MNT & Diseases Flashcards
What are the protein and fluid needs for an AKI? Symptoms of an AKI?
Symptoms: oliguria (<500 ml urine) and azotemia (urea in the blood)
Protein needs:
- 1.2-2.5 g/kg if catabolic or on dialysis
- 1-1.3 g/kg if noncatabolic and not on dialysis
Fluid needs: replace fluid output from previous day + 500 ml
What can nephrosis/nephrotic syndrome lead to? What are the protein/fluid/kcal/supplement needs?
Leads to: Albuminuria, edema, HLD, abnormalities in Ca, Fe, Cu, Zn
Protein: LOW to prevent excretion, 0.8-1g/kg
Fluid restriction for edema
35 kcal/kg/day
1-1.5 g Ca/day + vitamin D supplement
Low oxalate diet needed for calcium oxalate stones. What are some low oxalate foods?
Dark leafy greens, chocolate, strawberries, nuts, beef, tea
How would you prevent acidic stones with an alkaline/acid ash diet?
Increase anions by adding meat, fish, fowl, eggs, shellfish, cheese, corn, oats, rye
What are the protein and fluid needs for CKD?
The lower the GFR the less protein you need
CKD 3-5: 0.55-0.6 g/kg protein
HD & PD: 1-1.2 g/kg protein
Fluid generally unrestricted in CKD 1-4
MNT for esophagitis?
Decrease gastric acidity and reflux via small, low fat, bland, low fiber meals
What is odynophagia? Globus? Achalasia?
Odynophasia = painful swallowing
Globus = lump in the throat
Achalasia = lower esophageal sphincter doesn’t relax and open when swallowing, causing dysphasia
What are the nutrition interventions for drug addicts?
Sugar: maintain normal BG to decrease drug cravings, maintain wt
Caffeine: moderate or discontinued intake
Fried food: general healthy balanced meals
What supplement could lead to drug resistance in AIDS? What are the protein needs for AIDS pts?
St. John’s Wort
Asymptomatic: 0.8 g/kg protein
Wasting: 1.2-2 g/kg protein
Pediatrics: high protein and kcal for wt gain
Antiretroviral (ART) meds can lead to HALS (HIV associated lipodystrophy syndrome). What is HALS characterized by?
High TG, high cholesterol, insulin resistance
What can NRTI drugs like Retrovir lead to?
Anemia, loss of appetite
Low Cu, Zn, B12, carnitine
What is normal body temp? How much does BMR increase for every degree rise in F temp?
98.6 F
7%
What is the difference between marasmus and kwashiorkor?
Marasmus: loss of subcutaneous fat and lean body mass, normal to slightly low albumin, severe malnutrition, NO EDEMA OR DISTENDED ABDOMEN
Kwashiorkor: protein deficiency, visceral protein loss, low albumin (anasarca), EDEMA AND DISTENDED ABDOMEN PRESENT
What is the rule of nines?
Increase kcals based on burn size
Arm including hand, head and neck, genitalia =9%
Anterior trunk, posterior trunk, legs including feet = 18%
Hormones released after trauma
Glucagon: increases glucose production from AAs
Catecholamines (epi and norepi): hepatic glycogenolysis
ACTH: releases cortisol —> mobilizes AAs from muscle
Aldosterone: Renal Na retention, gluconeogenesis
ADH: Renal water reabsorption
What is the most common allergy for infants? What food is LEAST likely to cause an allergy?
Cows milk
Rice
COPD: what is it? MNT? Meds/treatments?
Airflow obstruction d/t excess mucus production so it’s harder to breathe.
MNT: avoid overfeeding (bc of CO2); small, frequent meals w/ nutrient-dense supplements (prevent wt loss and malnutrition)
Meds: vit D supps helpful if levels <10
ARDS (acute respiratory distress syndrome): what is it?
Kcal/pro/EN?
Meds?
Lungs can’t exchange gases properly —> hyper metabolism and increased energy needs; severely underweight
MNT: provide adequate kcals, 1.5-2 g/kg pro; antioxidants; EN formula with EPA and GLA
Meds: antibiotics
Cystic Fibrosis: what is it? MNT? Meds/treatments?
Pancreatic insufficiency leading to mucus buildup in pancreas, lungs and other organs. Mucus blocks pancreatic enzymes from reaching intestine affecting Cl transport across cell membrane.
