Study Flashcards
(293 cards)
1
Q
Steps to treat hyperemesis gravidarium
A
- IVF with multivitamins and B vitamins
- antiemetics
- avoidance of PO
- EN if unable to take PO after 24-48 hrs
- PN if EN trial failed
2
Q
failed EN trial for hyperemesis is
A
- n/v/d exacerbation
- significant gastric residuals
- tube displacement
- associated with >5% weight loss
3
Q
Infusion of phosphate should not exceed
A
7 mmol/hr
can cause thrombophlebitis and metastatic calcium-phosphate deposition with potential of organ dysfunction
4
Q
most common complication with PN administration
A
hyperglycemia
5
Q
cause of hyperglycemia in the stressed patient
A
increased insulin resistance
increased gluconeogenesis and glycogenolysis
suppressed insulin secretion
6
Q
glycemic target for critically ill adult
A
140-180 mg/dL
110-140 in some cases if can be safely achieved
<110 not recommended due to adverse effects of hypoglycemia
7
Q
components of basal-bolus regimen
A
o Basal insulin
o Nutritional component prior to meals
o Correctional insulin
8
Q
Glutamine dipeptides in parenteral solutions improve…
A
Improve water solubility
Improve stability during heat sterilization
Improve capability for prolonged shelf life
9
Q
is free glutamine stable in PN
A
no
10
Q
is parenteral or enteral glutamine more beneficial
A
parenteral - enteral is protein bound and difficult to determine exact content
11
Q
factors associated with PN prescribing errors
A
o Inadequate knowledge regarding PN therapy
o Certain patient characteristics – ex. age, impaired renal fnx
o Miscalculation of PN dosages
o Specialized PN dosage formulation
o Prescribing nomenclature
12
Q
how to order PN ingredients
A
o Amounts/day for adults
o Amounts/kg/day for pediatric and neonatal
o Limits confusion of conversion from amounts/L, % concentration, and volume
13
Q
High output fistula is
A
> 500 ml/day
14
Q
Is PN routine in Chron’s
A
no
15
Q
preferred nutrition intervention in acute pancreatitis
A
EN
16
Q
When to use PN in burn patients
A
only if unable to feed enterally
linked with increased mortality
17
Q
when may an adult cancer patient benefit from PN preoperatively
A
when severely malnourished and the therapy is to continue 7-10 days postoperatively
18
Q
PICC
A
a catherter inserted via peripheral vein whose distal tip lies in the vena cava
o Cephalic or basilic vein is often the insertion site
19
Q
PICC disadvantages
A
High rate of malposition
Limited arm mobility
Limited ability to perform daily self-care due to availability of only one hand
20
Q
PICC advantages
A
No risk of pneumothorax
Available as double, single, triple lumen
Does not require repeated skin puncture
21
Q
CDC recommendations regarding PICCs
A
Do not routinely place to prevent infection
Catheter replacement at scheduled intervals has not shown decrease in catheter related infections
Catheter insertion with guidewire is associated with less discomfort and mechanical complication
• Replacement during bacteremeia should not be done over a guidewire
Remove PICC only if it is suspected or known to be the source of the infection
22
Q
central line
A
catheters with the distal tips in either the superior or inferior vena cava
23
Q
common complication of bedside central line placement
A
misplacement including pneumothorax
24
Q
when can you start infusion after central line placement
A
immediately if placed with fluoroscopy
if not must radiographically confirm first
25
can you auscultate to confirm central line tip placement
no
26
Institute for Healthcare Improvement central line bundle
Group of evidence-based interventions that results in better outcomes when implemented together
Recommends avoiding central venous access devices with high risk for infection, such a femoral catheters, when other access is available
27
preferred central line site
subclavian
28
peripheral line osmolarity
up to 900 mOsm/L
29
osmolarity of 10% dextrose
500
30
osmolarity of 3% amino acid
300
31
1 g AA contributes how much osmolarity
10 mOsm
32
1 g dextrose contributes how much osmolarity
5 mOsm
33
how does increased amino acid affect calcium phosphate precipitation
reduces risk by forming soluble complexes with calcium reducing free calcium ions available and lowers pH improving calcium phosphate solubility
