Ch 5: Lipids Flashcards
What is ASPEN/SCCM stance on soybean oil emulsion as the sole source of IV fat?
ASPEN/SCCM suggest that when using soybean oil emulsion as the sole IV fat source, the ILE should be held for the first week (or given at a max of 100 g/wk if there is a concern or risk for EFAD)
_____ has been shown to be the most important SCFA in regulation and maintains of the colonic tissue (helps modulate inflammation)
Butyrate
What is ASPENS stance on the use of enteral formulation characterized by an anti-inflammatory lipid profile and antioxidants in patients with ARDS or severe acute lung injury?
A recommendation cannot currently be made
When should immune modulating enteral formulas of arginine and EPA/DHA/glutamine and nucleic acids not be used?
These formulas should not be used routinely in the medical ICU.
Furthermore, these products and other similar formulations (fish oil with or without arginine) should not be administered to severely septic patients
How long is typically needed before patients exhibit clinical signs of EFAD when given fat free PN?
EFAD may typically be seen in patients after 2-4 weeks of fat free PN, although clinical signs may be detected earlier, between 10-20 days.
Hypocaloric fat free PN or a cyclic feeding schedule of fat free PN may extend the period before the patient exhibits EFAD.
When supplementing EN, generally, a polymeric enteral formula that provides ____ % of the patient’s total energy requirements will supply adequate EFAs
10-15%
Which kind of triglycerides require bile salts for both enzymatic digestion and formation of micelles?
Long chain triglycerides
In critically ill patients requiring PN, ILE should not exceed ___ g/kg/day
1 g lipid/kg/day
What are the recommendations for acceptable serum TG levels after ILE for piggybacked and continuous ILE?
< 250 mL/dL 4 hours after ILE infusion (for piggy backed lipids) and < 400 mg/dL for continuous ILE infusion.
In adult patients requiring PN, ILE should not exceed ___ g/kg/day
2.5 g lipid per kg day
How much linoleic acid and linolenic acid is required in nutrition support patients to prevent an EFAD?
Reports have suggested that providing between 1-4% of total energy as linoleic acid is enough to prevent EFAD.
The requirement for a linolenic acid is lower (0.25%- 0.5% of total energy)
When should immune modulating formulas (containing both arginine and fish oils) be routinely used?
TBI and surgical ICU
When should formulations that contain fish oil and arginine be considered?
Severe trauma
What testing is used to identify an essential fatty acid deficiency?
A triene: tetraene ratio greater than 0.2 (Holman index) has been used to ID the presences of EFAD.
Mead acid is primarily produced in humans in the absence of EFA.
Per ASPEN, when should disease specific formulas be avoided?
In the surgical ICU