MNT:
- PERT w/ meals
- high protein, kcal, unrestricted fat
- high salt (2-4 g) in hot weather with heavy perspiration
Meds/treatment:
- MCT for malabsorption d/t pancreatic insufficiency
- water soluble forms of vit A and E, zinc
What are the symptoms of cystic fibrosis in kids?
Salty tasting skin
Pale, floating stools
Chronic wheezing and coughing
Epilepsy: MNT and Meds/treatment?
MNT:
- keto diet (90% kcal from fat, 4 g fat: 1 g non-fat)
- mild dehydration
- MCTs
- Ca, folate, vit K, vit D, B1, B6, B12 supps
Meds: anticonvulsants (phenobarbital)
Cerebral Palsy: what is it? MNT?
No control over voluntary muscles leading to spasms
Spastic aka stiff, difficult movement: low kcal (prevent obesity), high fiber and fluid (prevent constipation)
Non-spastic aka constant irregular motion: high kcal, protein and finger foods to prevent weight loss
Energy and protein needs for acute/rehab paralyzed pts?
Pts with paralysis at risk for developing pressure ulcers. What are protein needs for pressure ulcers?
Acute: 10% below energy needs; 2 g protein/kg
Rehab: 23 kcal/kg quadriplegic; 28 kcal/kg paraplegic; 0.8-1 g protein/kg
Pressure ulcers: stage 1 = 1.1-1.2; stage 2 = 1.25-1.5; stage 3 and 4 = 1.5-2
TBI: systemic inflammatory response? MNT? Meds/treatment?
Systemic inflammatory response —> hyper metabolism; hyperglycemia; insulin resistance; protein wasting
MNT: high protein (1.5-2 g/kg); high protein EN in the small bowel within the first 72 hrs; energy at 140% REE
Meds: arginine (wound healing), glutamine (protein building)
ADHD: MNT and meds?
MNT: wholesome foods at regular meal times with small servings and refills
Meds: adderall —> nausea, weight loss, lack of appetite
Autism: factors that increase their nutrition risk? MNT? Meds?
Increased nutrition risk: unnecessary food restrictions, possible food aversions, excessive supplementation
MNT: balanced diet, prevent constipation
Meds: risperidone
Alzheimer’s is associated with anomia. What is anomia?
MNT and meds for Alzheimer’s?
Anomia = type of aphasia where there’s lost words and can’t remember names of common items
MNT: finger foods and encourage self feeding; avoid distractions; consistent meal times; Mediterranean diet (low sat fat)
Meds: b6, b9, b12 associated with dementia
What can arthritis lead to? MNT? Meds?
Acquired normocytic anemia
MNT:
- antioxidants
- regular well-balanced anti inflammatory diet aka Mediterranean
Meds:
- NSAIDs
- methylprednisolone may decrease inflammation
There is no special diet for systemic lupus erythematosus. What nutrient deficiencies are associated with this disease?
Fiber, Fe, Ca, B9, B12
may also have anemia not r/t iron intake
Bone disorders result in deossification. What is that? MNT/meds and treatment for bone disorders?
Deossification = loss of bone d/t defective Ca absorption
MNT: low salt, 5 servings of fruits and veggies, adequate protein
Meds/treatment: HRT, weight bearing exercise, vit D and Calcium supplementation
Ulcer: MNT? Meds/treatment?
MNT: well-balanced diet as tolerated, no late night snacks; avoid irritants
Meds/treatment: antacids, antibiotics (kills H. Pylori); PPIs (cimetidine and ranitidine)
monitor B12, b9
GERD: MNT? Meds/treatments?
MNT: small, low fat meals; avoid irritants and acids aka caffeine and acidic juices
Meds/treatments: PPIs and antacids; elevate head of bed; weight loss
Hiatal Hernia: MNT? Meds/treatments?
MNT: avoid irritants and late night feedings; small bland meals; no high fat foods (that will reduce stomach acid and lessen acid reflux)
Meds/treatments: PPIs and antacids; surgery and weight loss
Gastritis: causes? MNT? Meds/treatment?
Causes: too much alcohol, chronic NSAID use, injury/infection
MNT: avoid irritants; consume clear liquids and advance as tolerated
Meds: PPIs, antacids, antibiotics
Gastroparesis: what is it? MNT? Meds/treatment?
Partial paralysis of the stomach d/t nerve injury (d/t DM). Delayed gastric emptying.
