ABSITE Review - Nutrition Flashcards
What is the daily caloric need?
25kcal/kg/day
Mention the kcal./g of fat, protein, CHO and dextrose.
Fat 9kcal/g
Protein 4 kcal/g
Oral CHO 4 kcal/g
Dextrose 3.4 kcal/g
What are the nutritional requirements (protein, fat, CHO) for an average healthy adult male?
Protein 1g/kg/day (20% essential AAs)
Fat 30% calories
CHO rest of the calories
Which states of health or disease can increase the kcal requirement?
Trauma, surgery or sepsis - 20-40%
Pregnancy increase 300kcal/day
Lactation increase 500kcal/day
How are the protein and kcal requirements affected by burns?
Calories: 25kcal/kg/day + (30kcal/day x %burn)
Proteins: 1-1.5 g/kg/day + (3g x %burn)
What is the maximum glucose administration in TPN?
3g/kg/hr
What is the fuel for colonocytes?
Short chain fatty acids
What is the fuel for small bowel enterocytes and neoplastic cells?
Glutamine - MC AA in bloodstream and tissue
Releases NH4 in kidney, helping with nitrogen excretion
What are the half-lives of albumin, transferrin and prealbumin?
Albumin - 20 days
Transferrin - 10 days
Prealbumin - 2 days
What are ACUTE indicators of nutritional status?
Retinal binding protein, prealbumin, transferrin, total lymphocyte count
What is the the IBW formula for women and men?
Men = 106lb + 6lb for each inch over 5ft Women = 100lb + 5lb for each inch over 5ft
Mention preoperative signs of poor nutritional status.
Acute weight loss >10% in 6 months
Weight < 3.0 - strong risk factor for morbidity and mortality after surgery
What is the respiratory quotient? What is the number for each metabolism?
Ratio of CO2 produced to O2 consumed = measurement of energy expenditure
RQ > 1 = lipogenesis (overfeeding) - Tx: decrease CHO & caloric intake
RQ < 0.7 = ketosis and fat oxidation (starving) - Tx: increase CHO and caloric intake
RQ = 7 - pure fat metabolism
RQ = 0.8 - pure protein metabolism
RQ = 1.0 - pure CHO metabolism
How long does the the glycogen stores last in starvation? What is used after they are used?
Depleted after 24-36 hours (2/3 skeletal muscle, 1/3 liver) –> body then switches to fats
Where the glucose-6-phosphatase is only found?
Liver
What is the primary substrate of gluconeogenesis?
Alanine
What are the gluconeogenesis precursors?
Amino acids (especially alanine), lactate, pyruvate, glycerol
What is the main source of energy in trauma and starvation?
Fat (ketones)
When bacterial translocation is a risk? What cause it?
Occurs when the gut is not feed. Bacterial overgrowth occurs due to increased permeanility due to starved enterocytes.
What is the fuel of brain usually? What is it in starvation?
Usually glucose
Ketones in starvation.
What are the obligate glucose users?
Peripheral nerves, Adrenal Medulla, RBCs, WBCs
What occurs when feeding after prolonged starvation/malnutrition? What electrolytes abnormalities are common?
Refeeding Syndrome
Results in decrease K, Mg and PO4 –> causes cardiac dysfunction and fluid shifts
What is Kwashiorkor?
Protein deficiency
What is Marasmus?
Starvation
