[216B] Nutrition Flashcards
What are the 2 micronutrients and 3 macronutrients?
Micro: vitamins & minerals
Macro: carbohydrates, proteins (amino acid) & lipids (fatty acid)
Macronutrients are a source of ____ and when in excess are stored in ____ tissue
energy, adipose
What is the difference between anabolism and catabolism?
Anabolism: synthesis
Catabolism: breakdown
What is a basal metabolic rate (BMR)? What’s the average BMR?
Amount of energy needed for body maintenance - 10kCal/lb
What are 3 situations where there might be an increased energy requirement for an individual?
- Growth + development phases
- Illness + infection
- Exercise
What are the 2 causes of malnutrition?
- Lack of nutrients
- Ineffective utilization of nutrients
What is failure to thrive (FTT)?
Inadequate nutrition to support growth + development
What are organic causes of FTT?
Pathologies (ie. cancer, GI disease)
What are non-organic causes of FTT?
Neglect + poverty
What is the tx for malnutrition + FTT?
- Increase caloric intake
- Hydrate
What is the difference between Kwashiorkor and Marasmus FTT?
Kwashiorkor: diets deficient of protein (belly protrudes)
Marasmus: total calorie + protein deficient (muscle atrophy)
What are the 3 types of feeds that can be prepared for enteral nutrition? What is the difference between them?
- Polymeric: intact nutrients + high calories (ie. protein)
- Oligomeric: digestible components (ie. amino acid)
- Specialized: if organ disease present
What are the 3 types of timing for enteral nutrition?
- Bolus (like a meal)
- intermittent (slower bolus)
- Continuous
Why is continuous feeding ideal for recovery?
Avoids dumping syndrome
What is the admin. route for total parenteral nutrition (TPN)?
IV (ideally central line)
What are 5 s/e of TPN?
- Fluid overload
- Infection
- Electrolyte imbalance
- Hyperglycemia
- GI dysfunction
When starving lasts > 5 days, what 3 things does the body do to compensate?
- Lipolysis for energy, increasing serum ketones
- Depletion of intracellular minerals
- Reduced organ fx
Why does re-feeding syndrome happen?
Glucose surge –> massive hemostatic changes
What is the root reflex?
Baby turns to stimulus: poking cheek and opens mouth
What is the suck reflex?
Baby sucks
How long should a baby exclusively be breastfed according to Canada guidelines?
6 months
Where is vitamin D3 formed?
Kidney + liver
How do vitamin D and calcium interact with each other?
Drive each other
When are calcium gluconate and calcitriol indicated?
Low serum calcium
[T/F] Can vitamin D be overdosed?
True
What is osteoporosis?
Fragile bones d/t increased bone resorption
What is the most common cause of osteoporosis?
Menopause
What is the 3 tx for osteoporosis?
- Vitamin D
- Calcium
- Bisphosphonates
What are 2 examples of biphosphonates?
- Alendronate (Fosamax)
- Risedronate (Actonel)
What are the 2 hormones that stimulate lactation?
- Prolactin
- Oxytocin
What are the 3 types of breastmilk?
- Colostrum
- Transitional milk
- Mature milk
What is prolactin responsible for in lactation?
Milk synthesis
What is oxytocin responsible for in lactation?
Milk excretion + ejection
Colostrum occurs - days post delivery and contains:
1-3; IgA, EGF, low in lactose
Transitional milk occurs - days post delivery and contains:
3-14; lactose, protein, fat
Mature milk contains:
Foremilk (water, low calorie + fat) and hindmilk (fat)
Breastmilk: Milk fat: \_\_% Calories: \_\_/100 mL Iron: 0.\_\_ mg/L Iron bioavailability up to \_\_%
56, 70, 0.35, 100
What is the average milk consumption in infants per day?
750 mL
What are 3 uses of iron?
- Normal cell function
- Mitochondrial energy production
- Hgb synthesis
What is the activation pathway for Vit D?
7-dehydrocholesterol + UVB exposure > Vitamin D3 (active)
What are the normal losses of iron per day in adults and pediatrics?
Adults: 1-2 mg
Pediatrics: 0.27 mg
What protein does iron bind to in the blood vs within cells?
Transferrin vs ferritin + hemosiderin
When during pregnancy is iron stored for the baby?
3rd trimester of gestation
How much mg/L of iron do formulas contain? What is the bioavailability of this iron?
4-13 mg/L, 10%
What are sources of heme iron vs non-heme iron? Their bioavailabilities?