MNT: small frequent low fat/low fiber meals (liquid fat may be ok); avoid caffeine, mint, alcohol, carbonation
Meds/treatment: prokinetics like erythromycin and metoclopramide; enzyme/endoscopic therapy for bezoar formation d/t undigested food or meds
Pancreatitis: causes? MNT? Meds/treatments?
Cause: blockage of ductal system OR digestive enzymes in pancreas become activated —> cell irritation and inflammation —> edema, cellular exudate, necrosis
MNT:
Acute hyper metabolic state
- NPO and IV fluids
- transition to small low fat alcohol-free meals as tolerated
- elemental EN into the jejunum
Chronic recurring gastric pain
- PERT added to mixed dishes, jams and jellies
- MCT
- max amount of fat without steatorrhea
- PN in severe prolonged cases
Meds/treatment:
- antacids (so PERTs work bc pancreatic bicarbonate secretion may be defective)
- B12 (not absorbed by the terminal ileum d/t exocrine insufficiency)
- water-soluble vitamins if malabsorbing fat-soluble
What are some risk factors for pancreatitis? What can chronic pancreatitis lead to?
Risk factors: high TG, injury, alcoholism
Can lead to malnutrition d/T malabsorption of nutrients
Lactose intolerance: causes? MNT?
Which vitamin and mineral supplements are recommended?
Due to lactase deficiency
MNT: lactose-free diet, no whey;
CAN HAVE probiotic yogurt, butter, aged/hard cheese, lactate, lactalbumin
Meds: calcium and riboflavin supplements
What tests are used to detect lactose intolerance?
Breath hydrogen test
Lactose intolerance test: up to 50 g lactose given after a fast. Intolerant = BG rises <25 Mg/dl above fasting. Tolerant = rise >25 mg/dl
Tropical Sprue: causes? Leads to?
Which vitamin deficiencies can result?
Kcal/protein?
Vit supps/meds?
Chronic GI disease d/t bacterial, viral, parasitic infection in the intestines and sometimes the stomach
Can lead to: malnutrition, diarrhea, B12 and B9 deficiencies d/t decreased HCl and IF
MNT: high kcal, high protein diet; IM b12 injections and oral folate supps
Meds: antibiotics
Celiac disease aka non-tropical sprue aka gluten-induced enteropathy
What is it? What nutrients are malabsorbed? What can celiac lead to?
Autoimmune disease where gluten damages the SI
Vitamin D, Ca, Fe, folate malabsorbed
Can lead to:
- KEDA deficiency
- macrocytic anemia
- iron deficiency anemia
- weight loss
- diarrhea
- steatorrhea
What are some gluten-free foods?
Rice, corn, potato, sorghum, arrowroot, tapioca, quinoa, soybean, carob bean, guar gum, flax, amaranth, millet, teff
Crohn’s disease:
Which 3 conditions can result?
Diet/fat/fluid?
What nutrient should you reintroduce once in remission?
Vit/mineral supps?
affects the terminal ileum most commonly
Can lead to: B12 deficiency (absorbed in the ileum) —> megaloblastic anemia; iron deficiency anemia d/t blood loss and decreased absorption
MNT: bowel rest, PN or low fiber/low residue diet during acute flare ups; high fiber when in remission to stimulate peristalsis; limit fat ONLY if steatorrhea bc high fat may improve energy balance; MCT; fluid and electrolyte balance
Meds/treatment: corticosteroids like prednisone; antidiarrheal agents like sulfasalazine; B12 supps, chewable MVI, assess Ca Mg Zn; ileostomy (monitor dehydration)
What are some low residue foods?
Lean protein, broth, pulp-free juice and soft cooked veggies like mushroom
Ulcerative colitis:
Diet for acute UC?
Types of foods?
Fluid?
What nutrient should you reintroduce when in remission?
What surgery is done if meds and diet don’t work?
affects the colon, begins in the rectum
MNT: acute UC - elemental diet to minimize fecal volume; easy to digest, soft bland foods; maintain adequate nutrition, fluid and electrolyte balance (bc UC leads to diarrhea, low appetite and malabsorption); high fiber when in remission to stimulate peristalsis
Meds/treatments: antidiarrheal agents (sulfasalazine); J pouch surgery if meds and diet don’t work
IBS:
MNT?
What type of tea may help?
