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Z.Fiser > Fiser.10.Nutrition > Flashcards

Fiser.10.Nutrition Flashcards

1
Q

What is your daily caloric need (kg/day)

A

20-25 calories/kg/day

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2
Q

How many calories per gram in fat?

A

9 calories / gram

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3
Q

How many calories per gram in protein?

A

4 calories / gram

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4
Q

How many calories per gram in PO carbohydrates?

A

4 calories per gram

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5
Q

How many calories per gram in dextrose?

A

3.4 calories per gram

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6
Q

What percent of calories should come from protein / fat /carbohydrates for a healthy adult male?

A

20% protein, 30% fat, 50% carbohydrates

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7
Q

How many g protein / kg / day?

A

1g protein / kg/day

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8
Q

What percent of protein intake should be essential amino acids?

A

20%

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9
Q

What molecule is provided by fat intake?

A

Essential fatty acids

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10
Q

How much can trauma increase your caloric requirement?

A

20-40%

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11
Q

How much can surgery increase your caloric requirement?

A

20-40%

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12
Q

How much can sepsis increase your caloric requirement?

A

20-40%

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13
Q

How much can pregnancy increase your caloric requirement?

A

300 kcal per day

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14
Q

How much can lactation increase your caloric requirement?

A

500 kcal per day

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15
Q

Which of the following increase your protein requirement: trauma, surgery, sepsis, pregnancy, lactation?

A

All of the above – trauma, surgery, sepsis, pregnancy, lactation `

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16
Q

What is the formula to calculate caloric requirements with burns

A

25 kcal/kg/day + (30 kcal/day * % burn)

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17
Q

What is the formula to calculate protein requirement for burn patients?

A

1-1.5 g/kg/day + (3g x % burn)

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18
Q

What is the majority of energy expenditure for burn patients?

A

Heat production

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19
Q

What percent of basal metabolic rate increases with each degree of fever?

A

10% for each degree above 38.0 degrees celsius

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20
Q

How do you calculate caloric need for overweight patients?

A

Weight =[(actual weight – IBW) * 0.25] + IBW

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21
Q

What does the Harris-Benedict equation calculate?

A

Calculates basal energy expenditure based on weight, height, age, and gender

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22
Q

What is the nutritional basis of central line based TPN?

A

Glucose based

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23
Q

What is the maximal rate of glucose administration for central line TPN?

A

3 g / kg/hr

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24
Q

What is the nutritional basis of PPN?

A

Fat-based

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25
Q

What cells are fed by short-chain fatty acids? Give an example

A

Butyric acid, fuel for colonocytes

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26
Q

What cells are fed by glutamine?

A

Small bowel enterocytes

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27
Q

Name two locations where glutamine is the most common amino acid?

A

Blood and tissue

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28
Q

How does glutamine help with nitrogen excretion?

A

Releases NH4 in the kidney

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29
Q

How does glutamine help in glucose balance

A

Can be used for gluconeogenesis

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30
Q

How is glutamine used with neoplastic cells?

A

Primary fuel for neoplastic cells

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31
Q

What is the half life of albumin?

A

18 days

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32
Q

What is the half life for transferrin

A

10 days

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33
Q

What is the half life for prealbumin

A

2 days

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34
Q

What is a normal protein level?

A

6.0 - 8.5

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35
Q

What is the normal albumin level?

A

3.5-5.5

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36
Q

Name three acute indicators of nutritional status

A

Retinal binding protein, prealbumin, transferrin

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37
Q

How do you calculate ideal body weight for men?

A

106 lb + 6 lb for every inch over 5 ft

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38
Q

How do you calculate IBW for women?

A

100 lb + 5 lb for every inch over 5 ft

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39
Q

What amount of preop weight loss is an indication of poor nutritional status?

A

Acute weight loss > 10% of total body weight in 6 months

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40
Q

What weight as a percent of IBW is an indicator of poor nutritional status?

A

Weight < 85% of IBW

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41
Q

What albumin level is an indicator of poor nutritional status?

