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10 Nutrition Flashcards

1
Q

Caloric need

A

20-25 calories/kg/day

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2
Q

Calories in fat

A

9 calories/g

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3
Q

Calories in protein

A

4 calories/g

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4
Q

Calories in oral carbs

A

4 calories/g

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5
Q

Calories in dextrose

A

3.4 calories/g

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6
Q

What is the distribution of protein/fat/carbs?

A

20% protein (20% should be essential AA)
30% fat
50% carbs

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7
Q

What is the amount of protein you should have each day?

A

1g protein/kg/day

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8
Q

How much can trauma, surgery or sepsis increase kcal requirements?

A

20-40%

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9
Q

How much does pregnancy increase kcal requirements?

A

300kcal/day

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10
Q

How much does lactation increase kcal requirements?

A

500kcal/day

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11
Q

Equation for calories required in burns?

A

25kcal/kg/day + (30 kcal/day x % burn)

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12
Q

Equation of protein required in burns?

A

1-1.5g/kg/day + (3g x % burn)

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13
Q

How much does a fever increase basal metabolic rate?

A

10% for every degree above 38.0oC

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14
Q

How do you calculate caloric need in obese patients?

A

weight = [(actual weight - IBW) x 0.25] + IBW

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15
Q

What are the components of the Harris-Benedict equation?

A

Weight, height, age, gender

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16
Q

What is the base for TPN? Max?

A

Glucose based

Max - 3g/kg/hr

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17
Q

What is the base for PPN?

A

Fat based

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18
Q

Fuel for colonocytes?

A

Short-chain fatty acids (i.e. butyric acid)

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19
Q

Fuel for small bowel enterocytes?

A

Glutamine

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20
Q

What is the most common AA in the bloodstream and tissues?

A

Glutamine

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21
Q

Role of glutamine in the kidney?

A

Helps with nitrogen excretion via releasing NH4 in the kidney

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22
Q

Primary fuel for most neoplastic cells?