Meds/treaments?
affects the LI (colon)
MNT: Low FODMAP diet; adequate nutrient intake; avoid gas-forming foods and swallowing air during eating; small meals; avoid caffeine and deep-fried foods; minimize stress
Peppermint tea (has menthol, smooth muscle relaxant) may relax lower esophageal sphincter –> reducing reflux, cramping, pain
Meds: probiotics, meds to treat symptoms
What are FODMAPs? What are some examples of FODMAPs?
Non-digestible short-chain carbs. Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols
O: wheat, rye, nuts, artichokes, legumes, garlic, onion
D: lactose foods likes ice cream
M: fructose like fruits and nectars like honey, maple syrup, agave
P: stone fruits, sugar alcohols like sorbitol
Constipation: causes? MNT? Meds?
Causes: nerve damage (SCI, stoke); weakened pelvic muscles; hormonal change/stress; laxative abuse; low fiber diet; low physical activity
MNT: drink fluids; exercise; increase fiber intake
Meds: laxatives
Diarrhea occurs when the intestine pushes stool through the bowel before the water can be reabsorbed. What are some causes of diarrhea?
Greasy high-fat diet, spicy foods, sugar, coffee/with milk
What is the MNT for adult diarrhea?
rehydrate, replace lost electrolytes (Na, K)
decrease GI motility (no clear liquids, foods high in lactose, sucrose, fructose and no caffeine/alcohol)
low-fat diet (high fat may cause diarrhea d/t the body not keeping up with the breakdown and absorption of fat)
low fiber diet (won’t stimulate the bowels)
What is the MNT for diarrhea in infants and children?
Acute: rehydrate and electrolyte repletion (glucose electrolyte solution)
Chronic/nonspecific:
- 40% kcal as fat, balanced with limited fluids
- restrict/dilute juices with high osmolar loads - apple, grape
What are the meds/treatments for diarrhea?
Anti-diarrheal agents
Probiotics: restores the beneficial bacteria which has been flushed out with diarrhea
Prebiotics: promote growth of healthy bacteria
- pectin, fructose, oats, whole grains
- FOS (onion, banana, garlic, artichoke, asparagus, chicory)
Diverticulosis:
what is it?
MNT?
The presence of diverticula (small and bulging pouches that form in the lining of the digestive tract d/t structural weakness)
related to constipation/lifelong intra-colonic pressures
MNT: high fiber diet to increase the volume and weight of the residue. Provides rapid transit.
Diverticulitis: what is it? MNT?
Diverticula become inflamed/infected
MNT: clear liquids bc they leave the stomach faster; LOW RESIDUE DIET; slowly increase fiber bc fiber increases gas and bloating
Which portions of the GI tract are of particular concern when resected? What are the implications of an ileal resection?
Loss of ileum (distal 1/3), ileocecal valve and colon are particularly concerning
Ileal resection:
- distal = B12, IF, bile salt absorption
- absorbs major portion of fluid so pts need to compensate for losses in the stool
- can’t recycle bile salts –> malabsorbed fats combine with Ca, Zn, Mg to form “soaps”; increased colonic absorption of oxalate forms renal oxalate stones; increased fluid and electrolyte secretion and colonic motility
Short Bowel Syndrome:
General PN & EN?
Jejunal?
Ileal?
Colon?
Vit/mineral supps for each section?
MNT:
- PN initially to restore/maintain nutrient status
- EN then transition to food as tolerated
- Jejunal: ileum can compensate so normal balance of macros; avoid lactose, oxalates, a lot of concentrated sweets
- Ileal: large resections –> complications so limit fat, use MCT (doesn’t need bile salts/needs less intestine surface area), drink 1+ L more than ostomy output/day
- Colon: loss of water and electrolytes, loss of salvage absorption of CHO and other nutrients
Meds/treatments:
- jejunal: vitamin/mineral supps
- ileal: vit ADEK, Ca, Mg, Zn supps; B12 (PN) then monthly injections if >100 cm terminal ileum removed
- Colon: chewable vitamins
What is the normal fat level range in stool? What is the range that indicates steatorrhea? MNT for steatorrhea?
Normal fat in stool: 2-5 g
Malabsorption (steatorrhea): >7 g
MNT: high protein, high complex CHO, fat as tolerated, vitamins (especially fat-soluble), minerals, MCT
Billroth 1:
What is it?
Why is it performed?
What can it lead to?
What vit deficiencies can result?
MNT/treatment?