A

Albumin < 3.0

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42
Q

What are patients with low preop albumin levels at increased risk of postop?

A

Increased risk of periop morbidity and mortality

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43
Q

What does the ratio of CO2 produced to O2 consumed measure?

A

Measurement of energy expenditure

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44
Q

What does respiratory quotient (RQ) > 1 indicate?

A

Lipogenesis and overfeeding

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45
Q

How do you treat an RQ > 1

A

Reduce carbohydrates and caloric intake

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46
Q

What does a RQ < 0.7 indicate?

A

Ketosis and fat oxidation (starvation)

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47
Q

How do you treat RQ < 0.7?

A

Increase carbohydrate and caloric intake

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48
Q

What is the RQ for pure fat utilization?

A

RQ < 0.7

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49
Q

What is the RQ for pure protein utilization?

A

RQ = 0.8

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50
Q

What is the RQ for pure carbohydrate utilization?

A

RQ = 1.0

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51
Q

Which postop days are the “diuresis phase”?

A

Postop days 2-5

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52
Q

What postop days are the catabolic phase?

A

Postop days 0-3

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53
Q

What postop days are the anabolic phase

A

Postop days 3-6

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54
Q

What is the nitrogen balance during the catabolic vs anabolic phases?

A

Catabolic = negative nitrogen balance Anabolic = positive nitrogen balance

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55
Q

In the injured patient, what is the magnitude of metabolic response proportional to?

A

Proportional to the degree of injury

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56
Q

What proportion of glycogen is stored in skeletal muscle versus the liver?

A

2/3 in skeletal muscle; 1/3 in liver

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57
Q

How much time before glycogen stores are depleted?

A

24-36 hours of starvation

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58
Q

What energy source does the body switch to after glycogen stores are depleted?

A

fat or fat/protein depending on underlying cause

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59
Q

what happens to basal metabolic rate in starvation vs injury?

A

stays the same in starvation, increased BMR in injury

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60
Q

what happens to [x] of TNF and IL1 in starvation vs injury?

A

not present in starvation, increased in injury

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61
Q

what is the main fuel oxidized in starvation vs injury

A

fat is oxidized in starvation and mixed fat/protein are oxidized in injury

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62
Q

what happens to ketone body production in starvation vs injury?

A

very high ketone body production in starvation vs no change/small increase in injury

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63
Q

what is the gluconeogenesis activity in starvation vs injury?

A

GN is slightly increased in starvation and very increased in injury

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64
Q

what happens to protein metabolism in starvation vs injury?

A

protein metabolism is slightly increased in starvation and way increased in injury

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65
Q

what happens to negative nitrogen balance in starvation vs injury?

A

there is a slight increase in NNB in starvation versus a big increase in NNB in injury

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66
Q

what happens to hepatic ureagenesis in starvation vs injury?

A

there is a slight increase in hepatic ureagenesis in starvation versus a big increase in injury

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67
Q

what happens to muscle proteolysis in starvation vs injury?

A

there is a slight increase in muscle proteolysis in starvation versus a big increase in injury

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68
Q

what happens to hepatic protein synthesis in starvation vs injury

A

there is a slight increase in hepatic protein synthesis in starvation versus a big increase in injury

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69
Q

Where is glucose 6 phosphate located?

A

in the liver only

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70
Q

Where does glucose 6 phosphate go during starvation?

A

Enters the skeletal muscle after breakdown from glycogen and stays there

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71
Q

Name four gluconeogenesis precursors

A

Alanine, lactate, pyruvate, glycerol

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72
Q

Which amino acids increase in times of stress?

A

Alanine and phenylalanine only

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73
Q

Which organ performs gluconeogenesis in late starvation?

A

kidney

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74
Q

Why does protein-conservation not occur after trauma or surgery?

A

Catecholamines and cortisol

75
Q

Does protein conservation occur with starvation?

A

yes

76
Q

What is the main source of energy with starvation and trauma? How do these energy sources differ between starvation and trauma?

