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ECC > 8: Nutrition > Flashcards

8: Nutrition Flashcards

1
Q

Over what time scale do you feed a critical patient?

A

Correct fluids and electrolytes over 24h, then feed on days 2 and 3

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2
Q

What three kinds of patients should you feed?

A

Anorexic for three days, recent weight loss above 10%, catabolic state e.g. burns or sepsis

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3
Q

How good is using bloods to estimate nutritional need?

A

Inaccurate

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4
Q

What is BER for cats?

A

BW x 50 kcals/day

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5
Q

What is BER for dogs and cats over 2kg?

A

BW x 30 + 70 kcals/day

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6
Q

What % of the BER do you initially give?

A

50%, then increase

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7
Q

In which situations is this calorie estimate an underestimate?

A

Long term or catabolic state

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8
Q

How often should you weight the animal?

A

At least once a week, daily if possible

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9
Q

Which kind of animals suffer accelerated starvation?

A

Concurrent injury, infection or neoplasia

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10
Q

What ultimately kills the animal in starvation?

A

Calorie loss causes body protein loss

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11
Q

What signs do you see in refeeding syndrome in cats?

A

Cardiac, respiratory, NM, haematology

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12
Q

What is the cause of refeeding syndrome?

A

Already has low K and P and sudden insulin release causes increased cell uptake

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13
Q

How do you prevent refeeding syndrome?

A

Slowly increased calories and give high protein rather than high carb diet

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14
Q

When is the only time you should use appetite stimulants?

A

If already interested in food

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15
Q

What are some examples of appetite stimulants?

A

Valium, mirtazapine, midazolam

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16
Q

How do you feed if they are food-aversive?

A

Tube feed

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17
Q

When should you not use an NG tube?

A

If oral, pharyngeal, oesophageal or nasal disease

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18
Q

What length should an NG tube be?

A

75% of nose to last rib

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19
Q

Where does an NG tube end and why?

A

Distal oesophagus to avoid acid reflux

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20
Q

Which kind of tubes are better tolerated for the long term?

A

Oesophagostomy or gastrostomy

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21
Q

When should you not use an oesophagostomy tube?

A

In oesophageal disease

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22
Q

What is a disadvantage of oesophagostomy tube?

A

Need GA to place

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23
Q

What kind of timescale are gastrostomy tubes used for?

A

Over 5 days

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24
Q

How are gastrostomy tubed usually placed?

A

Endoscopically

25
Q

What are the next most important factors after fluids and electrolytes?

A

Energy then protein, minerals and vitamins are last

26
Q

What are two common ways malnutrition can develop in a hospital?

A

Lack of records, witholding food for GA

27
Q

When does muscle protein loss occur compared to other changed in malnutrition?

A

Last - already serious by the time they lose muscle mass

28
Q

How long a period of anorexia does it take for stomach capacity to halve?

A

48 hours, so must introduce tube feeding slowly - and also see reduced gastric tone and emptying

29
Q

What happens to BER in uncomplicated starvation?

A

Lowers, because reduced insulin reduces the conversion of T4 to active T3

30
Q

In initial starvation, what is the glucose source?

A

Glycogen - used up within days

31
Q

After about a week, what is the main source of glucose?

A

Stored fat

32
Q

What is the glucose source in late starvation?

A

Back to body protein again

33
Q

What diet components do dogs need more of in stress and starvation?

A

More protein and fat, less CHO

34
Q

Which tissues are obligate glucose users?

A

RBCs, renal medullary cells, nervous tissue, fibroblasts, some tumours

35
Q

Which are the first body proteins to be used?

A

Plasma proteins, visceral proteins, muscle

36
Q

Which are the last body proteins to be used?

A

Bones, ligament, cartialge

37
Q

Which are the proteins lost in the first 2-3 days?

A

Liver protein - all albumin and fibrinogen

38
Q

What happens to the GI tract when it proteins are used up?

A

Reduced mass, flattened villi, reduced brush border activity, CHO and fat digestion affected first

39
Q

What are the effects on the immune system when protein is being used up?

A

Can’t make antibodies, reduced lymphocytes, reduced barrier function of skin and mucosa, reduced inflammatory response

40
Q

What are the terminal changes in starvation as protein becomes the primary energy source again?

A

Very thin SI wall, intercostal and diaphragm muscles fail

41
Q

Why does concurrent injury accelerate starvation?

A

Stress overrides the BMR down-regulation

42
Q

Why does injury accelerate starvation?

A

FIbroblasts use all the glucose, increased protein and amino acid requirements for wound healing, proteins are lost in haemorrhage, burns etc

43
Q

How does fever affect energy requirements?

A

Increases

44
Q

How does early feeding affect animals with tumours?

A

Doesn’t increase survival time, but does improve QOL as faster recovery and increased immunocompetence

45
Q

What are two indications for a restricted protein food?

A

Hepatic encephalopathy or severe uraemia

46
Q

Why should food fed by tube be iso-osmolar?

A

To prevent diarrhoea

47
Q

What are the problems with feeding cold food?

A

Cold food can induce vomiting, give rapid gastric emptying giving diarrhoea, and patient has to spend energy warming it

48
Q

What are three fatal complications of TPN?

A

Sepsis, thrombosis, intestinal atrophy

49
Q

What happens to enterocytes in TPN?

A

Hypofunctional, hypoplastic, altered myoelectrical activity, increased upper GI bleeding

50
Q

When is the only time you should use TPN?

A

Only if can’t absorb enteral nutrition for over a week

51
Q

What is the appetite stimulant of choice?

A

Mirtazipine

52
Q

When is the only time vitamin B works to stimulate appetite?

A

If depleted

53
Q

For how lon can you use an oesophagostomy tube?

A

Several weeks

54
Q

Why is a polyurethane tube better than PVC?

A

PVC is cheaper but hardens in stomach acid and kinks so hard to remove

55
Q

For how long can you use an NG tube?

A

Less than 1 week

56
Q

Can you send home with an oesophagostomy tube?

A

No

57
Q

For how long must a gastrotomy tube be in place before the adhesions form between the stomach and body wall?

A

At least 5-7 days - contraindicated below this

58
Q

How do you know when to remove a feeding tube?

A

Until eating 85% of requirements voluntarily

ECC (7 decks)

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