Gastroduodenostomy performed d/t gastric cancer
Leads to: dumping syndrome, reactive hypoglycemia
Deficiencies:
- B12 deficiency (lack of IF and bypassing SI interfere w/ absorption)
- B6 deficiency (needs B12 for transport inside the cell)
MNT/treatment:
- small frequent low fiber meals
- lactose poorly tolerated d/t rapid transport
- add butter for kcal (and slowed digestion)
- no fluids w/ meals bc you get full faster and it moves the food more quickly into the SI
- B12 shot if all of the stomach was removed
- calcium and vit D supps
- avoid high sugar foods/hypertonic concentrated sweets
- 50-60% complex carbs, protein at each meal
Billroth 2: What is it? Why is it performed? What can it lead to? MNT/treatment?
gastrojejunostomy performed d/t gastric cancer or peptic ulcer disease
Leads to: dumping syndrome; Ca and Fe malabsorption bc food bypasses duodenum –> reduced pancreatic enzyme secretion
MNT/treatment:
- small frequent low fiber meals
- lactose poorly tolerated d/t rapid transport
- add butter for kcal (and slowed digestion)
- no fluids w/ meals bc you get full faster and it moves the food more quickly into the SI
- B12 shot if all of the stomach was removed
- calcium and vit D supps
- avoid high sugar foods/hypertonic concentrated sweets
- 50-60% complex carbs, protein at each meal
Roux-en-Y: What is it? Why is it performed? What does it lead to? MNT/treatments?
Weight loss surgery
Can lead to: dumping syndrome; malabsorption d/t food bypassing parts of the stomach and the SI; long term –> malnutrition
MNT/treatments:
- liquid diet, low sugar and low starch post-surgery
- then pureed diet before soft foods can be eaten
- must take vitamins for the rest of life
What nutrient deficiencies may develop after a complete gastrectomy?
Ca, Folate, Fe, Cu, B12, B1, vit D
What are the 4 functions of the liver?
store and release blood
filter toxic elements
metabolize and store nutrients
regulate fluid and electrolyte balance
Some enzymes are stored in the liver so when the liver is damaged, enzymes are released into the blood circulation and labs are elevated. What are some of the enzymes and when are their levels elevated/decreased?
ALP (alkaline phosphatase) 30-120 UL:
- increased in liver disease, bone disease
- decreased in scurvy, malnutrition
LDH (lactic acid dehydrogenase)
- increased in hepatitis, MI, muscle malignancies
AST, SGOT (aspartate aminotransferase) 0-35 UL
- increased in hepatitis
ALT, SGPT (alanine aminotransferase) 4-36 UL
- increased in liver disease
Acute viral hepatitis: what can it lead to?
Meal pattern?
CHO/pro/fat/fluid?
Vitamin/mineral supps?
Can lead to: necrosis, jaundice, anorexia, nausea, fatigue
MNT:
- high fluid to prevent dehydration
- small frequent meals d/t anorexia
- 50-55% CHO to replenish liver glycogen and spare protein
- high protein (1-1.2 g/kg) bc protein helps with cell regeneration + convert fat to lipoprotein for removal from liver
- Mod-liberal fat; <30% kcal fat if steatorrhea
- Coffe (anitoxidant)
- 2 g Na if fluid retention
Meds: MVI (vitamin D), with B complex, Zn, vit C and K
What are complications/side effects associated with cirrhosis?
Portal HTN –> varices:
- blood can’t flow through the scarred tissue leading to built up pressure so blood is brought to the liver.
- to relieve the pressure, blood passes through other veins (esophageal, abdominal, collateral) resulting in varices
Protein deficiencies –> ascites, fatty liver, impaired blood clotting
Ascites:
- scarring blocks blood flow out of liver into vena cava –> liver expands w/ extra blood storage
- when at capacity, plasma leaks into peritoneal cavity –> high osmolar plasma pulls in fliud to dilute the load
- Na and water retention
Cirrhosis:
Kcal/pro/fat/fiber/fluid?
Vitamins/mineral supps?
MNT:
- high lean protein (0.8-1.2 g/kg; in stress at least 1.5) bc protein suppresses the uptake/storage/synthesis of fat AND prevents ascites
- high kcal (25-35 kcal/kg dry wt)
- mod-low fat bc FAT is PREFERRED FUEL, omega 3s, MCT if needed
- low fiber w/ varices bc high fibrous meals can cause the varices to erupt by scraping against the veins and causing severe bleeding, swelling and pain
- low fluid (1-1.5 L/day) and Na bc fluid builds up in the abdomen
Meds:
-MVI (vit D) w/ B complex, Zn, vit C, Mg
- Monitor need for vitamin A and D
What are some complications/side effects of alcoholic liver disease?
