Day 3- Disease Specific and Enteral Nutrition Flashcards
What are your caloric needs for a burn and wound victim?
What are your protein and lipid needs in wound and burn victims?
What are your carbs, water, and micronutrients in wound and burn victims?
> 30 kcal/kg/day. Underweight patients are 35-40 kcal/kg/day.
1.2-2 g/kg/day. If BSA burn >25% it’s 2.5-3g/kg/day. Need Arginine(protein synthesis) and Glutamine(stimulates inflammatory response in wound healing). Improved immunity and survival in low fat diet.
Need a lot of carbs due to collagen synthesis, Use Parkland formula for water which is 4 mL X weight(kg) X burn BSA and give 50% in first 8 hours and 50% over next 16 hours. Supplement with vitamin A,C, iron, and zinc.
What are your caloric needs for a trauma patient?
What are your protein and lipid needs in trauma patient?
What are your carbs, water, and micronutrients in trauma patient?
20-35 kcal/kg/day
1.5-2 g/kg/day. Arginine and Glutamine helpful. Generally unchanged lipids but Omega 3 may be helpful.
Insulin resistance is common so glucose control is important, no major water changes unless disease dictates, no major micronutrients but it broken bone consider vitamin D.
What are your caloric needs for a sepsis/infection patient?
What are your protein and lipid needs in sepsis/infection patient?
What are your carbs, water, and micronutrients in sepsis/infection?
Permissive underfeeding may be beneficial, patients are usually catabolic.
1.5-2 g/kg/day Glutamine beneficial but avoid arginine. Avoid more than 30%.
Watch for hyperglycemia. No major changes in the other 2.
What are your caloric needs for a pulmonary failure patient?
What are your protein and lipid needs in pulmonary failure patient?
What are your carbs, water, and micronutrients in pulmonary failure?
20-30 kcal/kg/day
1.5-2 g/kg/day. 30% of daily, may need to increase if you drop carbs.
Lower carbs may help get them off vent, fluid restriction, Aggressive phosphorous replacement may be warranted.
What are your caloric needs for a renal failure patient?
What are your protein and lipid needs in renal failure patient?
What are your carbs, water, and micronutrients in renal failure?
No major changes
1.5-2 g/kg/day in dialysis. Not on dialysis is 0.6-0.8g/kg/day. No major lipid changes.
No carb changes, fluid restricted to 1-1.5 L/day, Limit potassium, magnesium, phosphorous, use acetate or citrate salts to maintain acid base, supplement with water soluble vitamins and vitamin D.
What are your caloric needs for a liver failure patient?
What are your protein and lipid needs in liver failure patient?
What are your carbs, water, and micronutrients in liver failure?
Malnutrition is common. 30-35 kcal/kg in acute or chronic liver failure.
> 1g/kg/day. decrease in fulminate hepatitis or hepatic encephalopathy to 0.6-0.8 g/kg. No major fat changes, if triglycerides >300 mg/dL decrease lipids.
Increase carbs, fluid and sodium restriction,Avoid copper and manganese, zinc deficiency is common, supplement with fat and water soluble vitamins.
What are dietary requirements in short bowel syndrome?
What are dietary requirements in cystic fibrosis?
How do you treat celiac disease?
Oral rehydration, small frequent meals, vitamin supplements and avoid high sugar, fat, protein, fiber. Medications used to treat are PPI’s H2RA’s, Ursodiol, Growth hormones and GLP-2 analogues, Parenteral nutrition is common and can be used in the long term.
Pancreatic enzymes, 500 units of lipase/kg/day(no more than 10,000 units per day). H2RA and PPI, Ursodiol, Multivitamins, Cyproheptadine.
Avoid glucose.
When do you start EN?
When do you NOT give EN?
What are your types of EN access?
Dysphagia,Mental status changes, mechanical vent, malabsorptive states, must have functional GI tract, must be able to safely obtain access, If critically ill–> w/i 24-48 hours of no intake, if not it’s with in 7 days of no intake.
Mechanical intestinal obstruction, necrotizing enterocolitis, Will only need EN for a short period of time(<5-7) days,severe GI bleeds,non mechanical GI obstruction/paralytic ileus, high output fistulas(>500 mL/day).
Orogastric, Nasogastric/duodenal/jejunal, gastrostomy, jejunostomy, gastrojejunal.
Which of your EN tubes are long term?
What is your starting tube feed rate?
What is in your standard formula?
PEG, PEJ, PEG-J.
10-20 mL/hr, increase every 4-6 hrs as tolerated to goal(increase by 10-20 mL/hr).
1-1.2kcal/mL, 5-20% is protein, carbs 40-90%(polymeric corn syrup), can add fiber, provides linoleic acid, and medium chain FA’s.
How much water is normally in an EN formulation?
When do you use elemental formulas?
When do you use renal formulas?
75-85% of water. ranges from 270-700 osmoalilty water, high osmolality will cause diarrhea(normal human is 270-300 so aim around there).
Impaired digestion or absorption. High amino acids and low fat. Routine use is not recommended.
Kidney injury, on dialysis has high protein and calorie, otherwise is low. All low in phosphorous, potassium, calcium.
What is in hepatic formulas?
What is in hyperglycemia formulas?
Which meds cause drug nutrient interactions?
Calorically dense, low sodium, typically low protein but high in branched chain to minimize hepatic enceph, switch formulas i fno improvement in 3-5 days.
Use in patients with diabetes. Low carb and high fat.
Fq’s and thyroid preparations.
How much of our food should come from sugar and saturated fats and how much alcohol and sodium and grains?
What is the cut off for Parenteral nutrition?
What should your carbs per meal be less than when in hospital with diabetes?
<10%, <1 alcoholic drink per day for women and <2 for men, <2300 mg of sodium. Half of all grains should be whole grains.
Patient hasn’t been fed for 7 days or won’t be able to eat for >7 days.
<90.
