Fundamentals of Parental Nutrition Support Flashcards
What are the results of malnutrition?
1) increased morbidity & mortality
2) impaired wound healing
3) organ failure
What is marasmus?
chronic condition from prolonged inadequate intake or use of protein & calories
- weight loss > 10% TBW
- wasting of somatic protein & adipose
- visceral protein conserved
What are the consequences of marasmus?
impaired muscle function
impaired cellular immunity
What is kwashiorkor?
condition resulting from inadequate protein intake
- wasting of visceral (some somatic) protein
- adipose conserved
How do kwashiorkor & marasmus compare in terms of mortality?
kwashiorkor has higher mortality
What usually brings about kwashiorkor?
usually secondary to trauma, infection, burns
Describe mixed marasmus/kwashiorkor.
condition of severe protein & calorie malnutrition
- somatic protein & adipose wasting
- reduced visceral protein synthesis
What are the causes of mixed marasmus/kwashiorkor
chronic illness
starvation
hypermetabolic stress
What are the consequences of mixed marasmus/kwashiorkor?
reduced immunity
reduced wound healing
What is the half-life of albumin?
18-20 days
What is the half-life of transferrin?
8-9 days
What is the half-life of pre-albumin?
2-3 days
What are the 3 major tissue that rely on glucose?
1) RBCs
2) Neurons
3) Renal cortex
Describe the body’s initial response to starvation.
Gluconeogensis via glycogen & protein
Describe the body’s response to starvation at 5 days.
Adipose is broken down to ketone bodies.
BMR is reduced
What are the ketone bodies synthesized from fat?
1) beta-hydroxybutyrate
2) acetoacetic acid
How do hormone levels change with starvation response?
1) decreased insulin
2) increased glucagon
3) increased epinephrine
What conditions result in hypermetabolism?
1) trauma
2) burn
3) head injury
4) sepsis
What is the metabolic response in hypermetabolism?
1) altered CHO metabolism via decreased insulin efficiency
2) increased lipid oxidation
3) increased protein turnover
4) net loss of protein & body mass
What condition would you expect, in what timeframe, in a hypermetabolic patient who was previously well nourished?
kwashiorkor in 5-7 days
What condition would you expect, in what timeframe, in a hypermetabolic patient who was previously malnourished?
mixed form in 3-5 days
What malnutrition condition usually occurs in hypermetabolic elderly patients?
mixed form (previously malnourished)
What are the implications on malnutrition on ICU admits?
1) increased length of stay
2) more complications
How are caloric requirements determined?
1) H-B equation w/ correction factor
2) Indirect calorimetry via metabolic cart study
Who is calorimetry obtained indirectly?
metabolic cart study
Who conceptualized indirect calorimetry?
Antoine Lavoisier in 1700s
What does H-B equation measure?
BEE
How does BEE relate to BMR
BEE ~ BMR
How is REE obtained from BMR?
BMR * 1.2 = REE
How many kcal/kg/day would you expect in an ill patient?
25-30 kcal/kg/day
What is the correction factor for an ill patient?
1.1
How many kcal/kg/day would you expect in a moderately hypermetabolic, ill patient?
30 - 35 kcal/kg/day
How many kcal/kg/day would you expect in severely hypermetabolic, ill patient?
35-40 kcal/kg/day
What is the BMR correction factor for an ill, moderately HM patient?
1.2
What is the BMR correction factor for an ill, severely, HM patient?
1.5 - 2.0
How does indirect calorimetry work?
energy utilized is calculated by measuring O2 in and CO2 out
What is the respiratory quotient equation?
VCO2 / VO2 = RQ
What is the RQ for glucose?
1
What is the RQ for fats?
0.7
What is the R! for protein?
0.8
What does an RQ > 1.3 signify?
overfeeding
What is the goal RQ for TPN?
0.85
How are REE & RQ best utilized?
best utilized to determine appropriate caloric intake
How long does gluconeogenesis via proteolytic degradation take place in starvation?
10 days
How long does gluconeogenesis via proteolytic degradation take place in uncomplicated illness?
15 days
How long does gluconeogenesis via proteolytic degradation take place in trauma?
20 days
How long does gluconeogenesis via proteolytic degradation take place in burn?
40+ days
How does protein metabolism change during illness?
1) increased degradation for ~2 weeks
2) ketogenesis & decreased degradation thereafter
What is the normal protein requirement?
0.8 - 1.0 g/kg/day
What conditions result in increased protein requirements?
1) dialysis
2) age > 70
What the standard AA product strengths?
3, 4.5, 6%
What are the standard lipid strengths?
10, 20%
What is also included in lipid products?
glycerin, additional 50 kcal / 250 mL
What is the usual TPN fluid volume / day?
2000 mL/day
What general issues can cause malnutrition?
lack of nutrient absorption or altered metabolism
What conditions result in lack of nutrient absorption?
1) short bowel syndrome
2) celiac sprue
What conditions result in altered metabolism?
neoplasia, chronic inflammatory conditions (cachexia)