34
does CaCl or calcium gluconate dissociate more readily
CaCl
35
Increased temp affect on dissociation of calcium salts
increases dissociation increasing risk of precipitation
36
in what order should Ca and Phos be added to reduce risk of precipitate
phos first and ca near end - not back to back
37
when does calcification occur in pn
serum calcium level multiplied by serum phos level exceeds 55 mg/dl
38
when are branched chain amino acids indicated in encephalopathy
o Only indicated in chronic encephalopathy for those who cannot tolerate at least 1 gm/kg/day of standard protein despite optimal phamacotherapy
39
EFAD may be caused by
Failure to provide at least 2-4% of total caloric intake as linoleic acid and 0.25-0.5% as alpha linolenic acid may lead to deficiency
40
adult lipids to prevent EFAD
500 mL 10% or 250 ml 20% twice weekly
500 ml 20% once weekly
41
infant lipids for EFAD prevention
05-1 g/kg/day
42
lab to test for EFAD
triene to tetraene ratio >0.2
43
EFAD can occur within ___ of exclusive PN without fat emulsion
1-3 weeks
44
lipid infusion rate in adults
no more than 0.11 gm/kg/hr
45
lipid infusion rate in children
no more than 0.15 gm/kg/hr
46
lipid infusion rate in neonates
no more than 0.17 gm/kg/hr
47
is 10 or 20% lipid emulsion better
20%
| allows more efficient triglyceride clearance
48
10% lipid emulsion is less ideal than 20% because
has increased phospholipid content which is associated with plasma lipid alterations
49
avoid triglyceride of
>400 in adults
| >200 in peds
50
physical mixture (lipids)
emulsion of two or more oils
51
structure lipid
created through hydrolysis of triglycerides and transesterification of fatty acids to form composite triglyceride molecule with various propotions of MCFA and LCFA
Advantage over physical mixture because slower rate of release and utilization of MCFA
52
what should be reduced in hepatobiliary disease PN due to impaired excretion
manganese
| copper
53
aluminum contamination from parenteral nutrition causes
aluminum toxicity
54
sources of PN aluminum contamination
Calcium and phosphate salts
Heparin
Albumin
o No clear evidence that insulin is source
55
daily aluminum should not exceed
5 mcg/kg/day
56
how is manganese excreted
90% via bile into feces
57
Manganese toxicity
can occur on long term PN
| accumulates in brain affecting CNS
58
monitor manganese by
MRI brain imaging
| erythrocyte or whole blood assessment (60-80% in RBCs)
59
what may increase risk of manganese toxicity
cholestasis and biliary obstruction
60
early phase of manganese toxicity
weakness
anorexia
headache
apathy
61
only transfer, measuring, and mixing manipulations with closed or sealed packaging systems performed promptly and attentively
low contamination risk
62
compounding PN using manual or automated devices with multiple injections, detachments, and attachments of nutrient source products to the device or machine to deliver to final sterile container
medium contamination risk
63
using nosterile ingreadient or nonsterile devices prior to terminal sterilization
high contamination risk
64
extemporaneously compounded L-glutamine for supplementation in PN formulation
high contamination risk
65
cracking - emulsion destabilization
small lipid particles coalesce to form large droplet
signs
• yellow brown oil droplets near TNA surface
• continuous layer of yellow-brown liquid at the surface
• marbling streaking of oil throughout
clinical danger
66
creaming - emulsion destabilization
occurs almost immediately once IVFE mixed with other chemical constituents
cream layer visible at surface as translucent band separate from remaining dispersion
common, not significant determinant of infusion safety except in extreme cases
67
PN CHO intake should not exceed
4 mg/kg/min
68
rapid infusion of phosphate can result in
tetany due to abrupt decrease in serum calcium concentration
69
metabolic alkalosis can be caused by
- NG suctioning
- volume depletion
- diuretic use
- excess acetate
70
markers of metabolic alkalosis
increased pH
normal PaCO2
increased serum bicarb
71
ex of metabolic bone disease
osteomalcia
osteoporosis
osteopenia
72
aluminum toxicity can cause what (in terms of bone health)
osteomalacia by...
