final exam Flashcards
main gluconeogenic substrates
glycerol and alanine
thiamine
its deficiency cause wernike korsakoff encephalopathy
riboflavin
works as a hydrogen career in krebbs cycle as FAD
niacin
works as a hydrogen career in krebbs cycle as NAD
panthotenic acid
its a component of CoA as a acil defects
piridoxin
it deficiency cause sideroblastic anemia
biotin
its a cofactor of carboxylase enzymes in the mitochondria
folic acid
it has an important role before and during pregnancy to prevent neutral tube defects
cobalamin
its absorbed in the ileum with intrinsic factor produced in the stomach
if you have and elderly male px with a Hb of 11.3 mg/dL and VCM of 114; what deficiency do you suspect?
folic acid
this mineral has an important role in insuline resistence
chromium
this vitamin has been used in neurologic px for its antioxidant properties
vitamin E
this vitamin has a crucial role in carboxylation and activation of coagulation factors:
vitamin K
if you have a ox with anorexia nervosa, who has been restricting her energy consumption for 2 months; her labs show glucose in upper limit, hypertrigliceridemia and normal albumin; which is the main substrate that she is using?
lipids from adipose tissue
regarding proteolysis during metabolic adaptation to simple starvation and stress starvation
lower in starvation that in stress
regarding gluconeogenesis during metabolic adaptation to simple starvation and stress starvation
lower starvation and high in stress
regarding ketogenesis during metabolic adaptation to simple starvation and stress starvation
higher in starvation than in stress
nutritional screening tool recommended by ASPEN for hospitalized px
SGA
nutritional screening tool recommended by ESPEN for hospitalized px
NRS
absolute gastrointestinal contraindications for enteral nutrition
intestinal obstruction and ileus
you have a female px with advance dementia, who suffered a stroke and consequent dysphagia; the neurology doesnt expect a full recovery in the next 3 months; which would be the best option?
EN with gastrostomy
you have an obese px who suffered a car accident and is in the ICU, he is tolerating the EN; he is sedated and with hig values of PEEP in the mechanical ventilation; which would be the best option?
nasoyeyunal tube with continuous infusion
mention the parameters with which we calculate gastric capacity for the bolus:
5-7 ml/kg per bolus
according to ASPEN and ESPEN, how do we advance the infusion rate for continuous EN
start with 20 ml/hr increase 20 every 6-8 hr according to tolerance until you achieve the infusion rate goal
according to ESPEN, which is the max osmolarity we can use with a peripheral catheter
850 mosm/L
orden according to the best option for a central access, being 1 the first choice and 5 the last one
- subclavian catheter
- jugular catheter
- brachial catheter
- axillar catheter
- femoral catheter
true
- trilumen catheter have a higher risk of infection
- hickmann catheter is an example of a tunneled central catheter
false
- portacat catheter shoeld be used for PN for a long period of time
- PICCS are collocated for peripherical access
- PVI solutions are prederred to chlorhexidine for skin preparation for a CVC
its a way to control hypercatabolism other that nutrition:
all of the above: analgesia; pain control/temperature/prevention of infections
energy recommendation that you would ose for a undernourished px with a BMI 15.5 to prevent refeeding syndrome
10 kcal/kg
in reffeding syndrome ist very important to supplement the following:
thiamine
in the prevention of refeeding syndrome, thiamine supplement should be given:
intravenously
in the prevention of refeeding syndrome, thiamine should be administered
30 min before nutrition administration starts
main electrolyte we need to monitor in a px with refeeding risk
P
in the management of anemia in a px with refeeding syndrome, in which way iron supplementation should be administered
after 7 days we started nutritional therapy
dose in which we supplement omega 3 in critically ill px as immunotherapy
2000 mg per day
dose in which most investigations report toxicity with omega 3 supplementation
over 6 g a day
px at risk in which omega 3 supplementation should be carefully assessed and probably should not be used:
thombocytopenia
you are using glutamine supplementation to modulate inflammation in critically ill px which via is preferred?
PN
dose in which we supplement glutamine in a critically ill px
0.5 g/kg
main consideration to supplement a px with glutamine
px live function test must be normal
due to the fact that arginine is precursor of nitric oxide, its supplementation is not recommended and/or should be carefully assessed in this type of pathologies
sepsis
predominant features of liver disease in px with HPN are:
cholestasis in children and steatosis in adults
mention the safest limit for CHO infusion in PN when treating liver disease associate to PN
maximum 5 mg/kg/min
main consideration in lipids emulsions for PN in relation with cholestatic syndrome:
combinations of long chain/medium chain fatty acids with polyunsaturated fatty acid seem to reduce the risk
when treating cholestatic syndrome as a complication of PN, what should we do in terms of infusion rate?
cycle PN until the liver has recovered
when se treat cholestatic syndrome as a complication of long term PN we should consider the following
remove oligoelements from the PN
its an important risk factor for metabolic osteopathy as a complication of PN
to much phosphorus in the PN
in px with HPN, bone mineral density assessment by DEXA scanning is recommended at the following interval?
yearly
accoding to ESPEN guidelines, which is the limit of life expectancy we consider for using PN in a terminally ill px?
3 months
under which karnofsky score in a cancer px, HPN is recommended?
50
in acute pancreatitis, which should be the preferred via of administration for the nutrition
nasojejunal tube
consequence of overfeeding an ICU px
all of the answer are correct: difficulty to wean from ventilator, increased cardiac output, hyperglycemia
euglycemic concept in ICU px
140-480 mg/dL
