Disease States Flashcards
1
Q
Valproic acid
A
Depletes hepatic carnitine stores
2
Q
Treat gastric phytobezoar
A
Coke, cellulase, removal
3
Q
RQ
A
CO2/O2
1 = CHO
0.8 mixed
0.7 fat
4
Q
NUTRIC aspects
A
ICU patients who could benefit nutrition therapy
Age, APACHE II, SOFA (organ failure assessment), # comorbidities, days from hospital to ICU admit, IL-6
5
Q
Excess tension external/internal bolster leads to
A
Erosion/bleeding and ulceration of gastric mucosa
6
Q
Glucolipotoxicity
A
High glucose and FA has negative effect on pancreatic beta cells
7
Q
Chronic Intestine Pseudo Obstruction MNT
A
Motility disorder of peristalsis
Small frequent meals with low fat/fiber and increase liquids
8
Q
Octreotide used for
A
Diarrhea, severe dumping syndrome
9
Q
Contraindications using IC
A
Air leak ECMO HD (during and hours after) Supp O2 FIO2 >60% Inability cooperate
10
Q
Glycolysis (type, location, product)
A
Anaerobic
Cystoplasm
Pyruvate
11
Q
Kcals released per mole ATP
A
7 kcal
12
Q
Pyruvate -> Anaerobic and Aerobic conditions
A
Aerobic: TCA for max energy production
Anaerobic: Lactate (less)
13
Q
Where is TCA cycle
A
Mitochondrial membrane
14
Q
1 glucose produces how many ATP
A
36
15
Q
After 24 hours starvation, glucagon promotes
A
FA oxidation
16
Q
After 14 days of starvation, adipose provides
A
90% of EER
High FA oxidation -> ketogenesis
17
Q
Fiber DRi
A
14 g/1000 kcal
18
Q
Beta oxidation yields
A
1/2 amount of acetyl co-a as # of carbon
19
Q
Acceptable TAG 4 hours after ILE piggyback infusion
A
<250 mL
20
Q
EFAD indicator
A
Triene:tetraene ratio >0.2
21
Q
Conditionally essential AA
A
Tyrosine, taurine, glutamine, histidine, cysteine
22
Q
Alter reliable N balance
A
BUN fluctuates >10/day
Cr clearance <50 mL/min
Low UO
Muscle atrophy
23
Q
Only AA that undergoes oxidation via acetyl Co A in muscle
A
Leucine
24
Q
Structure/function claim
A
Describes roles intended maintain structure or function
Doesn’t require FDA
25
Health Claim
Effect on decreasing risk of disease
| Requires FDA
26
Phenytoin interacts with
Folic acid
27
Treat dehydration at home
1L x3 days
28
Relative risk ratio tends to
Overestimate treatment effect
Likelihood of outcome effect in study group compared to control - if 1.00 outcome is equal
29
Large RCT may flaw in
Generalizing to patient care (external validity)
30
Folate pregnancy
60 mcg
31
NG in pregnancy increased risk for
Reflux/delated gastric emptying
32
N balance pregnancy
4-6
33
Important vitamin/mineral in wounds
A, D, E, K, C, Zinc, Iron, Ca
34
Decrease energy expenditure (3)
Barbituates, Propranolol, Rocuronium
35
Needs in TBI if no IC
140% harris benedict
36
Mannitol causes
Low K, Mag and volemia
37
SCI protein immediately following
1.5-2.0
38
Quadriplegia/Paraplegia kcal needs
Quad: 20-22
Para: 22-24
39
Normal BMI for SCI
18-22
40
Stroke protein
1.0-1.5
41
ALS/Lou Gehrigs
Hypermetabolic: 34-35 kcal, 0.8-1.2
42
Carbidopa/Levodopa competes with ___ for transport
Protein
43
Protein for sepsis and stressed trauma
1.5-2.0
44
NRS 2002
BMI <20.5
Weight loss
Reduced intake weight
ICU pt
45
Burn protein
1.5-2.0 stressed
| 20% obese
46
Fluid burns >15% TBSA
4 mL of LR/kg x TBSA
1/2 in 1st 8 hours
Rest in rest 16 hours
47
Burns >20% TBSA: vitamins/minerals
Vitamin A, Zinc, VIt C, Copper, selenium
48
ASPEN recommends formula with omega 3 and arginine for
post op trauma and ICU
49
Prevent risk vent associated pneumonia
Elevate HOB 45 degree
Oral care with chlorohexidine
Limit broad spectrum abx
Suction
50
Meds delay gastric empty
Aluminum antacids, anticholinergics, lithium, octreotide, zofran, sucralfate, antidepress/SSRI
51
Crohns MNT (3)
1.0-1.5
Increase Ca/Vit D
Zinc if diarrhea
52
CF Ideal weight
Children >50% weight for length
Men: 23 BMI
Women: 22 BMI
53
CF MNT
35-40% fat
54
Protein losing gastroenteropathy MNT
Low fat diet
55
Food protein enterocolitis syndrome (FPIES)
Children wean from BM/formula - allergy, eventually grow out
56
Hereditary Hemochromatosis MNT
Limited iron alcohol and vitamin C intake
57
Wilsons disease symptoms and MNT
Resting tremor, ataxia, dystonia, rigidity
```
Chelation Therapy (oral penicillamine and zinc salts)
