Exam 3 - Walroth

Question 1

NBW =

Answer 1

IBW + 0.25(weight - IBW)

Question 2

albumin normal range

Answer 2

3.5-5 gm/dL

Question 3

prealbumin (transthyretin) normal range

Answer 3

15-40 mg/dL

Question 4

transferrin normal range

Answer 4

250-300 mg/dL

Question 5

CRP normal range

Answer 5

< 1 mg/dL

Question 6

Why should CRP and prealbumin always be checked together?

Answer 6

Prealbumin is falsely decreased in the presence of inflammation, so CRP is used to assess accuracy

Question 7

Prealbumin decreases as CRP increases =

Answer 7

inflammation

Question 8

Prealbumin decreases as CRP normal =

Answer 8

malnutrition (CRP has nothing to do with nutrition!)

Question 9

Risk factors for malnutrition in ICU patients

Answer 9

1. NPO > 7 days
2. gut malfunction
3. mechanical ventilation
4. increased metabolic needs

Question 10

nitrogen balance ideal goal:

Answer 10

+3-5

Question 11

calorie requirements for trauma pts:

Answer 11

25-30 kcal/kg/day

Question 12

protein requirements for trauma/ICU pts:

Answer 12

1.5-2 gm/kg/day

Question 13

1 g protein = _____ kcal

Answer 13

4 kcal

Question 14

RQ < 0.85 =

Answer 14

underfeeding

Question 15

RQ > 0.95

Answer 15

overfeeding

Question 16

Parenteral nutrition (PN) indications:

Answer 16

1. anticipated NPO > 7 days
2. inability to absorb nutrients via gut - small bowel resection or small bowel/colon ileus
3. fistulas
4. IBD
5. Hyperemesis gravidum
6. Bone marrow transplant

Question 17

Disadvantages of peripheral PN:

Answer 17

1. requires large amounts of fluids
2. limited in calories

Question 18

Advantages of central PN:

Answer 18

1. allows for hypertonic solutions and therefore more calories

Question 19

Disadvantages of central PN:

Answer 19

1. risk of infection
2. complications: pneumothorax, air embolus

Question 20

1 g dextrose = _____ kcal

Answer 20

3.4 kcal

Question 21

1 g lipid = ______ kcal

Answer 21

10 kcal

Question 22

max carb utilization = ______ mg/kg/min

Answer 22

4-5

Question 23

SMOFlipid components

Answer 23

soybean oil (30%)
medium chain triglycerides (30%)
olive oil (25%)
fish oil (15%)

Question 24

Advantages of SMOFlipid as compared to intralipid

Answer 24

1. lower increase in TG levels
2. improved liver function
3. reduced risk of infection
4. less pro-inflammatory

Question 25

What is the max hang time of IV lipids? Why?

Answer 25

12 hours because of risk of pathogen growth

Question 26

Patients with CrCl < ______ should not receive electrolytes in their PN

Answer 26

50

Question 27

Do not exceed ______% of caloric intake as lipids

Answer 27

60

Question 28

Maximum _______ gm/kg/day of lipids in adults

Answer 28

2.5

Question 29

Maximum _____ gm/kg/day of lipids in infants/peds

Answer 29

4

Question 30

IV fat emulsion ____% must be incorporated into a TNA

Answer 30

30

Question 31

When initiating PN, start at _____% of goal and achieve the final rate within _____ hours

Answer 31

25% 24 hours

Question 32

When initiating PN, how often should you check blood glucose?

Answer 32

q4-6h or before each increase in rate

Question 33

T/F: You should consider insulin therapy if their BG > 200 during the first check.

Answer 33

False, continue at same rate for 4 hours, then recheck BG. If still > 200, consider insulin therapy

Question 34

How do you discontinue PN?

Answer 34

Decrease rate by half q2h until rate is <50ml/hr, then d/c

Question 35

In patients with renal disease, we should use caution with which electrolytes in particular?

Answer 35

Potassium, phosphate, magnesium

Question 36

Acid-base balance is obtained through balance of which electrolytes?

Answer 36

Chloride and acetate

Question 37

Which vitamins are cleared renally and therefore should be used with caution in CKD patients?

Answer 37

zinc, selenium, chromium

Question 38

Addition of which vitamin to PN is NOT recommended?

Answer 38

Iron

Question 39

Which medication may be added to PN for GERD or stress ulcer prophylaxis? Which medications should not be added?

Answer 39

Famotidine can be used PPIs should NOT - not compatible with PN

Question 40

MIVF = _______ mL/kg/day

Answer 40

30-40

Question 41

1 mMol phos = ______ mEq phos

Answer 41

1.4

Question 42

Acetate is converted 1:1 to ___________ in the system?

Answer 42

bicarb

Question 43

Which is harder for the body to reverse: alkalosis or acidosis?

Answer 43

alkalosis

Question 44

What are some complications of PN?

Answer 44

-catheter-related sepsis -bacterial translocation -hyper- and hypoglycemia

Question 45

What electrolytes abnormalities are common in refeeding syndrome?

Answer 45

HYPOPHOSPHATEMIA hypomagnesemia hypokalemia

Question 46

Oral consumption contraindications:

Answer 46

1. Esophageal obstruction 2. Head and neck surgery 3. CVA 4. Dementia

Question 47

Advantages of EN (vs PN)

Answer 47

1. decreased chance of bacterial translocation 2. avoid risks associated with IVs- line infections, pneumothorax 3. more physiologic than PN 4. less stringent administration protocol 5. less expensive

Question 48

How many mL of multivitamin do we add to TPN?

Answer 48

10 mL

Question 49

How many mL of multi-trace elements do we add to TPN, given no renal or hepatic impairment?

Answer 49

1 mL

Question 50

Define marasmus

Answer 50

Protein and calorie deficient

Question 51

Define kwashiorkor

Answer 51

protein deficient only

Question 52

Marasmus characteristics

Answer 52

-wasting or skeletal muscle and SQ fat -hair loss -skin folds form -peeling, pigmented skin

Question 53

Kwashiorkor characteristics

Answer 53

-large belly -diarrhea -change in skin pigment -failure to gain weight

Question 54

Consider an addition of vitamin _____ for marasmus

Answer 54

B

Question 55

Kwashiorkor treatment

Answer 55

Provide carbs followed by high protein