Heme: meat, poultry, fish, 20%
Non-heme: legumes, nuts, eggs, 5%
What are some inducers and inhibitors of iron?
Inducer: protein, vitamin C
Inhibitor: Calcium
What are 4 types of formula? What type of milk are they made with?
- Standard iron fortified (cow)
- Lactose free (cow)
- Hypoallergenic (cow)
- Soy (soy)
What are some contraindications to breastfeeding?
- Infection
- Drugs
- Galactosemia
- Lactose intolerance
What is the primary active toxic metabolite for galactosemia?
Galactitol
What are some s&s of galactosemia?
- Vomiting
- Poor weight gain
- Fatigue
- Hypoglycemia
What are some complications of galactosemia?
- FTT
- Brain damage
- E. coli sepsis
What is the tx for galactosemia?
- Soy formula + Ca2+ supplements
- Tx of associated symptoms (ie. antibiotics)
Lactose intolerance is the deficiency of what enzyme?
Lactase
What are the 2 types of lactose intolerances and what are the differences?
- Congenital: genetic
- Primary: loss of lactase with age
What are some s&s of lactose intolerance?
- Unabsorbed lactose
- Diarrhea
- Gas
- Bloating
What are some tx for lactose intolerance (specifically in infants)?
- Avoid milk products
- Lactose free formula
- Soy formula
- Lactaid
What are 2 tests for lactose intolerance?
- Breath test
- Lab test
By 1 years old, what are some growth and development benchmarks we should expect to see?
- Brain is 2/3 of adult size
- Birth weight tripled
- Begins walking
- Beginnings of language
How can too much milk intake be bad?
- Secondary anemia (interferes with iron absorption)
- Displaces other food from diet
Anemia is a ____, not a diagnosis and is defined as an impaired ____ ____ capacity
symptom, oxygen carrying
What are 2 causes of anemia?
- Low production of Hgb, RBCs or iron
- Loss (ie. hemorrhage)
What is the tx for iron deficiency anemia?
- Prevention
- Iron supplements (ie. ferrous sulfate)
What are some important labs to order to check for anemia?
- Serum iron
- Ferritin
- CBC
- Hgb
- Hematocrit
- MCHC
What are some s/e of iron supplements?
- GI pain
- Constipation
- Drug-drug-food interactions
What are 2 examples of iron supplements given parenterally?
- Iron dextran
- Monoferric (Monofer, Venofer)
What are some s&s of iron poisoning? What causes these s&s?
Intestinal hemorrhage: - Vomiting - GI pain Mitochondrial damage: - Cardiac abnormalities - CNS abnormalities
What is the tx for iron poisoning?
Excretion:
- Evacuation of bowel
- Deferoxamine (Desferal) IV
Acute hemorrhagic anemia is when __-__% of blood volume is lost
10-30%
What are some s&s of acute hemorrhagic anemia?
- Compensation
- Hypotension
- Shock
What is the tx for acute hemorrhagic anemia?
- PRBCs
- Treat cause
- Iron meds
What are some s&s of an allergic transfusion reaction?
- IV site redness + pain
- Flushed face
- VS changes
- Headache
- Chills/fever
- Urticaria
- Back pain
- N&V
- SOB
What is the tx for an allergic transfusion reaction?
- Glucocorticoids
- Antihistamines
- Epinephrine
- O2
- NS
- Antibiotics
- Monitor organ fx
What should we administer to a starving pt before refeeding them (2)?
Thiamine & B-complex vitamins (contain 8 diff B vitamins)
What is thiamine’s function?
Cell fx & repair.
Vit C deficiency is called:
Scurvy
Vit A deficiency is called:
Vit A avitaminosis
Which vitamin do we give IM to newborns? Why?
Vit K: active vit K (K2) must be synthesized in the GI tract, but newborns have no gut flora, so they can’t. Thus, we need to give it to them IM.
What is vit K deficiency called?
VKDB (Vit K Deficiency Bleeding)
Vit B12 deficiency is called:
Cobalamin deficiency.
Vit B1 deficiency is called:
Beriberi
Vit B3 deficiency is called:
Pellagra.
When should a baby be started on solids?
6 months
When can babies start cow milk?
1 year old.
If a pt has low ferritin and transferrin, they likely have:
iron deficiency anemia.
If a pt has high ferritin and high transferrin, they likely have:
Hemolytic anemia (RBC destruction = lots of iron available).
If a pt’s transferrin is low, but their ferritin is normal, they likely have:
a hemorrhage/blood loss