• Impairing calcium bone fixation
• Inhibiting the conversion of vit d
• Reducing PTH secretion
73
aluminum toxicity is worsened by
renal insufficiency
74
most important contributor to metabolic bone disease
negative calcium balance
75
hypocalcemia occurs from
* Decreased calcium intake
| * Increased calcium urinary excretion
76
hypercalcemia occurs from
* Excessive calcium and inadequate phos supplementation
* Excessive protein in PN
* Cyclic PN infusion s
* Chronic metabolic acidosis
77
protein should not exceed what to help prevent hypercalcemia
o Ideally will not exceed 1.5g/kg/day
78
what is used to dx metabolic bone disease
bone mineral density
79
risk factors for metabolic bone disease
chron's
cancer
short bowel
hyperthryoidism
80
chron's contributes to metabolic bone disease because of
Malabsorption of Ca and vit D
| Use of corticosteroids
81
short bowel contributes to metabolic bone disease because of
renal wasting of Ca
82
PNALD is reduced by
o Cycling PN
o Supplementing with enteral
o Adding ursodiol
o Increasing omega 3:omega 6 ratio
83
3 basic types of hepatobiliary disorders associated with PN
steatosis
cholestasis
gallbladder sludging/stone
84
steatosis
```
• Mild elevation in
o Minotransferases
o Serum alkalin phosphatase
o Bilirubin concentraton
o Complication of overfeeding
```
85
cholestasis from PN is primarily in
children
86
cholestasis
* Impaired biliary secrection
* Elevation conjugated bilirubin levels, alkalin phos, gamma glutamyltransferase
* >2 mg/dL serum conjugated bilirubin is indicator
87
gallbladder sludging in PN is result of
lack of enteral stimulation
88
hypertonic hyponatremia
o Hyperglycemia causes shift of water out of cells into EC space, diluting serum sodium
not true sodium or water imbalance
89
for every 100 mg/dL increase in serum glucose above 100 mg/dL, serum sodium is expected to
decrease by approximately 1.6 mEq/L
90
causes of hyperglycemia in patient receiving PN
- CHO >4-5 mg/kg/min or 20-25 kcal/kg/day
- stress associated sepsis
- obesity
91
Develops when fibrin build up inside of vein causes the vascular access device to adhere to the vessel wall
mural thrombus
92
Layer of fibrin that develops around the outside of a central venous catheter secondary to aggregation of fibrin from the presence of a central venous catheter within a vein
fibrin sheath
93
fibrin sheath often results in
withdrawal occlusion
fibrin acts as a one-way valve
94
fibrin sheath is a
thombotic catheter occlusion
95
fibrin tail
Fibrin build up on the CVC tip
| Allows infusion through but prevents withdrawal of blood
96
intraluminal thrombus
Clot within the catheter lumen
Caused by inadequate flushing and blood reflux
Inability to infuse and aspirate without resistance
97
pinch off syndrome
Catheter is compressed between first rib and clavicle causing intermittent compression and pinching
pain relived by raising or lowering the arm
98
pinch off syndrome leads to
* intermittent occlusion of infusion and aspiration
| * increased risk of catheter fracture
99
treatment of pinch off syndrom
removal of catheter and reinsertion at more lateral position in subclavian vein or placement in internal jugular vein
100
central venous thrombosis
arm, shoulder, or neck swelling, limb, jaw, ear pain, dilated collateral veins over arm, neck, or chest
101
O.1N hydrochloric acid for clearing
• Crystalline occlusion because its acidic pH is favorable for calcium and phosphate solubility
102
sodium bicarb for clearing
• Precipitates associated with medication in high pH range such as tobramycin and phenytoin
103
70% ethanol for clearing
lipid reside
104
Groshong CVC
Three-position, pressure sensitive valve that restricts blood backflow and air embolism by remain closed when not in use
105
Groshong CVC eliminate
needs for heparin flushes for patency
should be flushed with NS after med admin or blood aspiration to ensure closed
106
