inter Flashcards
Main gluconeogenic substrates
Alanine, glutamine, glutamate, lactate
Extracelullar electrolytes
Na, Ca, cl
Intracellular electrolytes
k, mg, p
Name at least two micronutrients with antioxidant properties, and therefore are used to modulate the metabolic response to stress
C and e
This mineral has an important role in insulin resistance
chromium
This minerals have an important role in wound healing
selenium and zinc
This vitamin works as FAD in the hydrogen transport from krebs cycle to respiratory chain
riboflavin
The deficiency of this vitamin can be diagnosed megaloblastic anemia
cobalamin
This vitamin work as nad in the hydrogen transport from krebbs cycle to respiratory chain
Niacin (b3)
The deficiency of this vitamin may cause sideroblastic anemia
Pyridoxine (b6)
The deficiency of this vitamin causes beri beri
Thiamine (B1)
this vitamin works to unite acetyl coA into the krebs cycle
Pantothenic acid (b5)
One of the main functions of this vitamin is in the maturation of erythrocytes
Folic acid
Main substrate in the first phase of starvation
Hepatic glycogen and protein
Main substrate in the second phase of starvation
lipids from adipose tissue
nutrition screening tool recommended by espen for hospitalized patients
NRS
Nutrition screening tool recommended for older adults
MNA
Nutrition screening tool used in the ICU to assess nutritional support (child)
NUTRIC SCORE
Nutrition screening tool recommended for general population
MUST
Absolute gastrointestinal contraindications for enteral nutrition
Intestinal obstruction and ileus, severe peritonitis
Post pyloric tube feeding is used for patients with
aspiration, gastroparesis, gastro-oesophageal reflux
Bolus feeding is
Associated with higher rates of gastrointestinal symptoms compared to continuous infusion, convenient option in stable patients with PEG
Modern nasogastric feeding tubes
Cannot be used for more than 4-6 weeks
The correct position of an NG tube should be confirmed by
pH of the stomach >5 and or abdominal x ray
There are formulas with intact nutrients
Polymeric
There are formulas with hydrolyzed nutrients
Olygomeric (polymeric, modules)
water on formulas
- standard
- hypercaloric
- hypercaloric
When monitoring EN which indication regarding gastric residue should be taken into consideration to start prokinetic and/or slow down the infusion
over 600 ml in 24 hrs, half of the volume infused in the last hour, 500ml in soul measurement
Mention the parameter with which we calculate gastric capacity for the bolus
5-7 ml/kg per bolus
According to ASPEN and ESPEN how do we advance de infusion rate for continuous enteral nutrition
Star with 20 ml/hr and increase 20 every 6-8 hour according to tolerance until you achieve the infusion rate goal
what do i do if the patient didn ́t tolerate the enteral nutrition infusion rate increase?
identify the cause and return to last volume tolerated
in order to prevent refeeding syndrome we need to supplement __ of __ via ___ __ min before we start the nutrition administration
-300mg
-thiamine
-intravenosa
-30
This are frequent electrolyte imbalances in refeeding syndrome
hipofosfatemia e hipokalemia
Refeeding syndrome kcal:
5-10kcal
In the management of anemia in a patient with refeeding syndrome, in which way iron supplementation should be administered
after 7 days we started nutritional therapy
in the event of having signs of refeeding syndrome you should give ___ mg of ___
300mg
thiamine
Aminoacid essentials
Valina
} Leucina
} Isoleucina
} Treonina
} Cisteína* depende de metiotina
} Metionina
} Lisina
} Histidina** solo en niños
} Triptofano
} Tirosina* depende de fenilananina
} fenilalanina
Contraindicaciaciones relativas de la Nutrición Enteral
Varices esofágicas, acitis, úlceras, diálisis peritonal, nausea, vomito, diarrea
Tipos de sondas
Ostomia, gastrostomia, yeyenostomia, pospilorica etc. Decides cual pones depende del tiempo.
1. Ostomia la usas si ya tiene mayor tiempo
Complicaciones Nutrición enteral,
Diarrea, –> Cambio de bolus, de formula, medicamento
Infección–> decirle al medico que no ayude con medicamentos
Tape la sonda–> ponerle otra sonda
Nausea, vomito–Z alargar bolus, cambiar la formula
TNT
Total nutrition therapy
Paciente muy critico
cada 2 hrs.
7:00 20ml /hrs
9:00 40ml/hr
11:00 60ml/hr
13:00 71 ml/hr (11)
prohibido en síndrome de la realimentación porwue sino se muere de un shock cardiaco