A

Main energy source is ketones from fat with starvation, after trauma it is more mixed (fat + protein)

77
Q

What percent weight loss can patients tolerate without complication?

A

15% weight loss

78
Q

How many days can postop patients tolerate NPO status?

A

7 days

79
Q

What should you do after 7 days of postop NPO status?

A

TPN or DHT

80
Q

What are two reasons it is preferable to feed the gut over TPN

A

TPN-related complications; Prevent bacterial translocation from the gut

81
Q

What is the MOA of bacterial translocation during starvation?

A

Bacterial overgrowth + increased permeability due to starved enterocytes –> bacteremia

82
Q

Name two indications for a PEG tube

A

PO feeding not possible ever (s/p CVA) or not expected to occur > 4 weeks

83
Q

What fuel source does the brain use in starvation

A

Glucose –> ketones with progressive starvation

84
Q

Name four obligate glucose users

A

Peripheral nerves, adrenal medulla, RBCs, WBCs

85
Q

How does the hypothalamus respond to trauma? (3)

A

Releases ACTH (adrenocorticotropic hormone), ADH, and GH (growth)

86
Q

What is released locally by injured tissue? (3)

A

Cytokines, prostaglandins, platelet-activating factor

87
Q

How do the kidneys respond to trauma

A

Volume-conserving mechanisms with aldosterone and ADH

88
Q

Name the two humoral cascades triggered by trauma

A

Complement and kinins

89
Q

How does the skeletal muscle respond to trauma?

A

Mobilizes amino acids

90
Q

How does the pancreas respond to trauma?

A

Increase glucagon, decrease insulin

91
Q

How does the heart respond to trauma?

A

Increased stroke volume and increased heart rate

92
Q

How do the adrenals respond to trauma

A

Increase cortisol and catecholamines

93
Q

Why does peripheral vasoconstriction occur with trauma?

A

Redistributes blood to vital organs

94
Q

name the homeostatic adjustments of the hypothalamus, heart, adrenals, pancreas, kidney, inflammatory system, and peripheral vasculature to trauma

A

see pic

95
Q

When does refeeding syndrome occur?

A

After prolonged malnutrition / starvation

96
Q

Which electrolytes are altered in refeeding syndrome?

A

Decreased K, Mg, Phos

97
Q

What are the effects of refeeding syndrome on the organs?

A

Cardiac dysfunction, profound weakness, encephalopathy

98
Q

How do you prevent refeeding syndrome?

A

Refeed at low rate (1—15kcal/kg/day)

99
Q

What is the MOA of cachexia?

A

Anorexia, weight loss, wasting mediated by TNF-alpha –> glycogen breakdown, lipolysis, protein catabolism

100
Q

What is the difference between kwarshiorkor and marasmus?

A

Kwarshiorkor is protein deficiency and marasmus is starvation

101
Q

How much protein do you need to get 1g of nitrogen?

A

6.25 g protein contains 1 g nitrogen

102
Q

What is the formula for nitrogen balance?

A

(N in – N out) = ([protein/6.25] – [24 hour urine N + 4g])

103
Q

Define the difference between positive and negative nitrogen balance

A

Positive N balance = anabolism (more protein ingested than excreted). Negative N balance = catabolism (more protein excreted than ingested)

104
Q

What is the rate of total protein synthesis (in g/day) for a healthy 70kg male?

A

250g/day

105
Q

How does the liver interact with amino acids?

A

Liver responsible for amino acid production and breakdown

106
Q

What is the function of urea?

A

Breakdown product of amino acids made in the liver to get rid of ammonia

107
Q

What amino acids are the result of majority of protein breakdown in skeletal muscle? (2)

A

Glutamine, alanine

108
Q

Name three subtypes of fats

A

Triacylglycerides (TAG), cholesterol, lipids

109
Q

What three enzymes digest fat and what are the breakdown produts?

