc deficiency?

Acrodermatitis enteropathica

45

What is caused by copper deficiency?

Menkes kinky hair

46

Where is 25-OH vitamin D hydroxylated?

Liver

47

Where is 1,25 OH vitamin D hydroxylated?

Kidneys

48

How many kcal are required for a preterm and full term infant per day?

Both require 100-120kcal/kg/day

49

What is the appropriate protein requirement for a premature infant and term infant ?

3,5 g/kg per day (preterm)
2.5 g/kg per day (term)

50

What are 4 important components of renal solute load?

Sodium, potassium, chloride and phosphorus

51

What is an essential fatty acid?

Linoleic acid

52

What is the recommended concentration of iron in iron fortified formula?

12mg/L

53

When should iron supplementation occur?

4-6 months old
Also before 6 months in high risk (LBW, preterm)

54

What should you do for a child on iron supplements who develops constipation?

Add fruit juice to increase osmotic load - iron does NOT cause constipation

55

What is the definition of milk protein allergy?

IgE mediated response that can cause rash, vomiting and irritability

56

What is milk intolerance?

Non igE mediated response to milk to can cause rash or vomiting

57

What is the difference between lactose intolerance and milk protein allergy?

Lactose intolerance does not cause rash or vomiting

58

What is Fpies?

Food protein induced enterocolitis syndrome / non igE mediated protein intolerance

59

How does FPIES present?

Within first 3 months with heme positive stools

60

What is the treatment for FPIES?

Switch to protein hydrosylate formula or eliminate milk protein from mothers diet

61

What symptoms may be seen with deficiency of essential fatty acids?

Scaly dermatitis, alopecia and thrombocytopenia

62

How do you treat fatty acid deficiency?

IV lipids

63

What should you consider in an infant recently weaned from breast milk with facial dermatitis and thin hair?

Zinc deficiency

64

What might be the diagnosis in an infant with dry skin, poor wound healing perioral rash?

Zinc deficiency

65

How do newborns absorb fat?

They have decreased bile acids and can not absorb long chain triglycerides

66

In terms of total triglycerides, what is the difference between premie formula and breast milk?

Premie formula has 50% medium chain triglycerides and breast milk has 12% plus high linolenic acid

67

How does TPN affect bone demineralization ? What labs would be abnormal?

Inadequate phosphorus due to prolonged TPN >1 month (May have normal calcium and phosphorus levels but high alkaline phosphatase)

68

What is higher in colostrum than in mature breast milk?

Arachidonic acid
DHA
Zinc
Protein ( immunoglobulins )
Enzymes to increase digestion
Carotene

69

Which type of breast milk is highest in fat?

Hind milk ( end of feeding )

70

What essential vitamin is low in colostrum? Why is this important ?

Ergocalciferol ( increases risk for rickets)

71

What can happen to an infant placed on cows milk prior to age one? Why?

Hypocalcemia - cows milk has significantly high phosphorus which leads to low calcium

72

What 6 drugs are contraindications to breast feeding?

Metronidazole
Diazepam
Thyroid meds
Chemotherapy
Sulfonamides
Tetracycline

73

What 4 medical conditions would be contraindicated for breast feeding?

Tb
Cmv
HIV
Errors of metabolism (in baby)

74

What are 4 conditions that ARE NOT contraindications to breast feeding?

Mastitis
Candidiasis
Contact dermatitis
Fibrocystic breast disease

75

What is the whey to casein ratio in breast vs cows milk?

Breast: 70% whey, 30% casein
Cows milk: 20% whey, 80% casein

76

What is the difference between iron I'm breast milk vs formula?

Breast milk is lower in iron but has higher absorption

77

What is the difference between protein concentration in breast milk vs formula ?

0.9 g in breast milk
3.5 g in cows milk formula
1.4 g in modified formula

78

What is so special about the whey protein in breast milk?

It has alpha lactalbumin, lactoferrin, lysozyme and IgA

79

Are vitamins and minerals higher or lower in breast milk when compared to formula?

