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NGD > Nutrient utilization > Flashcards

Nutrient utilization Flashcards

1
Q

Well child nutrient utilization

A

“basal” needs - respiration, metabolism staying alive
+/- physical activity
Thermic effect of food - energy required to break down food (~10%) of intake
Growth: huge in infants

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2
Q

Sick child nutrient requirements

A

increased basal needs: High T, HR, RR, increased demand for ATP
reduced physical activity
reduced/no growth

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3
Q

physiology of stress

A

Burns/Sepsis/Surgery/Trauma
–> stimulation of CNS

ADH: water retention
Catecholamines: Renin, glucagon released
–> hyperglycemia, lypolysis, sodium retention
ACTH: glucocorticoid –> proteolysis, gluconeogenesis

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4
Q

ACTH effects

A

stimulated by CNS during stress
stimulate hepatic protein synthesis of acute phase reactants
stimulate catabolism of muscle –> aa for gluconeogenesis
Alanine (from muscle) stimulates glucagon

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5
Q

Catecholamine effets

A

stimulate glycogenolysis in muscle
stimulate gluconeogenesis from aa
decreased insulin relative to glucagon, insulin resistance –> hyperglycemia

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6
Q

Fasting state

A

cortisol stimulates muscle breakdown
cortisol, glucagon, epinephrine stimulate glucose production
aa are primary source of glucose
very large urinary nitrogen loss

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7
Q

Starvation state

A

fuel shift from aa –> fat
spares protein for vital functions
fat oxidation: glycerol (glucose) + FFA (energy)
incomplete fat oxidation –> ketone body formation for CNS, body

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8
Q

Protein turnover

A

increased in stress

reduced in starvation

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9
Q

Insulin during stress

A

increased to block lipolysis

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10
Q

Insulin during starvation

A

reduced to promote lipolysis

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11
Q

Nutrients needed in sick child - helpful

A 
Fe
P
Mg
Vitamin C, D
folate
B12
Se
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12
Q

Adolescence

A

WHO: 10-19
Period of rapid growth second only to infancy
nutrient requirements high, greatest during peak growht period, especially high for those who are very active
achieve final 20% of adult height and 40% of adult skeletal mass
Physical and sexual maturation
prevention of lifestyle disease

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13
Q

Peak height velocity - boys

A

longer childhood growth

higher peak velocity

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14
Q

Peak height velocity - girls

A

2-3 y before boys

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15
Q

Growth spurt

A

6 y in boys

4 y in girls

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16
Q

Weight growth in adolescence

A

boys: peak height velocity coindcides with peak weight velocity
Girls: peak weight velocity 6-9 mo before peak height velocity

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17
Q

Pre-pubertal/adult fat % in boys/girls

A

Pre-pubertal: 15%
Men: 15%, lean mass doubles btw 10-17
Women: 23%

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18
Q

Girls Fe requirements

A

9-13: 8 mg
14-18: 15 mg (11.4 OCP)
+1.1 if in growth spurt
+2.5 if menstruating

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19
Q

Boys Fe requirements

A

9-13: 8 mg, +2.9 if in growth spurt

14-18: 11 mg

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20
Q

Fe requirements during adolescence considerations

A

Vegetarian: multiply by 1.8 to correct for non-heme Fe

Upper level of iron - 45 mg/d based on GI side effects

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21
Q

Semi-vegetarian

A

no red meat

22
Q

Pesco-vegetarian

A

will eat fish

23
Q

Lacto-ovo-vegetarian risks

A

may be at risk for energy, protein, iron, zinc

24
Q

Vegan risks

A

at risk for energy, protein, iron, zinc, B12

25
Q

Anorexia N, restricting type

A

During last 3 mo, individual has not engaged in recurrent episodes of binge eating/purging
Weight loss primarily due to dieting, fasting, and/or excessive exercise

26
Q

Anorexia N, binge-eating/purging type

A

During last 3mo, individual has engaged in recurrent episodes of binge eating/purging

27
Q

Age of onset of anorexia nervosa

A

early to mid adolescence common, but can occur at any age even in childhood
Primarily seen in girls, but boys are seen more frequently in childhood year

28
Q

Boys with anorexia nervosa

A

shape is more of an issue than weight
concern around preventing development of a flabby shape
exercise predominates
small number, but increasing

