Exam 3 lecture 1 Parenteral and Enteral Nutrition Flashcards
How to calculate IBW
Male- 50 Kg + (2.3 x inches over 60”)
Female- 45.5 + (2.3 x inches over 60”)
How to calculate DBW (dosing body weight)? When to use it over IBW
DBW= IBW + 0.4 (wt-IBW)
use if body weight is 130% or more of IBW
APplies for certain drugs (antibiotics)
How to calculate nutritional body weight (NBW)
NBW= IBW + 0.25 (wt-IBW)
Use if actual body weight is 130% or more of IBW
APplies for calculating fluid, electrolytes, and nutrition parameters (FEN)
Use this if drug isnt antibiotic and is >130% of actual body weight
What is one of the most common indications for parenteral nutrition
small bowel resection
benefits of early initiation of nutrition
decrease disease severity, complications and ICU length of stay. Increases patient outcomes
what are some risk factors for malnutrition
-under body weight (UBW) = 20% below IBW
-Involuntary weight loss >10% within 6 months
-NPO> 7 days
-gut malfunction
-mechanical ventilation
-increased metabolic needs (trauma or burn pts, high dose steroids)
- alcohol/substance abuse
- protracted nutrient loss
time frame to start nutrition in hospital
eithin 48 hours of hospitalization
What are screening tools used in nutrition
NUTRIC
Nutrition risk score (NRS)
What is the score hugh risk patients have for NUTRIC? Low risk?
High risk- 6-10 (5-9 without IL-6)
low risk- 0-5 (0-4 without IL-6)
WHat are things to consider when doing a nutritional assessment
Risk factors for malnutrition
History
Anthropometrics
Classifications of malnutrition
Nitrogen balance
What are things in pateintsbhistory we use when ding a nutritional assessment
- Dietary- intake, swallowing, ulcers, anorexia, vomiting diarrhea
- medical- surgical history , PMH
- Medications- decrease nutrient absorption, alter taste, N/V
what is anthropometrics
somatic (muscle) protein stats
- weight
-triceps skin fold
-arm muscle circumfrence
WHat are labs that show visceral protein status. WHat is the best MP listed (marker point)?
albumin
transferrin
transthyretin (prealbumin)
retinol binding protein
the best is transthyretin
We do not just use prealbumin to make decisions in ICU
What is the relationship between prealbumin and CRP (c-reactive protein)? What is CRP? use? Normal level of CRP? What happens to prealbumin during inflammation?
prealbumin decreases as CRP increases–> inflammation
Prealbumin decreases as CRP normal—> malnutrition
CRP is an acute phase reactant that increases during inflammation
normal < 1 mg/dl
used to assess accuracy of prealbumin
prealbumin is falsely decreased in presence of inflammation
classifications of malnutrition
- marasmus- protein-calorie malnutrition. Decreased total intake and/or utilization of food
Wasting of skeletal muscle and sq fat
Immunosuppression in severe cases - Kwashorkor (protein malnutrition). Adequate caloric intake, relative protein malnutrition
- mixed- chronically ill starved patients who are metabolically stressed. decreased visceral proteins, poor wound healing, immunocompromised
symptoms of marasmus and kwashorkor? treatment?
kwashorkor symptoms- large belly, diarrhea, change in skin pigment, decreased muscle mass, failure to gain weight, hair changes
wasting of muscle not as evida=ent as marasmus
treatment- provide carbs followed by high protein
marasmus symptoms- Peeling and alternatively pigmented skin, hair loss, edema, swelling, skin folds are formed. Wasting of muscles are quite evident. Treatment provide a balanced substrate
What is nitrogen balance? How is nitrogen excreted? In what form? What increases the nitrogen balance? WHat percent of total nitrogen excretion.
it is a measurement of urinary excretion of nitrogen as urea nitrogen (urinary urea nitrogen; UUN)
- nitrogen released from protein catabolism. It is converted to urea and excreted in urne.
stress increases nitrogen balance. So does protein catabolism
Measured from 24 hr urine collection
represents 85-90% of total nitrogen excretion
What is the goal nitrogen balance
+3 to +5 grams
how to calculate nitrogen balance?
Nitrogen balance= (N in)- (N out)
N in= 24 hour protein intake (g)
——————————-
6.25
N out= 24 hour UUN + 4
(we use 4 because goal is between 3-5 g)
What is TEE?
total energy expenditure
caloric requirements based on condition of patient
a) non-stressed/non depleted- 20-25
b) Trauma/stress/surgery
critically ill 25-30 (EXAM)
major burns
c) Obesity: BMI 30-50 11-14 kcal/kg/day
actual body weight
d) Obesity: BMI>50 22-25 kcal/kg/day
ideal body weight
Calories needed for hospital stay patients XEAM
25-30
how to get a TEE from an REE
TEE= REE x 1.2
What is indirect calorimetry?
Preferred method for critically ill patients
Provides energy expenditure (REE, RQ) at that one pount in time, then extrapolated to 24 hrs
What is RQ? how do we calculate it?
For all energy production, oxygen is consumed and co2 is produced
RQ= Vco2/Vo2
What is a normal RQ? What does it mean if it is above or below the normal range?
0.85-0.95
if it is above 0.95- overfeeding
below 0.85- underfeeding
monitor once weekly
