Response to Injury, Fluids and Nutrition Flashcards
(27 cards)
Daily Requirement of Fluid
1500mL - 2500mL or 25-30 mL/kg
most common cause of volume deficit in surgical patients
loss of GI fluids
Formula for Anion Gap:
What is the normal value?
AG = Sodium - (Chloride + HCO3)
Normal value = <12 mmol/L
Causes of High Anion Gap Metabolic Acidosis
MUDPILES
methanol
uremia
DKA
propylene glycole, paraldehyde
isoniaizid, infection, iron
lactic acidosis
ethylene glycol
salicylates
Causes of Normal Anion Gap Metabolic Acidosis
HARD UP
hyperalimentation
acetazolamide
renal tubular acidosis
ureteroenteric fistula
pancreaticoduodenal fistula
In hypocalcemia, neuromuscular and cardiac symptoms do not occur until at what level of calcium?
Ionized fraction falls below 2.5 mg/dL
Symptomatic hyponatremia does not occur until sodium is at?
120 mg/dL
Treatment for symptomatic and asymptomatic hyponatremia.
Symptomatic: 3% normal saline running no more than 1 mEq/L until it reaches 130mEq/L or symptoms are improved
Asymptomatic: correction should be no more than 0.5 mEq/L to a maximum increase of 12 mEq/L/d
ECG changes in hyperkalemia
high peaked T waves
widened QRS complex
flattened P waves
prolonged PR interval
Treatment for hyperkalemia
when ECG changes are present: calcium chloride or calcium gluconate
kayexalate - cation exchanges resin
Treatment for hypokalemia
mild asymptomatic: oral repletion
KCL 40mEq per enteral access x 1 dose
asymptomatic hypokalemia: not tolerating enteral nutrition: KCl 20mEq IV q2h x 2 doses (slow infusion)
IV repletion: usually no more than 10 mEq/h
What is the formula for Modified Broca?
Men: 110 lbs (50kg) for the first 5ft (152 cm) then add 5 lbs (2.3 kg) for each additional inch (2.54cm)
Women: 100 lbs (45 kg) for the first 5 ft then add 5 lbs (2.3 kg) for each additional inch (2.54cm)
Formula for BMI
weight in kg / (ht in m) squared
Harris Benedict equation
Female BEE:
665.10 + (9.56 x W) + (1.85 x H) - (4.68 x A)
Male:
66.47 + (13.75 x W) + (5 x H) - (6.76 x A)
where
W = actual weight in kg
H = height in cm
A = age in years
estimated protein maintenance requirement for non stressed patients
0.8 - 1 g/kg/day
Formula for Protein Requirement
Protein(g) = total kcal x (g Nitrogen/ 150 kcal) x (6.25g Protein/ g Nitrogen)
Basal caloric requirement of a normal healthy adult
20-30 kcal/kg per day
Phases of Surgical Metabolism:
characterized by reconstruction of body’s normal tissue perfusion and efforts to protect homeostasis
Ebb Phase
Phases of Surgical Metabolism:
Decrease in total body energy and urinary nitrogen excretion
Ebb Phase
Phases of Surgical Metabolism
provides compensating response to the initial volume replacement
Catabolic Phase
Phases of Surgical Metabolism
Replacement of lost tissue
Anabolic Phase
Identify the phases of surgical metabolism:
1. 24-48 hours
2. 1-2 weeks
3. months
- Ebb Phase
- Catabolic Phase
- Anabolic Phase
Identify the energy source for the following
1. short term fasting <5 days
2. prolonged fasting
3. after injury
- muscles < lipids
- ketone bodies
- lipids
Indications for Parenteral IV Nutrition (4)
- Inability to absorb adequate nutrients via GI tract like massive short bowel resection, radiation enteritis, severe diarrhea, untreatable steatorrhea/malabsorption
- complete bowel obstruction or intestinal pseudo-obstruction
- severe catabolism with or without malnutrition when GI tract not usable within 5-7 days
- inability to obtain enteral access