29
Q

Bulimia nervosa

A 
Binge eating + extreme wt loss compensatory behaviours (purging/laxative/diuretic, fasting, exercise)
at least once a week for 3 mo
self evaluation unduly influenced by body shape + wt
can be normal or overweight
salivary gland enlargement
enamel erosion
esophagitis
arrhythmias
blood abnormalities (electrolytes, amylase, etc)
finger/back of hand may have callus
diarrhea/constipation
edema in ankle
30
Q

Bulimia nervosa age of onset

A

Later adolescence and young adulthood

31
Q

Eating disorder in partial remission

A

full criteria was met, but currently no longer fully meets all criteria

32
Q

“Eating disorder in full remission

A

full criteria was met, but now none of criteria has been met for a sustained period of time

33
Q

Binge eating disorder

A

regular/sustained binge eating episode

characterized by both eating in a discrete period of time and a sense of lack of control over eating during episode

34
Q

Binge eating disorder age of onset

A

young adulthood/midlife disorder

more even gender distribution

35
Q

Avoidant/restrictive food intake disorder

A

ARFID
new category
is like anorexia nervosa except without body image disturbance or weight/shape overvaluation

36
Q

Other Specified and Unspecified Feeding and Eating Disorder

A

OSFED, UFED, new terminology
Atypical anorexia nervosa: BMI normal
Purge disorder: sub-threshold forms of Bulimia Nervosa + binge eating disorder on basis of insufficient frequency or duration of ED behaviours

37
Q

Anorexia effect on NS

A 
can't think right
fear of gaining weight
sad, moody, irritable
poor memory
fainting
changes in brain chemistry
38
Q

Anorexia effect on skin, connective tissue

A 
thin and brittle hair
weak muscles, swollen joints, fractures, osteoporosis
easy bruising, dry skin
growth of fine hair all over body
cold intolerance
yellow skin
brittle nails
39
Q

Anorexia effect on CV system

A 
Anemia
low BP
slow HR
palpitations
heart failure
40
Q

Anorexia electrolyte disturbances

A

Low K, Mg, Na

41
Q

Anorexia effect on GI/GU

A

constipation
bloating
kidney stones
kidney failure

42
Q

Anorexia hormonal changes

A 
Amenorrhea
bone loss
problems growing
infertility
higher risk for miscarriage
higher risk for C-section
baby with low birth weight
post-partum depression
43
Q

Bulimia brain and behavioural changes

A 
depression
fear of gaining weight
anxiety
dizziness
shame
low self esteem
fatigue
44
Q

Bulimia soft tissue/muscle/bone changes

A

Cheek swelling, soreness
Mouth: cavities, tooth enamel erosion, gum disease, sensitive teeth
Throat: sore, irritated, can tear and rupture, blood in vomit
Abrasion of knuckles, dry skin

45
Q

Bulimia CV changes

A 
Arrhythmia
heart muscle weakened
heart failure
low pulse
low BP
anemia, fatigue
46
Q

Bulimia GI/GU changes

A 
Problems from diuretic abuse
Dehydration, low K, Mg, Na
Ulcers, pain, can rupture, delayed stomach emptying
Constipation
irregular BM
bloating, diarrhea, cramping
47
Q

Bulimia hormonal changes

A

irregular/absent period

48
Q

Consequences of eating disorders

A

Most changes are reversible EXCEPT:

  • bone density after a certain age
  • growth stunting - catch up growth can sometimes occur but may not be enough
  • brain changes not completely reversible, but consequences unknown
  • enamel erosion
49
Q

Eating disorder - criteria for urgent admission

A

Physiological instability:

  • postural hypotension - >20 mm Hg systolic
  • resting bradycardia
50
Q

Other reasons for admission due to eating disorders

A

Growth arrest and pubertal delay with poor weight gain in outpatient tx (esp for younger adolescents)
failure of outpatient tx
patient/parent not coping at home
lack of local services

51
Q

Medical reasons for admission in eating disorders

A

Refeeding syndrome can happen in severely malnourished patients
True phosphate deficiency manifests after 2-3 d of adequate nutrition
Requires close observation, regular blood tests and ECGs with phosphate tx, monitoring

52
Q

Clinical points in managing patients w/ eating disorders

A

Correct existing deficiencies, including fluid
Correct vol depletion, check renal function
measure K, Phosphorus, Mg daily, correct deficiencies
Calories: start where the intake is, increase q2-3d until at least 2000cal/D or more
MONITOR!

NGD (16 decks)

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