A

Pancreatic lipase, cholesterol esterase, phospholipase to micelles and free fatty acids

110
Q

What are the three components of micelles?

A

Bile salts, long-chain free fatty acids, and monoacylglycerides

111
Q

How do micelles enter enterocytes?

A

Fuse with membrane

112
Q

What are the two functions of bile salts

A

Increase absorption area of fats, help form micelles

113
Q

How is cholesterol related to bile salts?

A

Cholesterol is used to synthesize bile salts

114
Q

What are the four fat-soluble vitamins and how are they absorbed

A

A, D, E, K – absorbed in micelles

115
Q

How do medium-chain fatty acids enter the enterocyte?

A

Simple diffusion

116
Q

How do short-chain fatty acids enter the enterocyte?

A

Simple diffusion

117
Q

What are the components of chylomicrons and their percentages?

A

90% triacylglycerides, 10% phospholipids/protein/cholesterol

118
Q

Where do chylomicrons go after forming in the enterocyte?

A

Enter the lymphatics via thoracic duct

119
Q

What happens to LCFA after they enter enterocytes?

A

Enter lymphatics along with chylomicrons

120
Q

What happens to MCFA after they enter enterocytes?

A

Enter the portal system

121
Q

What happens to SCFA after they enter enterocytes?

A

Enter the portal system

122
Q

What happens after amino acids enter enterocytes?

A

Enter the portal system

123
Q

What happens to carbohydrates after they enter enterocytes?

A

Enter the portal system

124
Q

Where is lipoprotein lipase located (2)?

A

Endothelium of liver; Adipose tissue

125
Q

What are the substrates (2) of lipoprotein lipase and its breakdown products (2)?

A

Clears chylomicrons and TAGS from blood, breakdown into fatty acids and glycerol

126
Q

Where is “free fatty acid binding protein” located?

A

On endothelium of liver and adipose tissue

127
Q

What are the (2) substrates of free fatty acid binding protein?

A

Binds SCFA and MCFA

128
Q

Which two types of muscle use saturated fatty acids for fuel

A

Cardiac muscle, skeletal muscle

129
Q

Name the two MC ketones

A

Acetoacetate, beta-hydroxybutyrate

130
Q

Which four organs prefer ketones / fatty acids for fuel?

A

Colonocytes, liver, heart, skeletal muscles

131
Q

What is the function of unsaturated fatty acids?

A

Structural components for cells

132
Q

Where is hormone-sensitive lipase located?

A

In fat cells

133
Q

What is the storage form of fat?

A

triacylglycerides

134
Q

Which hormones is hormone-sensitive lipase reactive to? (3)

A

Growth hormone, catecholamines, glucocorticoids

135
Q

What is the substrate and 2 products of hormone-sensitive lipase and what does it do with its products?

A

Breaks down triacylglycerides to fatty acid and glycerol, released into bloodstream

136
Q

Name the two essential fatty acids

A

Linolenic, linoleic fatty acids

137
Q

What are the two functions of essential fatty acids

A

Needed for prostaglandin synthesis (LCFA); important for immune cells

138
Q

Name the three enzymes and the order they are encountered for carb digestion

A

Salivary amylase then pancreatic amylase and disaccharidases

139
Q

How does glucose enter the enterocyte?

A

Secondary active transport

140
Q

How does galactose enter the enterocyte?

A

Secondary active transport

141
Q

How does fructose enter the enterocyte?

A

Facilitated diffusion

142
Q

Where are fructose, glucose, and galactose released after entering the enterocyte?

A

Portal venous system

143
Q

What monosaccharides make up sucrose?

A

Fructose + glucose

144
Q

What monosaccharides make up lactose?

A

Glucose + galactose

145
Q

What monosaccharides make up maltose?

A

Glucose + glucose

146
Q

What are the four protein digestion enzymes and in which order are they encountered?

A

Stomach pepsin –> trypsin, chymotrypsin, carboxypeptidase

147
Q

What is the MOA of trypsin activation?