Systematic approach to prevent unnecessary catheter removals and/or unnecessary instillationsof compounds to relive the catheter occlusion
Obtain thorough hx of signs/symptoms of catheter malfunction from patient
Double-check cather function for patency and blood aspitation
Check for mechanical causes and assess if occlusion nis related to postural changes
• Clamps, kinked tubing, tigh sutures
Obtain thorough hx of recent flushing techniques, medication ninfusion, and blood aspiration
Assess for physical signs of edema, redness, pain, or dilated vessels
107
refeeding
sodium retension
hypophosphatemia
hypokalemia
hypomagnesemia
108
Na retention in refeeding leeds to
fluid overload
pulmonary edema
cardia decompensation
109
hypophosphatemia in refeeding leads to
respiratory failure and seizures
110
hypokalemia in refeeding leads to
cardiac arrhythmias and neuromuscular effects
111
hypomagnesemia in refeeding leads to
cardiac arrhythmias and neuromuscular effects
112
Max PN components
o 30-40 ml/kg/day of fluid
o 7 gm/kg/day CHO
o 2.5 gm/kg/day fat
o 2 gm/kg/day protein
113
clinical exit site infection
Erythema, tenderness or purulence within 2 cm of catheter exit site
114
management of clinical exit site infection
* Culture of drainage
* Blood culture
* Topical antimicrobial agent if no purulence and no clinical signs of sepsis
* Systemic antimicrobial if purulenc is present or if topical is unsuccessful
* Removal if systemic fails or patient has clinical signs of sepsis
115
most common infection for tunneled central venous catheter
contamination of catheter hub
116
most common infection for nontunneled central venous catheter
extraluminal colonization of catheter or intraluminal colonization of hub and lumen
117
how to decrease risk of catheter-associated sepsis
Use of full-barrier precutions during catheter insertion
Skin prep with chlorhexidine
Avoid prophylactic use of antibiotic ointment at catheter exit site to not encourage resistant flora growth
No evidence that antibiotic prophylaxis reduces incidence
Do educate health care personelle on how to maintain
118
Malassezia furfur
Associated with superficial infections of the skin and associated sutures
Yeast
Cause of catheter-related blood stream infection
Most common in premature infants and patients receiving IVFE
119
treatment of Malassezia furfur
* Discontinue IVFE
* Remove catheter
* Antifungal therapy
120
refractory hypokalemia can be due to
hypomagnesemia due to accelerated renal potassium loss or impairment of Na-K pump activity
121
respiratory acidosis
o Decreased pH
o Elevated PaCO2
o Normal sodium bicarb
122
respiratory acidosis is related to
overfeeding
123
check blood glucose for diabetics getting PN
every 2-6 hours
124
max CHO infusion rate
4 g CHO/kg/min
125
how much insulin/gm dextrose
0.05-0.1 units
then increase by adding 2/3 previous days sliding scale insulin requirement
126
standard formulas are what % free water
85
127
osmolarity of gastric secretions
300 mOsm
128
osmolarity of 1 kcal/ml formula
300-350
| is istonic
129
osmolarity of 1.2 kcal/ml
400-450
130
osmolarity of 1.5 kcal/ml
500-650
131
osmolarity of 2 kcal/ml
700-800
132
nitrogen output
losses + 2 g for insensible losses
133
hold TF for abdominal distension when girth exceeds baseline measurement by
8-10 cm
134
NPH is
intermediate
135
NPH/regular is
intermediate
136
insulin glargine is
long acting
137
tube feeding syndrom
related to high protein TF without adequate fluid leads to azotemia, hypernatremia, and dehydration
138
EN formula label should contain
```
o Patient identifiers
o Product name
o Enteral access delivery site
o Administration method
o Time/date the formula was prepared and hung
```
139
optimal sodium concentration o fORS
90-120 mEq/L
140
gastric residual check
every 4 hrs for the first 48 hours
141
when to use promotility agents with GRVs
2 checks > or = 250 ml
142
do not introduce cows milk before
12 months
143
iron requirements in infants
2-4 mg/kg/day
144
