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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
Q

Half-life of prealbumin

A

2 days

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26
Q

Acute indicators of nutritional status

A

Retinal binding protein
Prealbumin
Transferrin

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27
Q

Equation for IBW?

A 
Men = 106lbs + 6lbs for each inch over 5ft
Women = 100lbs + 5lbs for each inch over 5ft
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28
Q

What are the preoperative signs of poor nutritional status?

A

Acute weight loss >10% in 6 months
Weight <85% of IBW
Albumin <3.0

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29
Q

What is a indicator of nutritional status that is also a strong risk factor for morbidity and mortality after surgery?

A

Low albumin (<3.0)

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30
Q

What is the respiratory quotient (RQ)?

A

Ratio of CO2 produced to O2 consumed

Measure of energy espenditure

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31
Q

What does RQ > 1 indicate?

A

Lipogenesis
Overfeeding
Treat by decreasing carbs and caloric intake
High carb intake can lead to CO2 buildup and ventilator problems

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32
Q

What does RQ <0.7 indicate?

A

Ketosis and fat oxidation
Starving
Treat by increasing carbs and caloric intake

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33
Q

RQ with pure fat utilization

34
Q

RQ with pure protein utilization

35
Q

RQ with pure carbohydrate utilization

36
Q

What are the post-operative phases of metabolism?

A

Diuresis phase
Catabolic phase
Anabolic phase

37
Q

When is the diuresis phase of post-op period?

38
Q

When is the catabolic phase of post-op period?

A

Days 0-3 (negative nitrogen balance)

39
Q

When is the anabolic phase of post-op period?

A

Days 3-6 (positive nitrogen balance)

40
Q

At what point are glycogen stores get depleted? What takes it’s place?

A

24-36 hours
2/3 in skeletal muscles, 1/3 liver
Switches to fat

41
Q

What do skeletal muscles lack that make it so glycogen cannot be used to supply systemic glucose?

A

glucose-6-phosphatase

Only found in liver

42
Q

What AA are the precursors for gluconeogenesis?

A

AA (esp alanine, pheylalaline, glutamine), lactate, pyruvate, glycerol

43
Q

What blocks protein-conserving mechanisms after trauma?

A

Catecholamines and cortisol

They do occur with starvation

44
Q

What is the main source of energy in starvation and trauma?

A

Fat (ketones)

Trauma is more mixed - fat and proteins

45
Q

How much weight can a patient lose without having associated complications?

A

15% weight loss

46
Q

How long can patients tolerate without eating?

47
Q

What is the normal energy source for the brain? What is used during starvation?

A

Glucose

Ketones

48
Q

What tissues are obligate glucose users?

A

Peripheral nerves
Adrenal medulla
Red blood cells
White blood cells

49
Q

Define refeeding syndrome

A

Occurs after prolonged starvation/malnutrition
Decreased K, Mg and PO4 due to sudden use
Sx: cardiac dysfunction, profound weakness, encephalopathy

50
Q

How do you prevent refeeding syndrome?

A

Start at low rate

10-15kcal/kg/day

51
Q

What mediates cachexia? What is the mechanism?

A

Mediated by TNF-a
Glycogen breakdown, lipolysis, protein catabolism
Sx: anorexia, weight loss, wasting

52
Q

Cause of kwashiorkor

A

Protein deficiency

53
Q

Cause of marasmus

A

Starvation

54
Q

What is the ratio of nitrogen in protein?

A

6.25g of protein contain 1g of nitrogen

55
Q

Equation for nitrogen balance?

A

(N in - N out)

[protein/6.25] - [24-hour urinary N + 4g]

56
Q

Normal total protein synthesis

57
Q

Major product of protein breakdown from skeletal muscle?

A

Glutamine and alanine

58
Q

Preferred source of energy for colonocytes, liver, heart and skeletal muscles?

A

Fatty acids

59
Q

What are the essential fatty acids? Role?

A

Linolenic, linoleic
Needed for prostaglandin synthesis
Important for immune cells

60
Q

How are glucose and galactose absorbed?

A

By secondary active transport

Released into portal vein

61
Q

How is fructose absorbed?

A

Facilitated diffusion

Released into portal vein

62
Q

Sucrose =

A

Fructose + glucose

63
Q

Lactose =

A

Galactose + glucose

64
Q

Maltose =

A

Glucose + glucose

65
Q

Branched-chain amino acids?

A

Leucine
Isoleucine
Valine

66
Q

Essential amino acids?

A 
PVT TIM HALL
Phenylalanine
Valine
Tryptophan
Threonine
Isoleucine
Methionine
Histidine
Arginine
Leucine
Lysine
67
Q

Mineral and vitamin deficiency?

Hyperglycemia, encephalopathy, neuropathy

68
Q

Mineral and vitamin deficiency?

Cardiomyopathy, weakness

69
Q

Mineral and vitamin deficiency?

Pancytopenia

70
Q

Mineral and vitamin deficiency?

Poor wound healing

71
Q

Mineral and vitamin deficiency?

Weakness (failure to wean of ventilator), encephalopathy, decreased phagocytosis

72
Q

Mineral and vitamin deficiency?

Wernicke’s encephalopathy, cardiomyopathy

A

Thiamine (B1)

73
Q

Mineral and vitamin deficiency?

Sideroblastic anemia, glossitis, peripheral neuropathy

A

Pyridoxine (B6)

74
Q

Mineral and vitamin deficiency?

Megaloblastic anemia, peripheral neuropathy, beefy tongue

A

Cobalamin (B12)

75
Q

Mineral and vitamin deficiency?

Megaloblastic anemia, glossitis

76
Q

Mineral and vitamin deficiency?

Diarrhea, dermatitis, dementia

A

Pellegra - Niacin

77
Q

Mineral and vitamin deficiency?

Dermatitis, hair loss, thrombocytopenia

A

Essential fatty acid

78
Q

Mineral and vitamin deficiency?

Night blindness

79
Q

Mineral and vitamin deficiency?

Coagulopathy

80
Q

Mineral and vitamin deficiency?

Rickets, osteomalacia, osteoporosis

81
Q

Mineral and vitamin deficiency?

Neuropathy

82
Q

Function of the cori cycle

A

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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