Protein / Energy Nutrition

Question 1

What are estimated calorie requirements for hospitalized patients?

Answer 1

22-25 kcal/kg/day for relatively well patients

30-32 kcal/kg/day for very sick patients

Question 2

How do you estimate daily protein requirements for hospitalized patients?

Answer 2

g Nitrogen excreted in 24 hour urine x 6.25 = # grams protein broken down in 24 hours

0.8-1.0 g/kg/day

Question 3

Special feeding considerations - Respiratory Failure

Answer 3

Overfeeding causes increased O2 demand as the body tries to burn all of the nutrients via oxidative phosphorylation; increased O2 demand leads to increased CO2 production and need for more ventilation

Higher fat / less calories may be beneficial

Question 4

Special feeding considerations - Liver failure

Answer 4

Patients with liver disease may develop hepatic encephalopathy due to high levels of ammonia in the blood as a result of an inability of the hepatocytes to incorporate ammonia into urea; patients may develop ascites due to water/salt retention

Lower aromatic AA / higher branched chain AA may be helpful

Question 5

Special feeding considerations - Renal Failure

Answer 5

Kidney failure leads to increased blood urea nitrogen (BUN) produced by protein catabolism

Question 6

Special feeding considerations - Cardiac Failure

Answer 6

Patients with CHF who are at risk of fluid overload may require Na+ restriction < 2g/day

Typical ‘cardiac’ diet is fat, sodium, saturated fat, and cholesterol restricted

Question 7

D5 glucose

Answer 7

5% glucose in water

5g glucose / 100 mL generally administered at 1.2L / day for a total of 60g/day glucose, or 240kcal / day

Question 8

Re-feeding Syndrome

Answer 8

Patients who are malnourished with significant weight loss or who have had a prolonged period of poor nutrition are at risk

Complications: Hypkalemia, diarrhea, Wernicke’s encephalopathy (acute thiamine deficiency)

Begin with thiamin, folate, and multivitamin solution IV; begin feeding slowly and monitor electrolytes

Question 9

What are the 2010 U.S. Dietary Guidelines for sodium consumption?

Answer 9

< 2,300 mg/day for most individuals

< 1,500 mg/day for people over age 51 and those with HTN, DM, or chronic kidney disease

Question 10

What are the 2010 US Dietary Guidelines for saturated fat consumption?

Answer 10

< 10% of calories/day from saturated fatty acids; replace with mono and poly unsaturated fats

Question 11

What are the 2010 US Dietary Guidelines for cholesterol consumption?

Answer 11

< 300 mg/day dietary cholesterol