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ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn > Chapter 10 - Nutrition > Flashcards

Chapter 10 - Nutrition Flashcards

1
Q

What is the approximate daily caloric need?

A

25 kcal/kg/day

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2
Q

How many kcal/gram of fat?

A

9

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3
Q

How many kcal/gram of protein?

A

4

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4
Q

How many kcal/gram of oral carbohydrates?

A

4

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5
Q

How many kcal/gram of Dextrose?

A

3.4

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6
Q

How many kcal/cc is there in a 10% lipid solution?

A

1.1

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7
Q

How many kcal/cc are there in a 20% lipid solution?

A

2

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8
Q

What are the protein requirements of a healthy adult male?

A

1g/kg/day protein (20% essential AA)

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9
Q

How much does trauma, surgery, or sepsis stress increase the k/cal requirements?

A

20-30%

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10
Q

How much does pregnancy increase the kcal requirements?

A

300 kcal/day

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11
Q

How much does lactation increase kcal requirements?

A

500kcal/day

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12
Q

How do you calculate the calories required in a burn?

A

25kcal/kg/day + (30 kcal/day x % of burn)

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13
Q

How do you calculate protein required in a burn?

A

1-1.5 g/kg/day + (3g x % of burn)

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14
Q

How much does the basal metabolic rate rise in fever?

A

10% for each degree above 38.0

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15
Q

Central line TPN is based on what?

A

Glucose. Max glucose administration is 3g/kg/hr

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16
Q

Peripheral line parenteral nutrition is based on what?

A

fat

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17
Q

What is the fuel for colonocytes?

A

short chain fatty acids

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18
Q

What is the fuel for small bowel enterocytes?

A

Glutamine

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19
Q

What is the most common AA in bloodstream and tissue?

A

Glutamine

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20
Q

What does Glutamine do in kidney?

A

Releases NH4, helping with nitrogen excretion (can also be used for gluconeogenesis)

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21
Q

What is the primary fuel for neoplastic cells?

A

Glutamine

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22
Q

What is the half life of albumin?

A

20 days

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23
Q

What is the half life of Transferrin?

A

10 days

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24
Q

What is the half life of Pre-albumin?

A

2 days

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25
Q

What is the normal protein level?

A

6.0-8.5

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26
Q

What is the normal albumin level?

A

3.5-5.5

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27
Q

What are acute indicators of nutritional status?

A

retinal binding protein, pre-albumin, transferrin, total lymphocyte count

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28
Q

What is the Ideal Body Weight calculation?

A

Men: 106 + 6 for every inch over 5ft

Women: 100 + 5 for every inch over 5ft

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29
Q

What are preoperative signs of poor nutrition?

A
  • Weight loss >10% in 6 months
  • Hx of poor intake
  • Loss of muscle mass and subq fat
  • Worsening weakness
  • Edema (sign of hypoalbuminemia)
  • Labs only in addition to physical - transferrin, albumin, prealbumin
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30
Q

What is the respiratory quotient?

What is it used for?

A

ratio of CO2 produced to O2 consumed

used to measure the sufficiency of nutritional intake by determining the type of metabolism the body is using

ketones, protein, carbs give different RQs

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31
Q

An RQ of >1 means what?

A

lipogenesis - overfeeding; decrease carbs and caloric intake

can lead to ventilator problems for CO2 buildup

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32
Q

An RQ of <0.7 means what?

A

ketosis and fat oxidation (starving). Increase carbs and caloric intake

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33
Q

Pure fat metabolism has an RQ of?

A

0.7

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34
Q

Pure protein metabolism has an RQ of?

A

0.8

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35
Q

Pure carbohydrate metabolism has an RQ of?

A

1.0

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36
Q

Postoperative diuresis phase occurs when?

A

days 2-5

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37
Q

Postoperative catabolic phase occurs when?

A

days 0-3 (negative nitrogen balance)

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38
Q

Postoperative Anabolic phase occurs when?

A

days 3-6 (positive nitrogen balance)

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39
Q

How long before glycogen stores are depleted?

A

24-36 hours of starvation (2/3 in skeletal muscle, 1/3 in liver)

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40
Q

What do skeletal muscles lack that is found in the liver in regards to glycogen metabolism?

A

Glucose-6-phosphatase

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41
Q

What are the gluconeogenesis precursors?

A

AA (especially alanine), lactate, pyruvate, glycerol. Alanine is simpleist AA precursor for gluconeogenesis and is primary substrate.

42
Q

What AA increase during times of stress?

A

Alanine and Phenylalanine

43
Q

In late starvation, gluconeogenesis also occurs in what organ?

A

Kidney

44
Q

Why do protein conserving mechanisms not take place after trauma?

A

catecholamines and cortisol

45
Q

What is the main source of energy during trauma and starvation?

A

Fat (ketones)

46
Q

What percentage of weight loss can most patients tolerate without major complications?

A

15%

47
Q

How many days can patients tolerate without eating?

A

7 days. After that place dobbhoff or start TPN

48
Q

Why do you want to feed gut?

A

avoid bacterial translocation (enterocytes starved and allow bacterial leak)

49
Q

What is an elemental formula?

When would it be used?

A

all protein given in the form of amino acids

used for people having trouble absorbing/breaking down proteins - short bowel syndrome, infants w/ protein allergies

50
Q

When to consider PEG?

A

when regular feeding not possible (CVA), or when feeding not to occur for >4 weeks

51
Q

What does the brain utilize with progressive starvation?

A

ketones

52
Q

What are the obligate glucose users?

