Feeding and Nutrition Flashcards
What are normal caloric requirements?
35cal/kg/day
What are normal protein requirements?
- 7g protein /kg/day
* 1g protein = 4 cals
What are normal carb requirements?
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
Normal lipid requirements
20-25% non-protein cals
Max 2g/kg/day of fat emulsion (recommended 1g, kids 4g)
1g fat = 10cals
What are essential amino acids? (7)
(body can't make these, need from diet) Valine Leucine isoleucine Methionine Phenylalanine Threonine Tryptophan
What are non-essential amino acids (7)
Alanine Aspartic acid asparagine glutamic acid glycine proline serine
Essential Vitamins
Vit A Vit B1 (thiamine) Vit B2 (riboflavin) Vit B12 Vit C Vit K
What are essential minerals?
Copper Chromium Zinc Selenium Folate Biotin
What results from copper deficiency? (2)
Microcytic anemia
Delayed wound healing
What results from chromium deficiency? (2)
Impaired Glucose metabolism
Peripheral Neuropathy
What results from zinc deficiency? (5)
Delayed wound healing Decreased immunity Hair loss dermatitis Decreased taste
What results from selenium deficiency? (3)
Cardiiomyopathy
weakness
Decreased energy
What results from fatty acid deficiency? (3)
Dry flakey skin
Alopecia
TCP
What results from vitA deficiency? (1)
Poor wound healing
What results from B12/folate deficiency? (1)
Macrocytic anemia (megaloblastic anemia)
What results from a biotin deficiency? (3)
Skin rash
EKG changes
Neuromuscular changes
What results from vitamin C deficiency?
Poor wound healing (needing for collagen synthesis and assembly)
What results from vitamin K deficiency?
Impaired hemostasis (needed for clotting factors 2, 7, 9, 10)
What results from VitB6 deficiency?
Poor wound healing
What results from vitamin B1 (thiamine) and Vitamin B6 (riboflavin) deficiency?
Poor wound repair
What results from arginine deficiency?
Impaired wound healing
What are benefits of TPN? (4)
Improved wound healing
Decreased catabolic response to injury
Improved GI structure and fucntion
Improved clinical outcomes
Indications for TPN as primary therapy (5)
GI-cutaneous fistula Renal failure (ATN) Short bowel syndrome Acute burns Hepatic failure
What are indications for TPN as supportive therapy? (4)
Acute radiation enteritis
Acute chemotoxicity caused enteritis
Prolonged ileus > 7days
Weight loss before major surgery
What are technical complications of TPN? (from line itself)
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
What are late technical complications of TPN? (line itself)
Erosion of catheter into bronchus, right atrium, or other structurees
Subclavian vein thrombosis
Septic thrombosis
What are metabolic complications of TPN?
Deficiency states hypo or hyperglycaemia Hepatitis steatosis Fat overload syndrome (fever, back pain, chills, pulmonary insufficiency, blockage of reticuloendothelial system) Gut mucosal atrophy Overfeeding
What are septic complications of TPN?
Catheter infection
Aspiration
Bacterial colonization of stomach
What is the management of suspected TPN catheter sepsis?
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
What are some complications from enteral feeding?
Malpositioning of catheterr Aspiration Solute overload = diarrhea, dehydration, lyte imbalance Loss of K, Mg, other ions with diarrhea Pneumatosis intestinalis w/ perf Bowel necrosis
When appropriate which is preferred, enteral or parenteral feeds?
ALWAYS USE THE GUT FIRST IF POSSIBLE
