Feeding and Nutrition

Question 1

What are normal caloric requirements?

Answer 1

35cal/kg/day

Question 2

What are normal protein requirements?

Answer 2

1. 7g protein /kg/day

* 1g protein = 4 cals

Question 3

What are normal carb requirements?

Answer 3

75-80% of non-protein calories
100g/day to suppress gluconeogenesis

Normal max  = 7g/kg/day
Stressed  = 7.2-8.6g
hypercapnia = <4g
hepatic steatosis = <4g
Hyperglycemia/gluc intolerance = <5/day

1g carbs = 4 cals **dextrose 3.4cal

Question 4

Normal lipid requirements

Answer 4

20-25% non-protein cals
Max 2g/kg/day of fat emulsion (recommended 1g, kids 4g)

1g fat = 10cals

Question 5

What are essential amino acids? (7)

Answer 5

(body can't make these, need from diet)
Valine
Leucine
isoleucine
Methionine
Phenylalanine
Threonine
Tryptophan

Question 6

What are non-essential amino acids (7)

Answer 6

Alanine
Aspartic acid
asparagine
glutamic acid
glycine
proline
serine

Question 7

Essential Vitamins

Answer 7

Vit A
Vit  B1 (thiamine)
Vit B2 (riboflavin)
Vit B12
Vit C
Vit K

Question 8

What are essential minerals?

Answer 8

Copper
Chromium 
Zinc
Selenium
Folate
Biotin

Question 9

What results from copper deficiency? (2)

Answer 9

Microcytic anemia

Delayed wound healing

Question 10

What results from chromium deficiency? (2)

Answer 10

Impaired Glucose metabolism

Peripheral Neuropathy

Question 11

What results from zinc deficiency? (5)

Answer 11

Delayed wound healing
Decreased immunity
Hair loss
dermatitis
Decreased taste

Question 12

What results from selenium deficiency? (3)

Answer 12

Cardiiomyopathy
weakness
Decreased energy

Question 13

What results from fatty acid deficiency? (3)

Answer 13

Dry flakey skin
Alopecia
TCP

Question 14

What results from vitA deficiency? (1)

Answer 14

Poor wound healing

Question 15

What results from B12/folate deficiency? (1)

Answer 15

Macrocytic anemia (megaloblastic anemia)

Question 16

What results from a biotin deficiency? (3)

Answer 16

Skin rash
EKG changes
Neuromuscular changes

Question 17

What results from vitamin C deficiency?

Answer 17

Poor wound healing (needing for collagen synthesis and assembly)

Question 18

What results from vitamin K deficiency?

Answer 18

Impaired hemostasis (needed for clotting factors 2, 7, 9, 10)

Question 19

What results from VitB6 deficiency?

Answer 19

Poor wound healing

Question 20

What results from vitamin B1 (thiamine) and Vitamin B6 (riboflavin) deficiency?

Answer 20

Poor wound repair

Question 21

What results from arginine deficiency?

Answer 21

Impaired wound healing

Question 22

What are benefits of TPN? (4)

Answer 22

Improved wound healing
Decreased catabolic response to injury
Improved GI structure and fucntion
Improved clinical outcomes

Question 23

Indications for TPN as primary therapy (5)

Answer 23

GI-cutaneous fistula
Renal failure (ATN)
Short bowel syndrome
Acute burns
Hepatic failure

Question 24

What are indications for TPN as supportive therapy? (4)

Answer 24

Acute radiation enteritis
Acute chemotoxicity caused enteritis
Prolonged ileus > 7days
Weight loss before major surgery

Question 25

What are technical complications of TPN? (from line itself)

Answer 25

``` Pneumothorax Arterial lac Hemothorax Mediastinal hematoma Brachial plexus injury Hyrdothroax Thoracic duct injury Air embolism Catheter embolism Sympathetic effusions, substernal pain, fever from mediastinal effusion ```

Question 26

What are late technical complications of TPN? (line itself)

Answer 26

Erosion of catheter into bronchus, right atrium, or other structurees Subclavian vein thrombosis Septic thrombosis

Question 27

What are metabolic complications of TPN?

Answer 27

``` Deficiency states hypo or hyperglycaemia Hepatitis steatosis Fat overload syndrome (fever, back pain, chills, pulmonary insufficiency, blockage of reticuloendothelial system) Gut mucosal atrophy Overfeeding ```

Question 28

What are septic complications of TPN?

Answer 28

Catheter infection Aspiration Bacterial colonization of stomach

Question 29

What is the management of suspected TPN catheter sepsis?

Answer 29

Remove catheter is positive skin cultures If no skin cultures: Replace tubes and lines and feeds - send blood cultures Fever >8hr = remove line and culture tip No Abx needed unless fever >24hrs after removal Do not change catheters over guide wire when sepsis suspected If catheter is source then IV ABx, replace catheter after period of sterile blood cx

Question 30

What are some complications from enteral feeding?

Answer 30

``` Malpositioning of catheterr Aspiration Solute overload = diarrhea, dehydration, lyte imbalance Loss of K, Mg, other ions with diarrhea Pneumatosis intestinalis w/ perf Bowel necrosis ```

Question 31

When appropriate which is preferred, enteral or parenteral feeds?

Answer 31

ALWAYS USE THE GUT FIRST IF POSSIBLE