Exam 3 - Walroth Flashcards
NBW =
IBW + 0.25(weight - IBW)
albumin normal range
3.5-5 gm/dL
prealbumin (transthyretin) normal range
15-40 mg/dL
transferrin normal range
250-300 mg/dL
CRP normal range
< 1 mg/dL
Why should CRP and prealbumin always be checked together?
Prealbumin is falsely decreased in the presence of inflammation, so CRP is used to assess accuracy
Prealbumin decreases as CRP increases =
inflammation
Prealbumin decreases as CRP normal =
malnutrition (CRP has nothing to do with nutrition!)
Risk factors for malnutrition in ICU patients
- NPO > 7 days
- gut malfunction
- mechanical ventilation
- increased metabolic needs
nitrogen balance ideal goal:
+3-5
calorie requirements for trauma pts:
25-30 kcal/kg/day
protein requirements for trauma/ICU pts:
1.5-2 gm/kg/day
1 g protein = _____ kcal
4 kcal
RQ < 0.85 =
underfeeding
RQ > 0.95
overfeeding
Parenteral nutrition (PN) indications:
- anticipated NPO > 7 days
- inability to absorb nutrients via gut - small bowel resection or small bowel/colon ileus
- fistulas
- IBD
- Hyperemesis gravidum
- Bone marrow transplant
Disadvantages of peripheral PN:
- requires large amounts of fluids
- limited in calories
Advantages of central PN:
- allows for hypertonic solutions and therefore more calories
Disadvantages of central PN:
- risk of infection
- complications: pneumothorax, air embolus
1 g dextrose = _____ kcal
3.4 kcal
1 g lipid = ______ kcal
10 kcal
max carb utilization = ______ mg/kg/min
4-5
SMOFlipid components
soybean oil (30%)
medium chain triglycerides (30%)
olive oil (25%)
fish oil (15%)
Advantages of SMOFlipid as compared to intralipid
- lower increase in TG levels
- improved liver function
- reduced risk of infection
- less pro-inflammatory
What is the max hang time of IV lipids? Why?
12 hours because of risk of pathogen growth
Patients with CrCl < ______ should not receive electrolytes in their PN
50
Do not exceed ______% of caloric intake as lipids
60
Maximum _______ gm/kg/day of lipids in adults
2.5
Maximum _____ gm/kg/day of lipids in infants/peds
4
IV fat emulsion ____% must be incorporated into a TNA
30
When initiating PN, start at _____% of goal and achieve the final rate within _____ hours
25%
24 hours
When initiating PN, how often should you check blood glucose?
q4-6h or before each increase in rate
T/F: You should consider insulin therapy if their BG > 200 during the first check.
False, continue at same rate for 4 hours, then recheck BG. If still > 200, consider insulin therapy
How do you discontinue PN?
Decrease rate by half q2h until rate is <50ml/hr, then d/c
In patients with renal disease, we should use caution with which electrolytes in particular?
Potassium, phosphate, magnesium
Acid-base balance is obtained through balance of which electrolytes?
Chloride and acetate
Which vitamins are cleared renally and therefore should be used with caution in CKD patients?
zinc, selenium, chromium
Addition of which vitamin to PN is NOT recommended?
Iron
Which medication may be added to PN for GERD or stress ulcer prophylaxis? Which medications should not be added?
Famotidine can be used
PPIs should NOT - not compatible with PN
MIVF = _______ mL/kg/day
30-40
1 mMol phos = ______ mEq phos
1.4
Acetate is converted 1:1 to ___________ in the system?
bicarb
Which is harder for the body to reverse: alkalosis or acidosis?
alkalosis
What are some complications of PN?
-catheter-related sepsis
-bacterial translocation
-hyper- and hypoglycemia
What electrolytes abnormalities are common in refeeding syndrome?
HYPOPHOSPHATEMIA
hypomagnesemia
hypokalemia
Oral consumption contraindications:
- Esophageal obstruction
- Head and neck surgery
- CVA
- Dementia
Advantages of EN (vs PN)
- decreased chance of bacterial translocation
- avoid risks associated with IVs- line infections, pneumothorax
- more physiologic than PN
- less stringent administration protocol
- less expensive
How many mL of multivitamin do we add to TPN?
10 mL
How many mL of multi-trace elements do we add to TPN, given no renal or hepatic impairment?
1 mL
Define marasmus
Protein and calorie deficient
Define kwashiorkor
protein deficient only
Marasmus characteristics
-wasting or skeletal muscle and SQ fat
-hair loss
-skin folds form
-peeling, pigmented skin
Kwashiorkor characteristics
-large belly
-diarrhea
-change in skin pigment
-failure to gain weight
Consider an addition of vitamin _____ for marasmus
B
Kwashiorkor treatment
Provide carbs followed by high protein
