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PDAT3 > 9 - Nutritional Elements + Requirements > Flashcards

9 - Nutritional Elements + Requirements Flashcards

1
Q

45 mL/kg/day

Water Requirements - Volume Status

A

DEHYDRATION

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2
Q

40 mL/kg/day

Water Requirements - Volume Status

A

POST-OPERATIVE

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3
Q

35 mL/kg/day

Water Requirements - Volume Status

A

EUVOLEMIA

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4
Q

30 mL/kg/day

Water Requirements - Volume Status

A

ELDERLY or CHF

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5
Q

AMINO ACIDS

Energy Source

A

4 kcal / gram

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6
Q

FAT

Energy Source

A
  • *DEPENDS ON PRODUCT**
  • percent does not Rise DIRECTLY*

10% = 1.1 kcal/mL

20% = 2 kcal/mL

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7
Q

CARBOHYDRATE

energy Source

A

3.4 kcal/gram

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8
Q

What is the GOLD STANDARD for
Estimating Energy Requirements?

A

INDIRECT CALORIMETRY

Harris-Benedict

Fixed kcal/kg/day

Mifflin-St Jeor

Penn State Uni Predictive equations

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9
Q

Healthy + Normal Nutrition Status

How many kcal/kg/day does
ASPEN & SCCM recommend?

energy requirements

A

20-25
kcal/kg/d

first determine if obese or not

use ACTUAL BODY WEIGHT

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10
Q

ILLNESS or METABOLIC STRESS
w/ BMI <30

How many kcal/kg/day does
ASPEN & SCCM recommend?

energy requirements

A

25-30
kcal/kg/d

use ACTUAL BODY WEIGHT

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11
Q

ILLNESS or METABOLIC STRESS
BMI >30

How many kcal/kg/day does
ASPEN & SCCM recommend?

energy requirements

A

11-14
kcal/kg
in combination with HIGH PROTEIN FEEDING

OR
Penn State / Mifflin-St Jeor Equation
uses Actual Body Weight

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12
Q

MAJOR BURN INJURY

How many kcal/kg/day does
ASPEN & SCCM recommend?

energy requirements

A

> 30
kcal/kg/day

use actual body weight

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13
Q

Fixed kcal/kg

Calculation used for ENERGY REQUIREMENTS

A

WEIGHT used for OBESE PATIENTS
Ranges are availble for
Both ABW & IBW

Confirm weight used to derive calorie range before using

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14
Q

During periods of inadequate protein or energy intake,
what type of CATABOLISM occurs FIRST?

A

MUSCLE CATABOLISM –> AMINO ACIDS

  • *<75g** of skeletal muscle protein is catabolized to
  • *supply AA precursors** for liver gluconeogenesis & energy production

Protein Depletion >20% of body stores will lead to:
VVV
Comprimised IMMUNE SYSTEM –> INFXN & DEATH

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15
Q

Mild Protein Depletion
Albumin > 3.0 g/dL

What are the DAILY PROTEIN REQUIREMENTS?

A

1.1-1.3
g/kg/d

Need Normal Renal & Hepatic Function

Use ACTUAL BODY WEIGHT, unless OBESE –> IBW if obese

Obesity hypocaloric feeding regimens require HIGHER protein amounts

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16
Q
  • *Moderate** Protein Depletion
  • *Albumin 2.5 - 2.9 g/dL**

What are the DAILY PROTEIN REQUIREMENTS?

A

1.3-1.5
g/kg/d

Need Normal Renal & Hepatic Function

Use ACTUAL BODY WEIGHT, unless OBESE –> IBW if obese

Obesity hypocaloric feeding regimens require HIGHER protein amounts

17
Q

SEVERE Protein Depletion
Albumin < 2.5 g/dL

What are the DAILY PROTEIN REQUIREMENTS?

A

1.5-2
g/kg/d

Need Normal Renal & Hepatic Function

Use ACTUAL BODY WEIGHT, unless OBESE –> IBW if obese

Obesity hypocaloric feeding regimens require HIGHER protein amounts

18
Q

Parenteral Sources of

PROTEIN

A

Amino Acid Solutions

Base Compounds solution = 3.5-20%
mis of essential + non-essential Amino Acids

  • *Final concentration = 2.5-10%**
  • *Central** concentration max of 10% // peripheral concentration max = 2.5-3%
19
Q

Function of FATS

Nutritrient Requirements

A

Essential component of:
Cell membranes / padding organs / Insulation

Precursor of:
PROSTAGLANDINS

Esential Fatty Acids:

