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ABSITE > Fiser Chapter 10 NUTRITION > Flashcards

Fiser Chapter 10 NUTRITION Flashcards

1
Q

Caloric need

A

20-25 calories/kg/day

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2
Q

Calories in different forms

A

Fat 9 calories/g
Protein 4 calories/g
Oral carbohydrates 4 calories/g
Dextrose 3.4 calories/g

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3
Q

Nutritional requirements

A

20% protein
30% fat
50% carbohydrates

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4
Q

Trauma, surgery, sepsis increase kcal requirement

A

20-40% increase

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5
Q

Caloric need equation if overweight

A

weight = [(actual weight - ideal body weight) x 0.25] + IBW

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6
Q

Colonocyte fuel

A

Short-chain fatty acids (butyric acid)

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7
Q

Small bowel enterocyte fuel

A

Glutamine
Releases NH4 in kidney, helping with nitrogen excretion
Can be used for gluconeogenesis

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8
Q

Neoplastic cells fuel

A

glutamine

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9
Q

Albumin half life

A

18 days

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10
Q

Transferrin half life

A

10 days

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11
Q

Prealbumin half life

A

2 days

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12
Q

Acute indicators of nutrition

A

Retinal binding protein
Prealbumin
Transferrin

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13
Q

IBW

A

Men: 106 lb + 6 lb for each inch over 5ft

Women = 100 lb + 5 lb for each inch over 5 ft

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14
Q

Preop signs of poor nutrition

A

Acute weight loss > 10% in 6 months
Weight
Albumin < 3.0 (strong risk factor for M&M after surgery)

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15
Q

RQ ratio

A

CO2 produced : O2 consumed

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16
Q

RQ > 1

A

Lipogenesis (overfeeding)

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17
Q

RQ < 0.7

A

ketosis and fat oxidation (starvation)

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18
Q

RQ 0.7 exactly

A

Pure fat utilization

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19
Q

RQ 0.8 exactly

A

Pure protein utilization

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20
Q

RQ 1 exactly

A

Pure carbohydrate utilization

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21
Q

Postoperative phases

A

0-3 catabolic (negative nitrogen balance)
2-5 diuresis
3-6 anabolic (positive nitrogen balance)

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22
Q

Glycogen stores

A

Muscle and liver
Depleted after 24-36 hours, then fat
Muscle lacks G6Pase

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23
Q

Gluconeogensis precursors

A

AAs (alanine)
Lactate
Pyruvate
Glycerol

24
Q

Do protein conserving mechanisms occur after trauma or surgery?

A

No due to catecholamines and cortisol

25
Q

Do protein conserving mechanisms occur with starvation?

A

yes

26
Q

Main source of energy in starvation and trauma

A

Fat (ketones)

Trauma: more mixed (fat and protein) than starvation

27
Q

T/F most patients can tolerate a 15% weight loss without major cx?

A

True

28
Q

How long can patients tolerate without eating, after which should start tube feeds or TPN?

A

7 days

29
Q

Why is enteral feeding important?

A

To avoid bacterial translocation (bacterial overgrowth, increased permeability due to starved enterocytes, bacteremia) and TPN complications

30
Q

What does brain use for energy?

A

Normally glucose –> ketones during starvation

31
Q

What are the obligate glucose users?

A

Peripheral nerves

Adrenal medulla

RBCs

WBCs

32
Q

Refeeding syndrome symptoms

A

Low K, Mg, PO4

Cardiac dysfunction

Weakness

Encephalopathy

Prevent by starting at low rate (10-15 kcal/kg/day)

33
Q

Cachexia is mediated by what?

A

TNF-alpha

Glycogen breakdown, lipolysis, protein catabolism

34
Q

Kwashiorkor versus Marasmus

A

Kwashiorkor: protein deficiency

Marasmus: starvation

35
Q

How much nitrogen does 6.25 g of protein contain?

A

1 g nitrogen

36
Q

Nitrogen balance equation

A

N in - N out = (protein/6.25) - (24hr urine N + 4 g)

37
Q

Positive N balance versus Negative N balance

A

Positive = anabolism

Negative = catabolism

38
Q

Total protein synthesis for a healthy 70kg male is what?

A

250 g / day

39
Q

What organ is responsible for amino acid production and breakdown?

A

Liver

40
Q

Urea production is used for what?

A

To get rid of ammonia from amino acid breakdown

41
Q

Majority of protein breakdown from skeletal muscle is what amino acids?

A

Glutamine

Alanine

42
Q

How do short, medium, and long chain fatty acids enter enterocytes?

A

Short and medium: simple diffusion, into portal system, like amino acids and carbs

Long: enter lymphatics along with chylomicrons

43
Q

Vitamin deficiency causing hyperglycemia, encephalopathy, neuropathy?

A

Chromium deficiency

44
Q

Vitamin deficiency causing cardiomyopathy and weakness?

A

Selenium

45
Q

Vitamin deficiency causing pancytopenia?

A

Copper

46
Q

Vitamin deficiency causing poor wound healing?

A

Zinc

47
Q

Vitamin deficiency causing weakness (failure to wean off vent), encephalopathy, decreased phagocytosis?

A

Phosphate

48
Q

Vitamin deficiency causing Wernicke’s encephalopathy, cardiomyopathy?

A

Thiamine (B1)

49
Q

Vitamin deficiency causing sideroblastic anemia, glossitis, peripheral neuropathy?

A

Pyridoxine (B6)

50
Q

Vitamin deficiency causing megaloblastic anemia, peripheral neuropathy, beefy tongue?

A

Cobalamin (B12)

51
Q

Vitamin deficiency causing megaloblastic anemia, glossitis?

A

Folate

52
Q

Vitamin deficiency causing diarrhea, dermatitis, dementia?

A

Niacin (pellagra)

53
Q

Vitamin deficiency causing dermatitis, hair loss, thrombocytopenia?

A

Essential fatty acids (leucine, isoleucine, valine, arginine, histidine, lysine, methionine, phenylalanine, threonine, tryptophan)

54
Q

Vitamin deficiency causing night blindness?

A

Vitamin A

55
Q

Vitamin deficiency causing coagulopathy?

A

Vitamin K

56
Q

Vitamin deficiency causing rickets, osteomalacia, osteoporosis?

A

Vitamin D

57
Q

Vitamin deficiency causing neuropathy?

A

Vitamin E

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