inters Flashcards
Mention the main gluconeogenic substrates
glicerol
lactate
alanine
glutamine
extracellular electrolytes
Na, Ca, Cl
intracellular electrolytes
K, Mg, P
name at least two of the
main micronutrients with antioxidant properties, and therefore are used to modulate the metabolic response to stress
selenio, vitamin c, a, e, d, zinc
the mineral has an important role in insuline resistence
chromium
this minerals have an important role in wound healing
selenium and zinc
this vitamin works ad FAD in the hydrogen transport from krebs cycle to respiratory chain
riboflavin
the deficiency of this vitamin can be diagnosed with megaloblastic anemia and hyperhomocysteinemia
cobalamin
this vitamin works as NAD in the hydrogen transport from krebs cycle to respiratory chain
niacin
the deficiency of this vitamin may cause sideroblastic anemia
pyridoxine
the deficiency of this vitamin cause beri beri
thiamine
this vitamin works to unite acetil co a into the krebs cycle
pantothenic acid
one of the main functions of this vitamin is in the maturation of erythrocytes
folic acid
main substrate in the first phases of starvation
hepatic glycogen and protein
mais substrate in the second phases of starvation
lipids from adipose tissue
mention 2 characteristics of each phases of the metabolic response to stress: Ebb phase
inflammation
the glut is hypoperfused
mention 2 characteristics of each phases of the metabolic response to stress: flow phase (catabolic)
more REE
lipid (TAG) mobilization
mention 2 characteristics of each phases of the metabolic response to stress: flow phase (anabolic)
less REE
more protein requirements
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
NUTRIC-SCORE
nutrition screening tool recommended for general population
MUST
absolute gastrointestinal contraindications for enteral nutrition
b and c are correct:: intestinal obstruction and ileus and severe peritonitis
post-pyloric tube feeding is used for px with:
all the answers are correct: aspiration, gastroparesis, gastro-oesophageal reflux
bolus feeding is:
associated with higher rates of GI symptoms compared to continuous infusion and convenient option in stable px wiht PEG
modern nasogastric feeding tubes:
cannot be used for more than 4-6 weeks
the correct position of a NG tube should be confirmed by
pH of the stomach <5 and/or abdominal X ray
there are formulaes with intact nutrients
polymeric
there are formulaes with hydrolyzed nutrients
oligomeric
mention the water content on each type of formulae
standard polymeric (1 kcal/ml)-> 80%
hypercaloric (1-2 kcal/ml) -> 75%
hypercaloric (2 kcal/ml) -> 50%
when monitoring EN which indication regarding gastric residue should be taken into consideration to start prokinetic and/or slow down the infusion
all of the above: over 600 ml in 24 hr, half of the volumen infused in the last hour, 500 ml in a soul measurement
mention the parameter with which we calculate gastric capacity for the bolius
5-7 ml/kg per bolus
according to ASPEN and ESPEN, how do we advance the infusion rate for continuous EN:
start with 20 ml/hr and increase 20 ml/hr every 6-8 hr according to tolerance until you achieve the infusion rate goal
what do i do if the px didn´t tolerate the EN infusion rate increase
identify the cause and return to last volume tolerated
in the order to prevent refeeding syndrome we need to supplement 300 mg of thiamine (name of the vitamin) via IV (administration) 30 min before we start the nutrition administration
answers: 300 mg of thiamine
vía IV–> administration
30 min before
this are frequent electrolyte imbalance in refeeding syndrome
hypophosphatemia and hypokalemia
fill in the gaps according to the way we manage a px with risk of developing refeeding syndrome
day 1 (BMI below 14)-> 5 kcal per kg per day
day 1 (BMI above 14)-> 10 kcal per kg per day
day 2 to 10–> increase 5 kcal per kg per day
in the management of anemia in a px with refeeding syndrome, in which way iron supplementation should be administered
after 7 days started nutritional therapy
in the even of having signs of refeeding syndrome you should give:
300 mg of thiamine
in acute pancreatitis, which should be the preferred via of administration for the nutrition?
nasojejunal tube
consequence of overfeeding an ICU px:
difficulty to wean from ventilator, increased cardiac output and hyperglycaemia
euglycemic concept in ICU px:
140-180 mg/dL
in ERAS protocol for surgical px, which of the following is suggested to minimize risk at the surgery and improve catabolism
clear fluids until 2 hr before the surgery or glucose 20% IV