Liver’s ability to break down fat is reduced:
- Pt usually has high TG bc alcohol increases the synthesis of VLDL
- H2 replaces fat as fuel in Kreb’s cycle –> fat accumulation in liver and blood
Malnutrition bc alcohol replaces food in the diet
Folate and protein deficiencies most responsible for malabsorption
Alcohol inflames the stomach –> interferes w/ absorption of B1, B12, vitamin C, folic acid
Mg excreted after alcohol consumption
Alcoholic liver disease: MNT? Meds/treatments?
MNT:
- NO ALCOHOL
- thiamin and folic acid supplementation
- Increased need for B vitamins (to metabolize alcohol) and Mg
Meds/treatments:
- corticosteroids to reduce liver inflammation
- liver transplant
Non-alcoholic fatty liver disease: risk factors? MNT? Treatments?
Risk factors: BMI >35, T2DM, metabolic syndrome
MNT: healthy diet (Mediterranean); coffee (antioxidants)
Treatments: increased activity and wt loss
What are some complications/side effects of ESLD?
Liver fails –> functionality reduced to 25% or less –> liver can’t remove toxins from the blood or convert ammonia to urea –> ammonia accumulates
Toxins accumulate in the brain = hepatic encephalopathy (could lead to coma)
signs of impending coma: asterixis (flapping, involuntary jerking motions)
ESLD: Causes?
Na/kcal/pro?
Meds?
Causes: cirrhosis
MNT:
- low sodium w/ edema/ascites
- MCT if needed
- High kcal and high protein (1.2-1.5 g/kg)
- If in a coma, LOW protein bc the liver can’t convert ammonia to urea
Meds:
- lactulose (laxative that removes nitrogen)
- neomycin (destroys bacterial flora that produce ammonia)
- BCAAs bc they provide kcal and protein but don’t harm the liver (damaged liver unable to clear AAAs)
use BCAAs when standard therapy doesn’t work
Gallbladder disease aka cholecystitis: MNT? Meds/treatment?
MNT: low fat diet
- acute = 30-45 g
- chronic = 25-30% kcal
Treatments: cholecystectomy
- bile now secreted from liver directly into the intestine so limit fat intake for several months and slowly increase fiber to help normalize bowel movements
How do gallstones (cholelithiasis) form?
Infection –> excess water absorbed –> cholesterol precipitates out –> gallstones
CAD: Causes? Leads to?
Heart Healthy diet components?
Meds?
Caused by plaque buildup in the wall of arteries
Leads to:
- arteriosclerosis (loss of elasticity of blood vessel walls)
- MI (reduced coronary flow to myocardium d/t clot blocking a narrowed artery)
MNT: heart healthy diet
- sat fat <7% total kcal
- <200 mg cholesterol
- 2 g Na
- unsaturated fats, no trans fat
- whole grains, fruits and veggies, low fat/fat free dairy
- 20-30 g fiber, 5-10 g soluble fiber
Meds/treatment:
- lifestyle change, increased activity, wt loss
- heparin for blood clots
HTN: MNT? Meds/treatment?
MNT: DASH diet/Mediterranean diet
- <2300 mg Na
- modify high salt intake, alcohol consumption, physical inactivity, overweight
Meds/treatment:
- thiazide diuretics (may lead to hypokalemia)
- CCBs, alpha blockers, ACE inhibitors, beta blockers, etc.
What are the complications/side effects of heart failure?
Weakened heart can’t maintain adequate output –> edema and dyspnea
Reduced blood flow to kidneys –> secretion of hormones that hold in Na and fluid –> weight gain
Heart failure:
Diet/fluid/pro?
Meds?
Vit supps? Which vit to pay extra attention to?
MNT:
- DASH diet
- 1-2 L restriction, 2-3 g Na
- high protein (1.1-1.4 g/kg)
Meds/treatment:
- Digitalis to increase strength of heart contractions
- DRI for B9, Mg, MVI with B12
- physical activity
- check thiamin (lost w/ loop diuretics) to prevent further heart muscle deprivation
Type 1 DM: Why does it happen?
MNT + Meds?
Happens d/t insulin deficiency
MNT: CHO consistent diet
Meds: insulin
DKA: Why it happens? MNT? Meds/treatments?
