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P3 Therapeutics > Exam 3 - Walroth > Flashcards

Exam 3 - Walroth Flashcards

1
Q

NBW =

A

IBW + 0.25(weight - IBW)

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2
Q

albumin normal range

A

3.5-5 gm/dL

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3
Q

prealbumin (transthyretin) normal range

A

15-40 mg/dL

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4
Q

transferrin normal range

A

250-300 mg/dL

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5
Q

CRP normal range

A

< 1 mg/dL

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6
Q

Why should CRP and prealbumin always be checked together?

A

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

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7
Q

Prealbumin decreases as CRP increases =

A

inflammation

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8
Q

Prealbumin decreases as CRP normal =

A

malnutrition (CRP has nothing to do with nutrition!)

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9
Q

Risk factors for malnutrition in ICU patients

A
  1. NPO > 7 days
  2. gut malfunction
  3. mechanical ventilation
  4. increased metabolic needs
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10
Q

nitrogen balance ideal goal:

A

+3-5

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11
Q

calorie requirements for trauma pts:

A

25-30 kcal/kg/day

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12
Q

protein requirements for trauma/ICU pts:

A

1.5-2 gm/kg/day

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13
Q

1 g protein = _____ kcal

A

4 kcal

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14
Q

RQ < 0.85 =

A

underfeeding

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15
Q

RQ > 0.95

A

overfeeding

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16
Q

Parenteral nutrition (PN) indications:

A
  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
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17
Q

Disadvantages of peripheral PN:

A
  1. requires large amounts of fluids
  2. limited in calories
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18
Q

Advantages of central PN:

A
  1. allows for hypertonic solutions and therefore more calories
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19
Q

Disadvantages of central PN:

A
  1. risk of infection
  2. complications: pneumothorax, air embolus
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20
Q

1 g dextrose = _____ kcal

A

3.4 kcal

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21
Q

1 g lipid = ______ kcal

A

10 kcal

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22
Q

max carb utilization = ______ mg/kg/min

A

4-5

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23
Q

SMOFlipid components

A

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

24
Q

Advantages of SMOFlipid as compared to intralipid

A
  1. lower increase in TG levels
  2. improved liver function
  3. reduced risk of infection
  4. less pro-inflammatory
25
Q

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

A

12 hours because of risk of pathogen growth

26
Q

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

A

50

27
Q

Do not exceed ______% of caloric intake as lipids

A

60

28
Q

Maximum _______ gm/kg/day of lipids in adults

A

2.5

29
Q

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

A

4

30
Q

IV fat emulsion ____% must be incorporated into a TNA

A

30

31
Q

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

A

25%
24 hours

32
Q

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

A

q4-6h or before each increase in rate

33
Q

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

A

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

34
Q

How do you discontinue PN?

A

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

35
Q

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

A

Potassium, phosphate, magnesium

36
Q

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

A

Chloride and acetate

37
Q

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

A

zinc, selenium, chromium

38
Q

Addition of which vitamin to PN is NOT recommended?

A

Iron

39
Q

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

A

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

40
Q

MIVF = _______ mL/kg/day

A

30-40

41
Q

1 mMol phos = ______ mEq phos

A

1.4

42
Q

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

A

bicarb

43
Q

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

A

alkalosis

44
Q

What are some complications of PN?

A

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

45
Q

What electrolytes abnormalities are common in refeeding syndrome?

A

HYPOPHOSPHATEMIA
hypomagnesemia
hypokalemia

46
Q

Oral consumption contraindications:

A
  1. Esophageal obstruction
  2. Head and neck surgery
  3. CVA
  4. Dementia
47
Q

Advantages of EN (vs PN)

A
  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
48
Q

How many mL of multivitamin do we add to TPN?

A

10 mL

49
Q

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

A

1 mL

50
Q

Define marasmus

A

Protein and calorie deficient

51
Q

Define kwashiorkor

A

protein deficient only

52
Q

Marasmus characteristics

A

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

53
Q

Kwashiorkor characteristics

A

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

54
Q

Consider an addition of vitamin _____ for marasmus

A

B

55
Q

Kwashiorkor treatment

A

Provide carbs followed by high protein

P3 Therapeutics (13 decks)

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