Minerals

80

What is the difference in renal solute load in breast milk vs cows formula?

Lower renal solute load in breast milk

81

How many calories are in one ounce of formula? And how many mL of formula are in one ounce?

20kcal per oz
30 ml per oz

82

What can happen if you mix too much powder formula with a given amount of water ?

Increased protein stresses the kidneys

83

What is the max caloric content of formula?

30kcal/oz

84

What may happen if you add a lipid supplement to formula?

Diarrhea or delayed gastric emptying

85

Why are non-protein calories important in very low birth weight infants?

To avoid negative nitrogen balance from high proteins

86

What is the average daily weight gain for a full term newborn?

20-30grams per day

87

What is the average daily weight of a premie?

15-20 grams per day

88

What is the term "overweight " defined as?

BMI between 85-95th %

89

What are the chances that an obese 6 year old will be obese as an adult?

25% chance

90

What is the difference between an obese child secondary to overeating vs a hormonal reason?

If overeating, will usually be tall with advanced bone age
If hormonal problem, will usually be short with delayed bone age

91

What syndromes should you consider in a child who is obese with small hands, hypogonadism and delayed development?

Prader Willi or Bardet Biedel

92

What can occur in a child who drinks many diet sodas?

High risk for osteopenia due to high phosphoric acid

93

What should you beware of in a child taking goats milk?

Folate deficiency

94

What should breast feeding mothers who are vegan taken as a supplement?

Vitamin B12

95

What is the term for protein deficiency?

Kwashiorkor

96

What are physical signs of protein deficiency?

Pitting edema, rash, thin hair, pallor

97

What term describes general nutritional deficiency?

Marasmus

98

What are physical signs of marasmus?

Muscle wasting but no edema
Normal hair

99

What is the most common cause of NG feeds?

Diarrhea

100

What is the most severe complication of NG feeding?

vomiting and aspiration

101

How do you supply adequate nutrition in a child with heart failure ?

High caloric density while restricting fluids ( increase formula concentration)

102

How do you manage nutrition in a child with renal disease?

70% of calories should be carbohydrates. Lipids <20% and protein <2g/kg/day, with low phosphorus

103

How should you manage a child who presents with vomiting and diarrhea with mild dehydration ?

Oral rehydration and regular diet

104

Calculation for serum osmolality...

2 x Na + BUN/2.8 + glucose/18

105

What is the formula to correct acid bicarb for metabolic acidosis?

Weight x 0.3 x base deficit

106

How can you determine metabolic acidosis vs alkalosis from looking the bicarb ?

Bicarb > 25 = alkalosis
Bicarb < 25 = acidosis

107

How can you determine respiratory alkalosis vs acidosis by looking at the abg ?

PCO2 > 40 = resp acidosis
PCO2 < 40 = resp alkalosis

108

What medications can cause metabolic alkalosis?

Loop and thiazides diuretic s

109

How does the body compensate for metabolic alkalosis?

Hypoventilation

110

What ph and co2 levels do u expect to see in a patient with incomplete compensation for metabolic acidosis?

Low ph and low co2

111

What steps should you take to initially treat metabolic acidosis?

Adequate ventilation
Isotonic fluids
Sodium bicarb if severe (ph<7.1)

112

How does pyloric stenosis cause acid base imbalance?

Vomiting leads to low hydrogen and chloride --> bicarb reabsorption and metabolic alkalosis

113

What acid base inbalance occurs with hypoxia?

Hyperventilation leads to low co2 and alkalosis --> kidneys excrete bicarb to compensate

114

What diuretics can cause metabolic acidosis?

Acetal planned and spironolactone

115

What is the most common cause of non-gap metabolic acidosis in children ?

Diarrhea

116

What are three main causes on acidosis of normal anion gap?

Loss of bicarb (diarrhea, kidney dysfunction)
Addition of hydrochloric acid
Renal tubular dysfunction

117

What is the pathophysiology of distal tubular acidosis?

Inability of distal tubule to excrete H+ and acidify the urine --> ph >5.5

118

What can mimick RTA type 1?