increased intake of juice, soda, and SSB put children at risk for
magnesium and calcium deficiency
145
how much milk for adequate calcium in kids age 4-8
3 - 8 oz glasses/day
146
how much milk for adequate calcium intake for teens
4 - 8 to 10 oz glasses/day
147
85th to 94th percentile
overweight
148
>95%ile
obese
149
precocious puberty is associated with
advanced bone age
150
genetic short stature typically have bone age
similar to chronological age
151
hypothyroidism causes what in children regarding bone health
delayed bone age
152
growth hormone causes what in children regarding bone health
delayed bone age
153
cushing syndrome causes what in children regarding bone health
delayed bone age
154
fenton growth chart
allows comparison for preterm infants from 22 weeks gestastional age up through 10 weeks post term age
155
Z-score
express how far a child's weight falls from median on growth charts
156
below -3 z score
severely wasted
157
below -2 z score
wasted
158
above 2 z score
overweight
159
above 3 z score
obese
160
potassium for children
2-4 mEq/kg
161
Holliday segar
estimates caloric expenditure in fixed weight categories
assumes for each 100 calories metabolized, 100 ml h20 is required
162
calculation for Holliday segar
* 1st 10kg – 100 ml/kg/day
* 2nd 10kg – 50 ml/kg/day
* Each additional kg – 20 ml/kg/day when <50kg
* Or 15 ml/kg when >50 kg
163
Mosteller's formula
body surface area fluid calculation
the square root of height cm x weight kg divided by 3600, this is then multiplied by 1500ml/day
164
Vitamin D deficient rickets
```
Low or normal serum calcium
Low or normal serum phosphorus
High alkaline phosphatase
Increased PTH
Low 25OH vit D levels
1,25 OH vit D low to normal
```
165
Vitamin D dependent rickets
1,25 OH vit D will be elevated
166
renal tubular acidosis
Abnormal serum creatinine
| Abnormal anion gap
167
osteogenesis imperfecta
Genetic disease characterized by multiple bone fractures, short stature
Diagnosed by physical exam
Labs WNL
168
acute diarrhea
<14 days
169
persistent diarrhea
14 days or longer
170
chronic diarrhea
longer than 30 days
171
zinc for children with diarrhe
20 mg/day for 10-14 days
172
zinc for infants <6 mo with diarrhea
10 mg/day for 10-14 days
173
infant vitamin D requirement
400 IU
174
contraindications to NG feeding in baby
Upper airway secretions
Nasal polyps
Recurrent sinusitis
Otitis
175
galactosemia
Inborn error of metabolism that affects ability to metabolize galatose
Only treatment is to eliminate galatose
176
There is a higher concentration of galactose in
lactose free milk
177
infant formula osmolarity
<460 mOsm/kg
178
standard infant formula Kcal @ 20 Kcal/oz and osmolarity
200-380
179
osmolarity of infant protein hydrolysate
330-370
180
standard infant formula at 30 Kcal osmolarity
450
181
CHO modular impact on osmolarity
increases
182
fat modular impact on osmolarity
none
183
preterm formulas contain how much lactose vs glucose
40-50% lactose
| 50-60% glucose
184
preterm formulas contain what % MCT
40-50% - easier to absorb than the long chain in regular
185
when will regurgitation resolve
7-12 months
186
max GIR in infant
14-18 mg/kg/min
187
lipids for infants
0.5-1 g/kg/day
188
essential AA in neonates
taurine
| tyrosine
189
give which AA in smaller amounts to neonate
phenylalanine
methionine
glycine
190
pediatric selenium recommendation
2 mcg/kg/day
191
energy needs of critically ill and postop neonate
significantly lower due to absence of growth, decreased activity, and reduction of insensible losses
192
use how much pancreatic enzyme to reduce risk of fibrosing colonopathy
<10,000 units lipase/kg/day
193
CF related diabetes is related to
mucus obstruction of pancreatic beta cell preenting insulin secretion and potentially leading to beta cell destruction
194
meconium ileus
* Intestinal obstruction, mass in right lower quadrant, abdominal
* Most often in neonate
* Not caused by high dose enzyme therapy
195
Jejunum is primary site of absorption for...