A

Glutamine

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23
Q

Half life of albumin

A

18 days

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24
Q

Half life of transferrin

A

10 days

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25
Half-life of prealbumin
2 days
26
Acute indicators of nutritional status
Retinal binding protein Prealbumin Transferrin
27
Equation for IBW?
``` Men = 106lbs + 6lbs for each inch over 5ft Women = 100lbs + 5lbs for each inch over 5ft ```
28
What are the preoperative signs of poor nutritional status?
Acute weight loss >10% in 6 months Weight <85% of IBW Albumin <3.0
29
What is a indicator of nutritional status that is also a strong risk factor for morbidity and mortality after surgery?
Low albumin (<3.0)
30
What is the respiratory quotient (RQ)?
Ratio of CO2 produced to O2 consumed | Measure of energy espenditure
31
What does RQ > 1 indicate?
Lipogenesis Overfeeding Treat by decreasing carbs and caloric intake High carb intake can lead to CO2 buildup and ventilator problems
32
What does RQ <0.7 indicate?
Ketosis and fat oxidation Starving Treat by increasing carbs and caloric intake
33
RQ with pure fat utilization
RQ = 0.7
34
RQ with pure protein utilization
RQ = 0.8
35
RQ with pure carbohydrate utilization
RQ = 1.0
36
What are the post-operative phases of metabolism?
Diuresis phase Catabolic phase Anabolic phase
37
When is the diuresis phase of post-op period?
Days 2-5
38
When is the catabolic phase of post-op period?
Days 0-3 (negative nitrogen balance)
39
When is the anabolic phase of post-op period?
Days 3-6 (positive nitrogen balance)
40
At what point are glycogen stores get depleted? What takes it's place?
24-36 hours 2/3 in skeletal muscles, 1/3 liver Switches to fat
41
What do skeletal muscles lack that make it so glycogen cannot be used to supply systemic glucose?
glucose-6-phosphatase | Only found in liver
42
What AA are the precursors for gluconeogenesis?
AA (esp alanine, pheylalaline, glutamine), lactate, pyruvate, glycerol
43
What blocks protein-conserving mechanisms after trauma?
Catecholamines and cortisol | They do occur with starvation
44
What is the main source of energy in starvation and trauma?
Fat (ketones) | Trauma is more mixed - fat and proteins
45
How much weight can a patient lose without having associated complications?
15% weight loss
46
How long can patients tolerate without eating?
7 days
47
What is the normal energy source for the brain? What is used during starvation?
Glucose | Ketones
48
What tissues are obligate glucose users?
Peripheral nerves Adrenal medulla Red blood cells White blood cells
49
Define refeeding syndrome
Occurs after prolonged starvation/malnutrition Decreased K, Mg and PO4 due to sudden use Sx: cardiac dysfunction, profound weakness, encephalopathy
50
How do you prevent refeeding syndrome?
Start at low rate | 10-15kcal/kg/day
51
What mediates cachexia? What is the mechanism?
Mediated by TNF-a Glycogen breakdown, lipolysis, protein catabolism Sx: anorexia, weight loss, wasting
52
Cause of kwashiorkor
Protein deficiency
53
Cause of marasmus
Starvation
54
What is the ratio of nitrogen in protein?
6.25g of protein contain 1g of nitrogen
55
Equation for nitrogen balance?
(N in - N out) | [protein/6.25] - [24-hour urinary N + 4g]
56
Normal total protein synthesis
250g/day
57
Major product of protein breakdown from skeletal muscle?
Glutamine and alanine
58
Preferred source of energy for colonocytes, liver, heart and skeletal muscles?
Fatty acids
59
What are the essential fatty acids? Role?
Linolenic, linoleic Needed for prostaglandin synthesis Important for immune cells
60
How are glucose and galactose absorbed?
By secondary active transport | Released into portal vein
61
How is fructose absorbed?
Facilitated diffusion | Released into portal vein
62
Sucrose =
Fructose + glucose
63
Lactose =
Galactose + glucose
64
Maltose =
Glucose + glucose
65
Branched-chain amino acids?
Leucine Isoleucine Valine
66
Essential amino acids?
``` PVT TIM HALL Phenylalanine Valine Tryptophan Threonine Isoleucine Methionine Histidine Arginine Leucine Lysine ```
67
Mineral and vitamin deficiency? | Hyperglycemia, encephalopathy, neuropathy
Chromium
68
Mineral and vitamin deficiency? | Cardiomyopathy, weakness
Selenium
69
Mineral and vitamin deficiency? | Pancytopenia
Copper
70
Mineral and vitamin deficiency? | Poor wound healing
Zinc
71
Mineral and vitamin deficiency? | Weakness (failure to wean of ventilator), encephalopathy, decreased phagocytosis
Phosphate
72
Mineral and vitamin deficiency? | Wernicke's encephalopathy, cardiomyopathy
Thiamine (B1)
73
Mineral and vitamin deficiency? | Sideroblastic anemia, glossitis, peripheral neuropathy
Pyridoxine (B6)
74
Mineral and vitamin deficiency? | Megaloblastic anemia, peripheral neuropathy, beefy tongue
Cobalamin (B12)
75
Mineral and vitamin deficiency? | Megaloblastic anemia, glossitis
Folate
76
Mineral and vitamin deficiency? | Diarrhea, dermatitis, dementia
Pellegra - Niacin
77
Mineral and vitamin deficiency? | Dermatitis, hair loss, thrombocytopenia
Essential fatty acid
78
Mineral and vitamin deficiency? | Night blindness
Vitamin A
79
Mineral and vitamin deficiency? | Coagulopathy
Vitamin K
80
Mineral and vitamin deficiency? | Rickets, osteomalacia, osteoporosis
Vitamin D
81
Mineral and vitamin deficiency? | Neuropathy
Vitamin E
82
Function of the cori cycle
Glucose is used and converted to lactate in muscle Lactate is converted to pyruvate in the liver Pyruvate is used on gluconeogenesis Glucose is then transported back to the muscle

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