Potassium sparing drugs (spironolactone)

119

What can mimick RTA type 2?

Carbonic anhydrase inhibitors like acetazolamide

120

What is the pathophysiology of Proximal RTA?

Inability of proximal tubule to absorb bicarb which leaves high bicarb in urine

121

Where does reabsorption of bicarb occur?

Proximal tubule

122

Between RTA type 1 and 2, which is distal and which is proximal?

Type 1 = distal
Type 2 = proximal

123

Where does secretion of hydrogen occur in the kidneys?

Collecting duct

124

What causes type 4 RTA?

Aldosterone resistance (deficiency) causing hyperkalemia

125

What are the conditions associated with elevated anion gap metabolic acidosis ?

MUDPILES = methanol, uremia, dka, paraldehyde, iron/INH, lactic acid, ethanol/ethylene glycol and salicylates

126

What should you consider in an infant who appears healthy at birth but later develops poor feeding, lethargy and seizures?

Inborn error of metabolism - organic acidemia

127

What condition causes high ammonia but no metabolic acidosis?

Urea cycle defects

128

What occurs With volume on a cellular level when there is hypernatremia?

If high sodium, water is dawn out of intracellular compartment into the extra cellular space causing increased volume

129

In a child with diabetes insipidus, what is the serum and urine osmolality?

High serum osmolality but dilute urine

130

How is nephrogenic diabetes insipidus transmitted?

X linked - only in males

131

What is the best study to order in order to determine which type of hyponatremia a patient has?

Fractional excretion of sodium

132

With diabetes insipidus, do you get high or low sodium?

High sodium

133

What may occur to sodium if there is excessive GI losses?

Hyponatremia--> Kidneys retain sodium --> low urine sodium (<10)

134

What is the cause of hyponatremia secondary too increased water retention ?

SIADH

135

What will the urine in a child with siadh be like?

High osmolality (>300) and high sodium (>25)

136

What is the first treatment of siadh?

Fluid restriction

137

What are the serum sodium and potassium levels in a child with siadh?

Low Na, normal K

138

What are the 5 main causes of SIADH?

Surgery
Infection
Pulmonary disorder
Endocrine disorder
Neurological disorder

139

What are two potential medications for SIADH?

Demeclocycline (only if >8y/o)
Lithium
A

140

What is the initial step in a hemodynamically unstable child with low urine output?

Isotonic fluid bolus 20/kg

141

What medication can cause siadh ?

Vincristine

142

How do diuretics affect sodium?

Thiazides and metolazone both block renal sodium reabsorption causing hyponatremia

143

What is dilutional hyponatremia? What lab findings are common?

Water intoxication
Sodium is NORMAL
Urine Na is high

144

How does third spacing occur after extensive surgery?

Endothelial damage / leakage
Hypoalbuminemia and low oncotic pressure

145

What happens to sodium levels with third spacing?

Low urine sodium (<10)
Edema
Hyponatremia

146

What is the measures and total body sodium in conditions with edema due to low oncotic pressure (ie. nephrotic syndrome)?

Measured sodium is low BUT total body sodium is actually high

147

What are some classic symptoms of hypokalemia?

Muscle pain, weakness, paralysis
Constipation, ileus, polyuria

148

What are the 3 main causes of hypokalemia?

Poor intake
Gi losses
Renal losses

149

If a child comes to your office with 3 days of vomiting and is weak, what should you consider?

Hypokalemia

150

What are 4 possible EKG findings secondary to hypokalemia ?

Flattened T waves
ST depression
PVC
U wave

151

How do you treat hypokalemia in an emergency situation?

KCl 1 mEq/L over an hr (max 40)

152

If mild hypokalemia and dehydration, what is the appropriate management?

Fluid replacement with added K

153

If hypokalemia in a child with acidosis, what should you treat with?

Potassium acetate

154

What electrolyte abnormality causes prolonged QT interval?

Hypocalcemia and hypomagnesemia

155

What are 4 main causes of hyperkalemia?