water soluble vitamins with the exception of b12 which is in the ileum
196
complete ileal resection precludes absorption of
vit b12 and bile acids - increases diarrhea
197
PKU is deficiency in
phenylalanine hydroxylase
198
PKU treatment
restrict phenylalanine and supplement tyrosine
199
biliary atresia
atrophy of the bile ducts
causes obstruction of bile flow from the liver to the biliary system and small intestine causing malabsorption of fat and fat soluble vitamins
200
cylothorax
accumulation of chyle in the pleural space due to thoracic duct damage
associated with cardiac surgery
201
if burns are > than what %, needs cannot be met by PO alone
20%
202
Ebb response lasts
3-5 days
203
Ebb response includes
```
o Depressed ree
o Hyperglycemia
o Low plasma insulin
o Loss of plasma volume
o Decreased oxygen consumption
o Decreased BP
o Reduced cardiac output
o Decreased body temperature
```
204
flow response includes
* Elevated catecholamine
* Elevated or normal plasma insulin
* Hyperglycemia
* Elevated glucagon and glucocorticoids
* High glucagon-to-insulin ratio
* Catabolism
* Increased body temp
* Increased cardiac output
* Redistribution of polyvalent cations such as zinc and iron
* Mobilization of metabolic reserves
* Increase urinary excretion of nitrogen, sulfur, magnesium, phos, and potassium
* Accelerated gluconeogenesis
205
flow response peaks
between day 6 and 10 following injury
206
typically home PN is covered for patients with
Less than or equal to 5 feet of small bowel beyond the ligament of Treitz
Gastrointestinal losses exceeding 50% of oral intake
• 2.5-3 liters/day in and >1.25-1.5 liters/day out
Bowel rest required for at least 90 days and 20-35 cal/kg/day prescribed
207
special justification for home PN coverage when
* Calorie outside of 20-35/day
* Protein outside 0.8-1.5 G/kg/day
* Lipid use >1500 Gm/month
208
symptoms of hypocupremia
```
Anemia
Leukopenia
Foot numbness
Gain difficulty
Dysfunction of spinal cord
```
209
anemia associated with low copper
macro or normocytic
210
symptoms of spinal cord disfunction from copper deficiency
* Paresthesisa and numbness in lower extremities
* Sensory ataxia
* Spastic gait
211
copper deficiency can look similar to
B12 deficiency
212
Magnesium brain deposition can occur when IV administration is
1.1 mg/day
213
what potentiates action of insulin
chromium
214
symptoms of zinc deficiency
* Loss of taste
* Altered smell
* Skin rash
* Growth failure
* Alopecia
* Decreased muscle work capacity
* Gonadal hypofunction leading to decreased plasma testosterone and fertility
215
acute phase response for iron and ferritin
decreased iron
| increased ferritin
216
folate absorption
converted to monoglutamate by jejunal enzymes for entry into intestinal wall
then further reduced before portal circulation for reabsorption via enterohepatic circulation
217
folate absorption limited by
* Zinc deficiency
* Chronic alcohol consumption
* Changes in jejunal luminal pH
* Impaired bile secretion
218
choline is required for
lipid transport and metabolism
219
0.85 RQ
mixed substrate
220
<0.82 RQ
underfeeding
| lipid catabolism
221
>1 RQ
overfeeding, lipogenesis, increased respiratory demand
222
>1 RQ indicates
excessive CO2 production
223
stress phase lasts
24 hours
224
catabolic phase lasts
7-10 days
225
selenium status measured by
plasma glutathione peroxidase
erythrocyte content
blood levels
226
signs of Vit D toxicity
```
o Nausea
o Vomiting
o Weakness
o Fatigue
o Diarrhea
o Headache
o Confusion
o Tremor
o Soft tissue calcification in long term
```
227
signs of vit D deficiency
o Hypocalcemia
o Osteomalacia
o Osteoporosis
228
ileal brake
Inhibitor feedback which slows gastric emptying and intestinal transit
Triggered by fat in distal ileum
229
Swinamer equation
Uses body surface area in addition to physiological variables to predict RMR
Found to be predictive in ~55%
230
SMOF
30% soybean
30% MCT
25% olive
15% fish
231
SMOF omega6:3 ratio
2.5:1
232
albumin half life
14-20 days
233
retinol binding protein half life
12 hrs
234
prealbumin half life
2-3 days
235