Linoleic & Linolenic Acids

20
Q

Fat Deficiencies

A

Esential FA’s = Linoleic & Lonolenic Acids

Diffuse Dermatitis

CLOTTING = platelet aggregation

Diminished Would healing

Hemolytic anemia

Hepatic dysfunction

21
Q

FAT REQUIREMENTS

% / Min / Max

A

30% of total kcal
as a starting point

Min = 5% of WEEKLY caloric intake from fat
to prevent essential FA deficiency

  • *MAX = 60% of total daily calories**
  • *<2.5g/kg/day**
22
Q

Parenteral Source of FAT

Nutrient Requirements

A

Fat = Most Concentrated Energy Source

INTRALIPID FAT EMULSION
10% = 1.1 kcal/mL
20% = 2 kcal/mL
30% = 3 kcal/mL, used in compounding 3in1 TPNbags only

SMOFlipid 20% =2 kcal/mL
Has fish oil + MCT + Olive Oil + Soybean Oil
theoretically should be less pro-inflammatory, but is not proven

23
Q

Fat Infusion Considerations

DURATION // SPEED

A
  • *Isotonic Solutions** may be given directly through Peripheral Vein
  • *10% & 20%**

Run over:
12-24 hours

  • do NOT infuse over:*
  • *> 30 - 50 mg/kg/hr**
24
Q

CONTRAINDICATIONS

of FAT INFUSION

A

Elevated
TG’s >300mg/dL
need to use less fat for patient, ~5% kca

EGG ALLERGY

  • *PANCREATITIS DUE to HYPERtg’s**
  • pancreatitis due to other things is FINE, only from HYPERtg’s is contraindicated*
25
Q

When do FAT / CALORIC requirements

NEED TO BE ADJUSTED?

A

If patient is on:

FAT-BASED IV SOLUTIONS = PROPOFOL

has a lot of fat in it already.

26
Q

Carbohydrate (Dextrose)

Caloric Conversion

A

3.4 kcal/gram

DEXTROSE

27
Q

Protein

Caloric Conversion

A

4 kcal/gram

Protein

28
Q

Fat

Caloric Conversion

A

10% Lipid Emulsion = 1.1 kcal/mL

20% Lipid Emulsion = 2 kcal/mL

29
Q
  • *Respiratory Quotient = RQ**
  • *VCO2 / VO2**

What Values mean what?

Indirect Calorimetry

A

< 0.7 = UNDERFEEDING
Want to be ~ 0.82 - 0.85

> 1 = OVERFEEDING

30
Q

Goal for:
NITROGEN BALENCE
N2 (in) - N2 (out)

N2 (in) = protein/6.25 (include both oral and IV protein)

N2 (out) = [UUN g/ml) x 24 hr urine volume (mL)] + 2-4 (insensible losses)

A

SLIGHTLY POSITIVE

31
Q

Carbohydrate Requirements

A

Make up the
rest of the energy requirements
after accounting for calories from fat / protein

Usually:
45 - 65%
of total calories

  • *Parenteral = Dextrose**
  • *Enteral =** Sucrose / Fructose / Corn Syrup+Maltodextrin
32
Q

Concentration / Max Infusion Rate

Dextrose Infusion Considerations

A

Dextrose

5-35%
of final concentration
Central Max = 35%
Peripheral Max = 10-12.5%

Max Infusion Rate:
3-5 mg/kg/min

33
Q

MICRONUTRIENT
Nutrition Requirements

A

Must be added to PN

Amount depends on many factors:
Hepatic / Renal Fxn
Fluid / Cardiac Status
Prior Nutritional Status

Electrolytes are
DOSED BY WEIGHT

34
Q

MVI-12

A

Contains the:

  • *RDA of 12 Vitamins**
  • *10 mL/d**

Some other products also contain RDA for

  • *Vitamin K** - need to give seperately
  • *10mg weekly** or 1.5 mg/day
35
Q

What Additional Vitamins might need to be added?

A

FOR ALCOHOLICS
FOLATE + THIAMINE

  • *Vitamin K** might need to be given seperately
  • *10mg weekly** or 1.5 mg/day
36
Q

Special Considerations for

SELENIUM

A

Excreted VIA KIDNEYS

Normal Need = 60mcg

  • *Renal Failure/Disease**
  • *HALF = 30 mcg**
  • except for CRRT, use standard dose*
37
Q

Special Considerations for
TRACE ELEMENTS

A

ZINC

COPPER

MANGANESE

Chromium
urine / bile excretion

Selenium
kidney excretion 60mcg –> 30mcg

Iron
not normally required unless long term TPN

38
Q

Special Indications for ZINC

A

GI Fistula

Wound Healing

Zing –> 3-12mg/day ABOVE normal requirements

  • ALSO:*
  • *Increase DOSE (2.5-5mg normal) for RENAL patients**

PDAT3 (23 decks)

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