A

Trypsinogen is released by pancreas and activated by enterokinase, released from duodenum

148
Q

Which molecules does trypsin activate

A

Activates other pancreatic protein enzymes; Can autoactivate other trypsinogen molecules

149
Q

What are the three breakdown products of protein by proteases?

A

Amino acids, dipeptides, and tripeptides

150
Q

How are amino acids, dipeptides, and tripeptides absorbed by enterocytes?

A

Secondary active transport

151
Q

Where are amino acids released from enterocytes?

A

Into the portal vein

152
Q

Why do you limit protein intake in patients with liver or renal failure?

A

Prevent buildup of ammonia that could lead to worsening encephalopathy

153
Q

Name the three branched chain amino acids

A

Leucine, isoleucine, valine (LIV)

154
Q

Where are BCAAs metabolized?

A

In the muscle

155
Q

What disease process are BCAAs potentially important for?

A

liver failure

156
Q

Are BCAAs essential amino acids?

A

yes

157
Q

Name the 10 essential amino acids

A

PRIVATE TIM HALL (PVT TIM HALL) Phenylalanine; Valine; Threonine; Tryptophan; Isoleucine; Methionine; Histidine; Arginine; Lysine; Leucine

158
Q

What percent of TPN is amino acid solution?

A

10%

159
Q

What percent of TPN is dextrose solution?

A

50%

160
Q

What 7 electrolytes are included in TPN

A

Na, Cl, K, Ca, Mg, PO4, acetate

161
Q

Are vitamins and minerals included in TPN

A

Yes

162
Q

How are lipids administered in TPN patients?

A

Separately from TPN

163
Q

How many calories per cc in a 10% lipid solution?

A

10% lipid solution with 1.1kcal/cc

164
Q

How many calories per CC in a 20% lipid solution?

A

2 kcal / cc

165
Q

What are the sx of a chromium deficiency? (3)

A

Hyperglycemia, encephalopathy, neuropathy

166
Q

Sx of selenium deficiency? (2)

A

Cardiomyopathy, weakness

167
Q

Sx of copper deficiency? (1)

A

pancytopenia

168
Q

Sx of zinc deficiency? (1)

A

poor wound healing

169
Q

Sx of phosphate deficiency? (3)

A

Weakness, encephalopathy, decreased phagocytosis

170
Q

How would weakness a/w phosphate deficiency affect a ventilated ICU pt?

A

Failure to wean off vent

171
Q

Sx of thiamine (B1) deficiency? (2)

A

Wernicke’s encephalopathy, cardiomyopathy

172
Q

Sx of pyridoxine (B6) deficiency? (3)

A

Sideroblastic anemia, glossitis, peripheral neuropathy

173
Q

What is sideroblastic anemia?

A

Bone marrow produces ringed sideroblasts instead of normal erythrocytes

174
Q

Sx of cobalmin (B12) deficiency? (3)

A

Megaloblastic anemia, peripheral neuropathy, beefy tongue

175
Q

Sx of folate deficiency (2)?

A

Megaloblastic anemia , glossitis

176
Q

Sx of niacin deficiency (3)?

A

Pellagra: diarrhea, dementia, dermatitis

177
Q

Sx of essential fatty acid deficiency? (3)

A

Dermatitis, hair loss, thrombocytopenia

178
Q

Sx of vitamin A deficiency? (1)

A

Night blindness

179
Q

Sx of vitamin K deficiency? (1)

A

coagulopathy

180
Q

Sx of vitamin D deficiency? (3)

A

Rickets, osteomalacia, osteoporosis

181
Q

Sx of vitamin E deficiency? (1)

A

neuropathy

182
Q

Which part of the cori cycle occurs in muscle

A

Glucose is utilized and converted to lactate

183
Q

What does the liver do in the cori cycle

A

Lactate goes to the liver and is converted back to pyruvate and then glucose via gluconeogenesis

184
Q

Where does the glucose generated via gluconeogenesis go?

A

Back to the muscle

Z.Fiser (22 decks)

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