Avoid high copper food (fish, nuts, chocolate, mushrooms)
```
58
Fat malabsorption usually associated with decreased ___ absorption which increased ___
Calcium
| Oxalates
59
Octroetide can cAuse
Hyperglycemia
60
Ascites: Mild to Severe
Mild 3-5 kg
Moderate: 7-9 kg
Severe: 14-15 kg
61
Cirrhosis MNT
REE x1.2-1.4, 30-40% fat
| Pro 1.0-1.5
62
Vitamins/Minerals in alcoholics
1, 2, 6, 12, folate, zinc, mag, C
63
Esophageal varices and TF
OK to use soft/fine bore tube if not bleeding
64
If Alk Phos, AST, ALT are high in pancreatitis, like ____ cause
Biliary
| S/p high fat meal
65
APACHE II in Pancreatitis
most predictive of severity/clinical outcomes
< or equal 9: mild/mod
> or equal 10: severe
66
Acute pancreatitis is more ____ than chronic
Hypermetabolic/catabolic
67
Gastric outlet syndrome
Obstruction interferes with gastric emptying
| N/V, pain, early satiety
68
Pancreatitis protein
1.5 g pro
69
If have ____ () in pancreatitis, lower risk for high TAGs
Lipids <1 g/kg/d and glucose control
70
Steatorrhea dx
>7 g fat after eating 100 g
71
Pseudocyst: What is and what it can cause
Lesion looks like cyst but fluid on tissue
SBO or GOO
72
Do not put ____ in J tube d/t risk for clogging
Pancreatic enzymes
73
GFR Stage 4 and 5
<29
| <15
74
CKD Non HD MNT
30-35 kcal
| 0.6-0.8 g pro, 1.0 in illess
75
CRRT needs
30-35
| 1.0-2.5
76
Potassium recommendation if high in HD
40 mg/kg/d
77
PD can provide ____ kcal
500-1000 kcal
~40% uptake
78
Dont restrict na or water in nonoliguric AKI unless
Hypernatremia or fluid overload
79
Oral citrate can ___ aluminum absorption
Increase
80
Measure iron status
Iron, TBC, Ferritin, Iron saturation
81
SI length
400-800 cm
| Absorb 6-8 L /day
82
Ileum absorbs __ (2)
Bile and hormones
Bile in colon -> watery diarrhea
Hormones -> dumping
83
Supplement ___ if at least 50 cm of ileum is resected
b12
84
Low K, Mag and Ca common in
SBS
85
Urine Na Goal SBS
>20
86
SBS, GB, and PNand Dual X ray
2-3 years sbs
1-3 others
87
SBS MNT
```
35-45 kcal, 1.5-2.0 pro
10-15 g fiber
Small, frequent meals
Isotonic ORS separate from meals - limit water
Limit simple sugars
Liberal salt
```
W/ Colon: 20-30% fat
W/o colon: 40-60% fat
88
EN in SBS formula type
Isotonic polymeric
| May need semi elemental
89
Oley Foundation
Home NS patients
90
Wean PN in SBS need at least ___ cm
Jejunostomy: 100 cm
Colon: 30 cm
91
Most medications absorb in
Jejunum
92
Loperamide
Anti diarrheal
93
Avoid cholestyramine in
SBS
94
Lack of ileocecal valve increases risk for
SIBO
95
Tegludatide used for
Improves gastric emptying and decreases GI secretions
96
Cyclosporine and tacrolimus cause ___ and increase risk for ___
Hyperglycemia, hyperkalemia, and hypomagnesemia
| new onset diabetes after transplant
97
S/p organ and bone marrow transplant protein
1. 5-2.0 acute
| 1. 0 chronic
98
Abx decrease
E, K, Folate
99
PN usually after ___ transplant
SI
100
HIV metabolic changes
Increased REE
Inappropriate substrate use
Futile cycling lipids
Increased lipogenesis
101
Food Insecurity assessment
USDA questionnaire
| Radimer Cornell
102
Waist circumference and waist to hip ratio to differentiate between
Wasting and lipodystrophy
| MUAC and NHANES as reference
103
Ca, Mag, and Aluminum decrease absorption of what meds
Azithromycin and Levafloxin
104
Thiazide diuretics increase
Calcium excretion -> Increased calcium levels
105
EN in cancer for
Active treatment and malnourished who unable ingest/absorb for >7-14 days
106
Mineral deficiency risk when bypass duodenum and proximal jejunum (5)
Iron, Ca, Zn, Cu, Se
107
S/p hematopoietic stem cell transplant MNT
```
No iron
Low microbial diet
30-35 if malnourished
1.5-2.0 protein
Maybe parenteral glutamine
```
108
Tumor Lysis Syndrome labs (3)
Hyperkalemia
Hyperphosphatemia
Hyperuricemia
109
Loop diuretics can cause
Azotemia, hypomag, hypokalemia
110
Insulin sensitivity factor
1500 or 1800/sensitive factor = x mg/dL
Premeal glucose - goal = y
y/x = units needed
1500 for regular, 1800 for rapid
111
Correct Na for hyperglycemia
Na + [0.016 x (glucose - 100)]
112
Max dex rate for DM or critically ill
4 mg/kd/min
113
Find desired g dextrose based on goal
goal (3-5) x wt x 1440 / 1000
114
Vitamins/minerals s/p GB