transferrin half life
8-10 days
236
acid base disorder from diuretic
metabolic alkalosis
loss of bicarb poor CL rich EC restricting EC volume
now same amount of bicarb in smaller volume
237
short chain fatty acid chain length
2-4 carbons
238
medium chain length
6-12 carbons
239
long chain length
14-18 carbons
240
butyric length
short
241
lauric length
medium
242
stearic length
long
243
oleic length
long
244
very long chain fatty acid length
20 carbon or more
245
most enteral dietary lipids are ingested as
trglycerides
246
fatty acids up to ___ can be absorbed directly via the villi of the intestinal mucosa
10 carbons
247
long chain triglycerides require
bile salts for digestion and formation of micelles
248
fatty acids are oxidize for ATP
in any cell with mitochondria
249
linoleic and alpha linoleic acids require what to enter mitochondria
L-carnitine
| due to long chain length
250
carnitine is required as
cofactor for transformation of free long-chain fa into acylcarnitines and transport into the mitochondria
251
majority of fat digestion occurs where
duodenum by pancreatic lipase
252
what hydrolyzes fat in small intestine
pancreatic lipase
cholesterol ester hydrolase
phospholipase
253
role of bile salts
emulsifiers in fat digestion
254
oils rich in linoleic acid
corn
soybean
safflower
255
oils rick in alpha linolenic
soybean
| canola
256
soybean lipid emulsion composition
55-60% linoleic
| 3-4% alpha linolenic
257
body water females
50%
258
body water males
60%
259
TBW composition
2/3 IC
| 1/3 EC
260
EC water compostion
1/4 intravascular
| 3/4 interstitial
261
urea accounts for __% total urinary nitrogen loss
80%
262
skeletal muscle contains how much glycogen
300-400 grams
| <1560 Kcal
263
Na cotransporters are required for what vitamins
```
C
B6
E
D
B1
choline
```
264
determine amount of N in protein
divide total grams protein by 6.25
265
leucine in fasting
increase in bloodstream and in the muscle
| oxidation in the muscle increases
266
pyruvate oxidation in fasting
limited by acetyl coa production
267
pyruvate and lactate in fasting
pyruvate reduced to lactate
| both return to liver for gluconeogenesis
268
AMDR have been established for
omega 3, 6, and total fat
269
Hartnup's syndrome
Autosomal recessive disorder
| Basic amino acids are not absorbed
270
hartnup's may present as
pellagra like
- dermatitis
- diarrhea
- dementia
271
substrate for NO production
arginine
272
increased pCO2 from pulmonary insufficiency
decreases pH
273
increase pCO2 is greatest
with overfeeding
274
loop diuretics cause
o Excess K and mag excretion – hypokalemia and hypomagnesemia
o Azotemia due to volume depletion
275
iron absorbed
duodenum
276
calcium absorbed
duodenum
277
folic acid absorbed
proximal jejunum
278
b12 absorbed
distal ileum
279
wet beriberi
Enlarged heart
Nonspecific electrolyte abnormalities
Vasodilation
Peripheral neuritis
280
which suppresses more acid
| PPI or H2-blockers
PPI
281
PPI requires what for absorption
50 cm of jejunum
| use liquid in severe sbs
282
small bowel bacterial overgrowth can lead to
metabolic acidosis
283
Zinc is necessary for
Synthesis of granulation ntissue
Reepithelialization
Anti-inflammatory
Antimicrobial
284
zinc deficiency seen in
Diarrhea
Malabsorption
Hypermetabolic states
285
zinc serum level in stress
falls as albumin primary transporter
286
cyclosporine can cause
Hyperkalemia
Hypomagnesemia
Hyperglycemia
Hypercholesterolemia
287
deficiencies common after gastric bypass
```
Thiamin
Zinc
Folate
B12
Iron
Copper
```
288
copper deficiency can be a complication of
celiac disease
289
conditionally indispensable AA include
```
arginine
cysteine
glutamine
glycine
proline
tyrosine
```
290
SIADH
hyponatremia
Inappropriate ADH release leading to increased total body water and dilutional hyponatremia
Increased sodium concentration and osmolaltity in urine due to excessive water reabsorption
291
small intestine length
300-600 cm
292
need PN when small intestine
<120 cm
| though can be as little as 60 cm if ileocecal valve present
293
valoproic acid induces what type of deficiency
carnitine