A
  • peripheral nerves
  • adrenal medulla
  • red blood cells
  • white blood cells
53
Q

What happens during refeeding syndrome?

A

drop in K+, Mg+, and PO4. causes cardiac dysfunction and fluid shifts. Start refeeding at low rate (10-15kcal/kg/day)

54
Q

What cell signaling protein is thought to mediate cachexia?

A

TNF alpha

55
Q

What is kwashiorkor?

A

protein deficiency

56
Q

What is Marasmus?

A

starvation

57
Q

How many grams of protein contains 1 gram of Nitrogen?

A

6.25

58
Q

How do you calculate Nitrogen balance?

A
  • (protein in/6.25) - (24 hour Urine N + 4 grams)
  • positive # = anabolism
  • negative # = catabolism
59
Q

What is the total protein synthesis for a healthy, normal, 70kg male?

A

250 g/day

60
Q

What is the function of Urea production?

A

get rid of ammonia from amino acid breakdown

61
Q

What is AA is produced in the majority of skeletal muscle breakdown?

A

glutamine and alanine

62
Q

In digestion, what breaks down triacylglycerides, cholesterol, and lipids?

What are they broken down into?

A

Pancreatic lipase, cholesterol esterase, phospholipase

broken down into micelles and free fatty acids

63
Q

What are Micelles?

A

Aggregates of bile salts, long chain fatty acids, and monoacylglycerides

64
Q

How do micelles enter enterocytes?

A

they fuse with the membrane

65
Q

What are the fat soluble vitamins?

A

A, D, E, K

66
Q

How do medium and short chain fatty acids enter enterocytes?

A

simple diffusion

67
Q

After micelles and other fatty acids enter enterocytes, how are they transported out?

A
  • chylomicrons are formed - 90% TAG’s, 10% phospholipids/proteins/cholesterol
  • chylomicrons enter lymphatics - thoracic duct
  • MC & SC FA’s - portal system - liver
  • LC FA’s enter lymphatics like chylomicrons
68
Q

Where is lipoprotein lipase found and what does it do?

A

liver endothelium; clears chylomicrons and TAG’s from blood breaking them down to FA’s and glycerol. Then taken up by hepatocytes

69
Q

Where is free fatty acid binding protein found and what does it do?

A

Liver endothelium; binds short and medium chain FA’s

MCFAs/SCFAs - simple diffusion into enterocytes - portal system - liver

70
Q

What is the most important route of entry for dietary cholesterol?

A

VLDL; synthesized in liver

71
Q

What are saturated fatty acids used for?

A

Fuel for cardiac and skeletal muscles

72
Q

What are unsaturated fatty acids used for by the body?

A

structural components of cells

73
Q

Where is Hormone sensitive lipase found, what does it do, and what stimulates it?

A
  • found in fat cells
  • breaks down TAG’s to fatty acids and glycerol
  • stimulated by GH, catecholamines, glucocorticoids
74
Q

What are essential fatty acids?

A

linolenic, linoleic

75
Q

Omega-3 fatty acids are needed for what?

A

PGI3, TXA3, LTB5 (all even)

76
Q

Omega-6 fatty acids are needed for what?

A

PGE2, TXA2, LTB4 (all even)

77
Q

Glucose and Galactose use what process for absorption?

A

secondary active transport

78
Q

Fructose uses what process for absorption?

A

Facilitated diffusion

79
Q

Sucrose is made up of what?

A

fructose + glucose

80
Q

Lactose is made up of what?

A

galactose + glucose

81
Q

Maltose is made up of what?

A

glucose + glucose

82
Q

Trypsinogen is released from where and activated by what?

A

pancreas; activated by enterokinase from duodenum (can also be autoactivated by trypsin)

83
Q

What are the branched chain amino acids?

A

isoleucine, leucine, valine

The BRANCH IS LOOSE, VAL!

84
Q

Chromium deficiency?

A

hyperglycemia, encephalopathy, neuropathy

85
Q

Selenium deficiency?

A

Cardiomyopathy, Weakness, Hair loss

86
Q

Copper deficiency?

A

Pancytopenia

87
Q

Zinc deficiency?

A

Hair loss, poor healing, rash

88
Q

Trace element deficiency?

A

poor wound healing

89
Q

Phosphate deficiency?

A

Weakness, failure to wean off Vent (hyporesponsive diaphragm) encephalopathy, decreased phagocytosis

90
Q

Thamine B1 deficiency?

A

Wernicke’s, cardiomyopathy, peripheral neuropathy

91
Q

Pyridoxine deficiency?

A

Sideroblastic anemia, glossitis, peripheral neuropathy

92
Q

Cobalamin B12 deficiency?

A

Megaloblasic anemia, peripheral neuropathy (as opposed to folate deficiency), beefy tongue

93
Q

Folate deficiency?

A

megaloblastic anemia, glossitis

94
Q

Niacin deficiency?

A

Pellagra (diarrhea, dermatitis, dementia)

95
Q

essential fatty acid deficiency?

A

dermatitis, hair loss, thrombocytopenia

96
Q

Vitamin A deficiency?

A

Night blindness

97
Q

Vitamin K deficiency?

A

coagulopathy

98
Q

Vitamin D deficiency?

A

Rickets, osteomalacia

99
Q

Vitamin E deficiency?

A

Neuropathy

100
Q

Briefly describe steps of Cori cycle

A

Glucose used in muscle, broken down to lactate, lactate to liver, lactate converted to pyruvate, pyruvate to glucose via gluconeogenesis, glucose back to muscle

ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn (51 decks)

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