Acute Illness

Question 1

What are the 3 adaptations to decreases in energy intake?

Answer 1

• reduced EE
• protein sparing (reliance on FFA and ketones)
• decrease use of protein for gluconeogenesis

Question 2

What are the 2 adaptations to decreases in protein intake?

Answer 2

• increased amino acid recycling

- reprioritization towards visceral protein synthesis

Question 3

The metabolic response to illness is characterized by what 3 things?

Answer 3

• increased metabolic rate
• altered protein synthesis and catabolism
• altered substrate utilization (e.g. insulin resistance/hyperglycemia)

Question 4

What is the change in EE with illness?

Answer 4

increases with severity of illness

Question 5

What is the assessment of nutritional status in acute illness composed of?

Answer 5

• evaluate for pre-existing malnutrition

consider:

• intake (e.g. ability of patient to eat by mouth)
• severity of illness
• additional losses that influence nutrient needs

Question 6

What are the nutritional goals in a hospitalized patient?

Answer 6

• maintain body weight and physiologic function

- minimize complications, length of stay, recovery time, readmission rate

Question 7

What are the advantages of enteral nutrition?

Answer 7

• can prevent/treat malnutrition
• safer than parenteral
• more physiologic
• immune benefits
• lower cost

Question 8

What is the main benefit of gastric feeds compared to small intestinal feeds?

Answer 8

• gastric feeds is more physiologic

- small intestinal feeds may reduce aspiration risk

Question 9

The majority of cases of diarrhea in tube feeding is caused by what?

Answer 9

medication administration through the feeding tubes

Question 10

What tubes are used for short term duration?

Answer 10

nasoenteric/oroenteric

Question 11

How can you provide gastric feeds?

Answer 11

• bolus
• overnight infusion
• continuous infusion

Question 12

How can you provide small intestinal feeds?

Answer 12

• overnight infusion
• continuous infusion

no boluses because no reservoir

Question 13

What formula selection is considered the generic formula and requires normal GI function?

Answer 13

polymeric

Question 14

If you are worried about malabsorption what formula type do you give?

Answer 14

monomeric/elemental

Question 15

What can you add to a patient’s diet to control diarrhea with tube feeding?

Answer 15

fiber to make the stool bulkier

Question 16

What is the maximum oxidative capacity of glucose for adults?

Answer 16

5 mg CHO/kg/min

Question 17

What form of amino acids do we give in parenteral nutrition?

Answer 17

crystalline form

Question 18

If a patient receiving parenteral nutrition has an egg allergy that is a contraindication agaisnt what?

Answer 18

emulsified lipids

egg yolk is the emulsifier

Question 19

What are the risks of parenteral lipid administration?

Answer 19

• hypertriglyceridemia
• arachidonic acid production
• bacteremia

Question 20

What is the most common metabolic complication of parenteral nutrition?

Answer 20

hyperglycemia

Question 21

What are the 2 main hepatic complications of parenteral nutrition?

Answer 21

• hepatic steatosis

- cholestasis

Question 22

What is a main risk of children on long term parenteral nutrition?

Answer 22

intestinal failure associated liver disease (IFALD)