Excess intake
Renal failure
Acidosis (redistribution)
Cell breakdown

156

What is the common EKG finding with hyperkalemia?

Peaked T waves
If K>10...absent p waves, wide QRS

157

What should you consider in a patient with wide QRS with muffled heart sounds or absence of pulses?

Hyperkalemia (severe)

158

How do you treat severe hyperkalemia in a patient showing signs of electromagnetic dissociation (distant heart sounds, non palpable pulses)?

Immediate IV calcium chloride

159

What 5 options can you use to treat mild hyperkalemia?

Glucose + insulin
Sodium bicarb
Albuterol
LASIx
Oral polystyrene resin

160

What happens to potassium during alkalosis?

H+ moves extracellular to compensate but then K+ moves into the cell causing low serum K

161

What happens to potassium levels during acidosis?

H+ moves into the cell and K+ moves into extra cellular fluid causing high measured K

162

What two lab findings would you find in a patient using loop diuretics?

Hypokalemia
Alkalosis

163

What is the equation for FeNa?

Urine Na / serum Na
Divided by
Urine creatinine / plasma creatinine

164

What is a low FeNa value and what does it indicate?

<1.5
Pre renal azotemia

165

When is hypertonic 3% saline indicated ?

In severe hyponatremia, after normal saline given with no improvement

166

What could be the diagnosis in a patient with dehydration that was rehydrated with water?

Hyponatremia dehydration (sodium <135)

167

What type of electrolyte disturbance can lead to cerebral pontine Damage?

Hyponatremia

168

Which type of electrolyte disturbance leads to tearing of bridging blood vessels and intracranial hemorrhage?

Hypernatremia which causes fluid shift to the extra cellular space and shrinkage of brain cell

169

What is the treatment for hypernatremia >170?

Assume 10% dehydration and slowly correct sodium over 48-72 hours at a rate of 0.5mEq/L/hr

170

What clinical findings would be seen in a patient with hypernatremic dehydration?

Doughy skin, irritable, high pitched cry, seizures

171

What is the equation for replacing low sodium?

Desired minus measured sodium x kg x 0.6 plus maintenance (3meq/kg/d)

172

What are the signs associated with 5% dehydration?

Tachycardia
Decreased tears
Decreased urine output

173

How do you correct 5% dehydration?

50ml/kg + maintenance
Give half over 8 hours and remainder over 16 hours

174

What are signs of 10% dehydration?

Tachycardia
Sunken eyes
Poor skin turgor
Sunken fontanelle

175

How do you treat 10% dehydration?

NS bolus then
100cc/kg + maintenance over 24 hours

176

What is the max you can decrease the sodium level in a 24 hr period? Why?

10-12
To avoid cerebral swelling

177

What are signs of 15% dehydration?

Shock and delayed cap refill

178

What is the treatment of 15% dehydration?

NS bolus (repeat until improvement)
Over 24 hours give maintenance plus 150ml/kg

179

When is oral rehydration fluid used? What does this have and how should it be given?

If moderate to severe dehydration
75 mEq/L of sodium
Give 50 ml/kg over 1-4 hours

180

What is the classic electrolyte disturbance in pyloric stenosis ?

Hypochloremic hypokalemic metabolic alkalosis

181

What happens to the urine electrolytes with pyloric stenosis?

Kidneys retain chloride causing urine chloride <10

182

What is the common electrolyte disturbance associated with cystic fibrosis?

Hypochloremic hyponatremic metabolic alkalosis and dehydration

183

What is important to remember about post-op fluid management ?

Increased risk for increased ADH secretion and over hydration

184

What is similar and different between SIADH and hyponatremic dehydration?

Both have low sodium and chloride but dehydration gives high BUN

185

What's the difference and similarity between diabetes insipidus and hypernatremic dehydration?

Both have high sodium and chloride and BUN.
Hypernatremic dehydration have high specific gravity but diabetes insipidus has low specific gravity

186

What do you do if lab findings show low sodium <120 and normal chloride ?

Repeat lab (lab error)

187

What is another name for vitamin A?

retinol