Intro to Nutrition

Question 1

What are the different total nutrient admixtures?

Answer 1

All in one
3 in 1 (amino acids, dextrose, lipids)
2 in 1 (amino acids, dextrose only)

Question 2

What is marasmus?

Answer 2

Deficiency in total caloric intake and/or utilization of food

Wasting of somatic protein and adipose tissue but not visceral protein

Question 3

What is kwashiorkor?

Answer 3

Relative protein deficiency characterized by depletion of visceral and somatic protein with relative preservation of adipose tissue

Question 4

Compare enteral and parenteral nutrition advantages

Answer 4

Enteral: Less cost, more complete nutrient profile, ? fewer complications

Parenteral: Easier administration, better patient acceptance, more reliable delivery

Question 5

When would you start enteral feeding on day one?

Answer 5

After burn or trauma

Question 6

When would you start enteral feeding on day 3?

Answer 6

Malnourished or hypercatabolic

Question 7

When would you start enteral feedings in someone who has no oral intake?

Answer 7

7 days

Question 8

What are the 6 characteristics of malnutrition?

Answer 8

Insufficient food and nutrition intake
Weight loss over time
Loss of muscle mass
Loss of fat mass
Fluid accumulation
Measurable diminished grip strength

Question 9

What visceral protein levels are traditionally used in nutritional assessment?

Answer 9

Albumin (half life 14-20 days)
Transferrin (half life 8-10 days)
Prealbumin (half life 2 days)

Question 10

What is the carbohydrate source in TPN?

Answer 10

Anhydrous dextrose

Question 11

How many calories are in a gram of carbs? What is the max infusion rate?

Answer 11

3.4 kcal
4-7 mg/kg/min for adults
10-14 mg/kg/min for infants

Question 12

Describe glycerol

Answer 12

Alternative to dextrose for clinical use to replenish carbs
4.3 kcal per gram
Can be infused peripherally
Most pts require 3-4 L/day with IVFE to provide minimum energy requirements
SAFETY DATA ONLY AVAILABLE FOR ADULTS

Question 13

How many calories are in each gram of lipids?

Answer 13

9 kcal/gram

Question 14

What are the available concentrations for lipids? Which do we use?

Answer 14

30%, 20%, and 10%
30% is NOT approved for direct IV administration
20% is preferred in neonates due to lower phospholipid-to-triglyceride ratio. Why? Higher phospholipids associated with impaired triglyceride clearance.

Question 15

What is the max for lipid administration?

Answer 15

Do not exceed 2.5 g/kg/day or 60% of total calories

Recommended 1 g/kg/day not to exceed 30% of total calories

Question 16

How do we treat Essential fatty acid deficiency?

Answer 16

Linoleic and arachidonic acid

100g IVFE weekly

Question 17

In what patients are lipids contraindicated?

Answer 17

Pts with an egg allergy

Pts who cannot clear lipids

Question 18

How should you start a patient on lipids?

Answer 18

Start with a test dose of 0.5 to 1 mL/min for the first 15 to 30 mins because of the potential for hypersensitivity reaction

Question 19

What are signs and sx of hypersensitivity to lipids?

Answer 19

Dyspnea, chest pain, palpitations, chills

Headache, nausea, fever, increased LFTs, cholestasis

Question 20

How many calories are in amino acids?

Answer 20

4kcal per gram

Question 21

What special considerations are needed for neonates and pediatrics with regard to amino acids?

Answer 21

Need increased amounts of taurine, aspartic acid, and glutamic acid

Cysteine: essential AA for preterm and term infants

Carnitine: supplementation reserved for neonates expected to receive PN for 7 days or longer