General Nutrition Flashcards
How much unintentional weight loss is a red flag?
5-10% in 6 months
Someone with decreased ABW, normal lean body mass, and decreased total body water is considered what?
dehydrated
What is the estimated average requirement?
meets vitamin and trace element needs of 50% of persons
What is the caloric recommended daily intake for carbohydrates?
4kcal/g
What is the caloric recommended daily intake for protein?
4 kcal/g
What is the caloric recommended daily intake for fat?
9 kcal/g
What affects albumin/ protein assessment?
- dehydration
- decreased hepatic function
- abnormal renal function loss
- abnormal GI function loss
What would cause increased levels of albumin?
- dehydration
- anabolic steroid use
What would cause a decrease in albumin?
- fluid overload
- malnutrition
- burns
- nephrotic syndrome
- cirrhosis
How often do albumin levels need to be checked? Why?
every 2-3 weeks;
half-life= 2-3 weeks, chronic marker
How often do pre-albumin levels need to be checked? Why?
every 2-3 days;
half-life= 2-3 days, acute marker
Is a baseline value more important for albumin or pre-albumin?
albumin
What types of underlying pathologies can contribute to nutritional problems?
- neoplastic diseases
- digestive/ absorptive diseases
- COPD
- cirrhosis
What is marasmus?
severe malnutrition where the body digests its organs leads to kwashiorkor
What is kwashiorkor?
acities due to severe protein/ albumin depletion
What are early signs of malnutrition?
- dermatitis
- glossitis
- cheilosis (crust around lips from fat deficiency)
- jaundice
What are the consequences of underfeeding?
metabolic abnormalities and nutrient deficiency –> infection, wound healing, arrhythmias
What are the consequences of starvation?
changes in metabolic process –> digestion of organs/ muscle –> inability to clear fluids around the heart and lungs –> pneumonia –> death
What medications are recommended for underweight/malnourished and able to tolerate oral intake safely?
- Mirtazapine
- Testosterone
- Megestrol Acetate
- Dronabinol
What patients would Mirtazapine (Remeron) work best in?
weight loss due to depression
What patients would Megestrol acetate (MEGACE) work best in?
- cancer
- AIDS
- end of life
- palliative care
What is the MOA of Megestrol acetate?
synthetic progestin; anti-estrogenic properties
What are SEs with Megestrol acetate (MEGACE)?
- Thromboembolic events
- diabetes
What patients would Dronabinol (MARINOL) work best in?
AIDS patients
What are SEs with Dronabinol (MARINOL) ?
- CNS depression
- exacerbation of mental illness
How is Dronabinol (MARINOL) administered?
1 hour before lunch and dinner
What patients would Testosterone work best in?
malnourished males with low testosterone
Why is testosterone rarely used?
SE profile, fluid retention
What happens during initial onset of starvation?
Decreased insulin and glucose utilization
Increased catecholamines and gluconeogenesis
(fight/flight response)
What happens as starvation progresses?
Fatty acid utilization becomes main source of energy –> vital organs (heart/respiratory muscles) used as caloric source
What is hypermetabolism?
Neuroendocrine (sympathetic) response to maintain homeostasis due to injury
What is acute hypermetabolism?
lasts 24-36 hours after injury; promotion of hyperglycemia and protein catabolism
How should acute hypermetabolism be managed?
increase calories 1.5-2 times BEE
Why is nutritional support vital during adaptive hypermetabolism?
increased metabolic rate, protein consumption, glucose flow, and hyperthermia
What are indications to recieve chronic nutritional support?
- inability to absorb nutrients using GI tract (small bowel resection, small intestine diseases, radiation)
- inadequate nutritional intake (inability to swallow due to aspiration risk, lack of appetite)
When should acute nutritional support be given?
nutrition cannot be provided for 5-7 days