Happens bc of hyperglycemia d/t deficiency/excess CHO intake. There is dehydration d/t polyuria.
MNT: rehydration
Meds: insulin
What are some indicators of type 2 DM?
Acanthosis nigricans (gray brown skin in folds)
glutamic acid decarboxylase antibodies
Type 2 DM: why it happens? MNT? Meds/treatments?
Happens d/t insulin resistance (could become deficient). Long term: neuropathy, nephropathy, retinopathy
MNT: healthy eating
Meds/treatment: physical activity, wt loss, monitor BP and lipids
GDM: Why it happens? MNT?
Increased risk if BMI >30, hx of GDM
- screen at 24-28 weeks w/ 50 g glucose. If 140+ then need further testing
MNT:
- 15-30 g CHO at breakfast, rest divided evenly
- 175 g CHO/day
Addison’s Disease: causes?
MNT?
Meds?
Vitamin/mineral supps?
Causes: adrenal cortex insufficiency aka atrophy of adrenal cortex
MNT:
- Frequent high protein, high salt meals
high salt bc with low aldosterone, Na will be lost and K will be retained
Meds:
- corticosteroids (chronic use –> osteoporosis)
- vitamin D and calcium
What are the complications/side effects of Addison’s disease?
Decreased cortisol –> glycogen depletion, hypoglycemia
Decreased aldosterone –> Na loss, K retention, dehydration
Decreased androgenic –> tissue wasting, weight loss
Goiter: causes? MNT?
Enlargement of the thyroid gland d/t insufficient thyroid hormone
MNT:
- iodine
- Avoid goitrogens (cruciferous veggies, soy products)
Gout: causes?
Protein/CHO/fat/fluid?
Meds?
Disorder of purine metabolism. Increased serum uric acid deposits in the joints causing swelling and pain.
MNT:
- avoid alcohol
- moderate protein (no high purine diet = red meat, alcohol, seafood, processed foods. HIGH PURINE VEGGIES LIKE ASPARAGUS/SPINACH ARE OK)
- liberal CHO and fluid
- low fat reduces uric acid
Meds: colchicine (urate eliminant)
Galactosemia: causes? MNT?
Which foods are ok to eat?
inborn error of metabolism d/t missing enzyme that converts galactose-1-PO4 to glucose-1-PO4
MNT:
- Galactose and lactose-free diet the ONLY treatment
- OKAY foods = soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG
urea cycle defects aka OTC (ornithine transcarbamylase deficiency):
causes? MNT?
Can’t synthesize urea from ammonia –> ammonia accumulates
MNT:
- protein restriction (1, 1.5, 2 g/kg) to lower ammonia
- therapeutic formulas to adjust protein composition, limits ammonia production
Glycogen storage disease: causes? MNT?
No glucose-6-phosphatase in liver so unable to convert glycogen into glucose –> hypoglycemia
MNT:
- low fat, high CHO diet
- consistent exogenous glucose feedings + raw cornstarch
PKU: causes? MNT?
Missing phenylalanine hydroxylase so phenylalanine can’t be converted to tyrosine –> accumulates –> poor intellectual function
MNT:
- avoid aspartame
- restrict phenylalanine, supplement tyrosine
- Low in Phe formulas but enough to support growth
- Low protein diet
- control foods like potatoes, pasta and cereals to prevent dental caries
MSUD:
causes?
MNT?
Which foods to avoid?
inborn error of metabolism of BCAAs
MNT:
- restrict BCAAs
- provide adequate CHO and fat to spare AAAs
- small amounts of milk to support growth (may use gelatin)
- AVOID eggs, meat, nuts, other dairy products
Homocystinuria: causes?
Which B vitamins should be increased in newly diagnosed pts?
What do you do if they don’t respond?
Treatable inherited AA metabolism disorder:
- methionine and homocysteine increase in plasma, homocysteine excreted in the urine
MNT:
- newly diagnosed –> increased B6, B9, B12 doses d/t low levels
- low protein, low methionine diet if they don’t respond
Congenital Sucrase Isomaltase Disease (CSID): causes? MNT? Meds/treatment?
What special considerations are there for diabetics?
Genetic condition where you can’t break down sucrose and maltose
MNT: diet modification of sucrose, starch and maltose
Meds/treatment: sacrosidase (oral enzyme replacement for sucrase)
- don’t need to restrict sucrose, only starch and maltose
- if diabetic, check BG bc enzyme converts sucrose into glucose and fructose
