Acute Illness Flashcards
What are the 3 adaptations to decreases in energy intake?
- reduced EE
- protein sparing (reliance on FFA and ketones)
- decrease use of protein for gluconeogenesis
What are the 2 adaptations to decreases in protein intake?
- increased amino acid recycling
- reprioritization towards visceral protein synthesis
The metabolic response to illness is characterized by what 3 things?
- increased metabolic rate
- altered protein synthesis and catabolism
- altered substrate utilization (e.g. insulin resistance/hyperglycemia)
What is the change in EE with illness?
increases with severity of illness
What is the assessment of nutritional status in acute illness composed of?
- 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
What are the nutritional goals in a hospitalized patient?
- maintain body weight and physiologic function
- minimize complications, length of stay, recovery time, readmission rate
What are the advantages of enteral nutrition?
- can prevent/treat malnutrition
- safer than parenteral
- more physiologic
- immune benefits
- lower cost
What is the main benefit of gastric feeds compared to small intestinal feeds?
- gastric feeds is more physiologic
- small intestinal feeds may reduce aspiration risk
The majority of cases of diarrhea in tube feeding is caused by what?
medication administration through the feeding tubes
What tubes are used for short term duration?
nasoenteric/oroenteric
How can you provide gastric feeds?
- bolus
- overnight infusion
- continuous infusion
How can you provide small intestinal feeds?
- overnight infusion
- continuous infusion
no boluses because no reservoir
What formula selection is considered the generic formula and requires normal GI function?
polymeric
If you are worried about malabsorption what formula type do you give?
monomeric/elemental
What can you add to a patient’s diet to control diarrhea with tube feeding?
fiber to make the stool bulkier
What is the maximum oxidative capacity of glucose for adults?
5 mg CHO/kg/min
What form of amino acids do we give in parenteral nutrition?
crystalline form
If a patient receiving parenteral nutrition has an egg allergy that is a contraindication agaisnt what?
emulsified lipids
egg yolk is the emulsifier
What are the risks of parenteral lipid administration?
- hypertriglyceridemia
- arachidonic acid production
- bacteremia
What is the most common metabolic complication of parenteral nutrition?
hyperglycemia
What are the 2 main hepatic complications of parenteral nutrition?
- hepatic steatosis
- cholestasis
What is a main risk of children on long term parenteral nutrition?
intestinal failure associated liver disease (IFALD)