MVI, D, Folate, Cal citrate, Iron, B12
115
EN increase QOL and survival in
Head/neck cancer
CVA with dysphagia
Neuromuscular dystrophy
Growth failure children
116
J tube typically placed by
Witzel technique
| Greater freedom movement and prevent irritation
117
S/p esophogastectomy may cause
Loss peristalsis
Smaller stomach, need softer food
Risk chylothorax
118
Gastric surgery complication
Anastomotic stricture, Anastomotic ulcer, SBO
119
Chylothorax and MNT
Chyle in pleural space
| High protein, very low fat, MCT
120
Ileostomy output shoudl be less then ___/24 hours
1L
121
____ most common s/p gastric resection
Iron deficiency anemia
122
Ebb phase
3-5 days
| Decreased energy, hyperglycemia, decreased temp, decreased volume
123
IC measures
REE and RQ
Gas exchange
Using Weir equation
124
What factor other than overfeeding increases RQ
Excess buffer like bicarb
Hypoventilation decreases RQ
125
Stress phase response to illness
First 24 hours
126
FA greater than ___ carbona requires bile acids
10
127
Urea accounts for about ___ of urine nitrogen loss
80%
128
After 2 days of starvation brain uses ___ as fuel
Ketones
129
Prolonged NG output decreased
K, Cl, Na
130
Copper deficiency can cause ____ anemia
Microcytic hypochromic
131
What type of malnutrition - hypoglycemia, ketosis, lipolysis?
Starvation
132
What type of malnutrition - hyperglycemia, hypermetabolism, lipolysis?
Stress
133
SGA good for what populations
GI surgery
Liver transplant
Dialysis
134
Frailty
```
Sarcopenia
Weight loss
Exhaustion
Weakness
Slow walking
Low PA
```
135
Reverses effect levodopa
B6
136
Decreases appetite in older adult
Narcotics
Histamine receptor antagonists (H2 blocker)
Antihypertensive
137
Contributes to Digoxin toxicity (3)
Hypercalcemia, hypokalemia, hypomag
138
SF 36 vs Katz ADL vs Lawton Brody vs FIM
Health related QOL
ADLs
Instrumental ADLs
Functional independence in rehab setting
139
Marasmus and whose at risk
Loss fat and somatic muscle
Illness, starvation, elderly
140
Kwashiorkor
Visceral muscle loss cause low albumin -> edema
141
Hypothyroidism can cause
| Hyperthyroidism can cause
Hypoglycemia
| Hyperglycemia
142
Low Mg can lead to
Na/water depletion
143
Superior vena cava syndrome
compression of the SVC characterized by shortness of breath, dyspnea, cough, cyanosis of face, neck, shoulder and arms, and distended chest or neck veins.
144
Mural thrombus
when fibrin builds up inside the vein and causes the vascular access device to adhere to the vessel wall
145
Intraluminal thrombus
clot within the catheter lumen and caused by inadequate flushing and blood reflux
146
Which type of diuretic induces hyponatremia?
Thiazides
147
High Risk Compounding
involves using nonsterile ingredients or nonsterile devices prior to terminal sterilization (i.e. extemporaneously compounded L-glutamine for supplementation in a PN formulation).
148
Define cracking of a TNA mixture/visual signs
yellow-brown oil droplets at or near the TNA surface.
a continuous layer of yellow-brown liquid at the surface of the TNA.
marbling or streaking of the oil throughout the TNA.
149
Typical osmolality of formulas based on cal/mL
1.0 kcal/mL (300-350 mOsm/kg), 1.2 kcal/mL (400-450 mOsm/kg), 1.5 kcal/mL (500-650 mOsm/kg), 2 kcal/mL (700-800 mOsm/kg).
150
PN requirements
Complete patient identifiers (patient name, medical record number or other unique identifiers, patient location)
Birth date and/or age
Allergies and associated reactions
Height and dosing weight in metric units
Diagnosis/diagnoses
Indication(s) for PN
Administration route/vascular access device (peripheral vs central)
Contact information for prescriber
Date and time order submitted
Administration date and time
Volume and infusion rate
Infusion schedule (continuous or cyclic)
Type of formulation (dextrose/amino acids with separate infusion of IVFE or total nutrient admixture)
Ingredients ordered as amounts per day (for adult patients) or amounts per kilogram per day (for pediatric and neonatal patients)
Electrolytes salt form rather than the individual ion.
generic name for each ingredient
151
Zollinger Ellison
disorder in which too much gastric acid
