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Drew 923 > Fundamentals of Parental Nutrition Support > Flashcards

Fundamentals of Parental Nutrition Support Flashcards

1
Q

What are the results of malnutrition?

A

1) increased morbidity & mortality
2) impaired wound healing
3) organ failure

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2
Q

What is marasmus?

A

chronic condition from prolonged inadequate intake or use of protein & calories

    • weight loss > 10% TBW
    • wasting of somatic protein & adipose
    • visceral protein conserved
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3
Q

What are the consequences of marasmus?

A

impaired muscle function

impaired cellular immunity

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4
Q

What is kwashiorkor?

A

condition resulting from inadequate protein intake

    • wasting of visceral (some somatic) protein
    • adipose conserved
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5
Q

How do kwashiorkor & marasmus compare in terms of mortality?

A

kwashiorkor has higher mortality

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6
Q

What usually brings about kwashiorkor?

A

usually secondary to trauma, infection, burns

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7
Q

Describe mixed marasmus/kwashiorkor.

A

condition of severe protein & calorie malnutrition

    • somatic protein & adipose wasting
    • reduced visceral protein synthesis
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8
Q

What are the causes of mixed marasmus/kwashiorkor

A

chronic illness
starvation
hypermetabolic stress

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9
Q

What are the consequences of mixed marasmus/kwashiorkor?

A

reduced immunity

reduced wound healing

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10
Q

What is the half-life of albumin?

A

18-20 days

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11
Q

What is the half-life of transferrin?

A

8-9 days

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12
Q

What is the half-life of pre-albumin?

A

2-3 days

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13
Q

What are the 3 major tissue that rely on glucose?

A

1) RBCs
2) Neurons
3) Renal cortex

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14
Q

Describe the body’s initial response to starvation.

A

Gluconeogensis via glycogen & protein

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15
Q

Describe the body’s response to starvation at 5 days.

A

Adipose is broken down to ketone bodies.

BMR is reduced

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16
Q

What are the ketone bodies synthesized from fat?

A

1) beta-hydroxybutyrate

2) acetoacetic acid

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17
Q

How do hormone levels change with starvation response?

A

1) decreased insulin
2) increased glucagon
3) increased epinephrine

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18
Q

What conditions result in hypermetabolism?

A

1) trauma
2) burn
3) head injury
4) sepsis

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19
Q

What is the metabolic response in hypermetabolism?

A

1) altered CHO metabolism via decreased insulin efficiency
2) increased lipid oxidation
3) increased protein turnover
4) net loss of protein & body mass

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20
Q

What condition would you expect, in what timeframe, in a hypermetabolic patient who was previously well nourished?

A

kwashiorkor in 5-7 days

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21
Q

What condition would you expect, in what timeframe, in a hypermetabolic patient who was previously malnourished?

A

mixed form in 3-5 days

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22
Q

What malnutrition condition usually occurs in hypermetabolic elderly patients?

A

mixed form (previously malnourished)

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23
Q

What are the implications on malnutrition on ICU admits?

A

1) increased length of stay

2) more complications

24
Q

How are caloric requirements determined?

A

1) H-B equation w/ correction factor

2) Indirect calorimetry via metabolic cart study

25
Q

Who is calorimetry obtained indirectly?

A

metabolic cart study

26
Q

Who conceptualized indirect calorimetry?

A

Antoine Lavoisier in 1700s

27
Q

What does H-B equation measure?

A

BEE

28
Q

How does BEE relate to BMR

A

BEE ~ BMR

29
Q

How is REE obtained from BMR?

A

BMR * 1.2 = REE

30
Q

How many kcal/kg/day would you expect in an ill patient?

A

25-30 kcal/kg/day

31
Q

What is the correction factor for an ill patient?

A

1.1

32
Q

How many kcal/kg/day would you expect in a moderately hypermetabolic, ill patient?

A

30 - 35 kcal/kg/day

33
Q

How many kcal/kg/day would you expect in severely hypermetabolic, ill patient?

A

35-40 kcal/kg/day

34
Q

What is the BMR correction factor for an ill, moderately HM patient?

A

1.2

35
Q

What is the BMR correction factor for an ill, severely, HM patient?

A

1.5 - 2.0

36
Q

How does indirect calorimetry work?

A

energy utilized is calculated by measuring O2 in and CO2 out

37
Q

What is the respiratory quotient equation?

A

VCO2 / VO2 = RQ

38
Q

What is the RQ for glucose?

A

1

39
Q

What is the RQ for fats?

A

0.7

40
Q

What is the R! for protein?

A

0.8

41
Q

What does an RQ > 1.3 signify?

A

overfeeding

42
Q

What is the goal RQ for TPN?

A

0.85

43
Q

How are REE & RQ best utilized?

A

best utilized to determine appropriate caloric intake

44
Q

How long does gluconeogenesis via proteolytic degradation take place in starvation?

A

10 days

45
Q

How long does gluconeogenesis via proteolytic degradation take place in uncomplicated illness?

A

15 days

46
Q

How long does gluconeogenesis via proteolytic degradation take place in trauma?

A

20 days

47
Q

How long does gluconeogenesis via proteolytic degradation take place in burn?

A

40+ days

48
Q

How does protein metabolism change during illness?

A

1) increased degradation for ~2 weeks

2) ketogenesis & decreased degradation thereafter

49
Q

What is the normal protein requirement?

A

0.8 - 1.0 g/kg/day

50
Q

What conditions result in increased protein requirements?

A

1) dialysis

2) age > 70

51
Q

What the standard AA product strengths?

A

3, 4.5, 6%

52
Q

What are the standard lipid strengths?

A

10, 20%

53
Q

What is also included in lipid products?

A

glycerin, additional 50 kcal / 250 mL

54
Q

What is the usual TPN fluid volume / day?

A

2000 mL/day

55
Q

What general issues can cause malnutrition?

A

lack of nutrient absorption or altered metabolism

56
Q

What conditions result in lack of nutrient absorption?

A

1) short bowel syndrome

2) celiac sprue

57
Q

What conditions result in altered metabolism?

A

neoplasia, chronic inflammatory conditions (cachexia)

Drew 923 (28 decks)

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