Nutrition Flashcards
Yellowish tinge to the skin without scleral icterus. What do you suspect?
Hypercarotenemia (eating a lot of yellow-orange vegetables including squash, carrots, etc).
True or false. Zinc deficiency can be associated with cystic fibrosis
True. Zinc-binding ligands may be missing from the intestinal tract.
In the setting of otherwise healthy children, usually occurs when you stop breastfeeding (breast milk contains zinc-binding ligands).
What are signs of a Vitamin E deficiency?
Neurological defects and hemolytic anemia.
Kwashiorkor vs Marasmus differences?
Kwashiorkor- protein malnutrition with otherwise close to normal daily nutritional intake
Marasmus- general total caloric deficiency
Moon face, protuberant belly, lower extremity pitting edema– name the nutritional disorder; otherwise fairly normal height, weight for age.
Kwashiorkor
Generalized FTT with poor weight gain and height gain. Fine hair, brittle nails/teeth. Once fed, remains vigorously hungry.
Marasmus.
Niacin deficiency symptoms?
Vitamin B3 deficiency; triad of 3D’s– diarrhea, dermatitis, dementia
Canal necklace, angular chelitis and mucositis, glove and stocking distribution of dermatitis, dementia–name the vitamin deficiency?
Pellagra 2/2 niacin deficiency (Vit B3)
Name the vitamin deficiency: generalized myalgias, gingivitis and bleeding of gums, loss of teeth, irritability, X-ray of long bones shows ground glass appearance of bones and cortical thinning, petechia and hyperkeratosis of hair follicles?
Scurvy or Vitamin C deficiency.
Crohn’s disease has an increased risk of deficiency of which vitamins?
Vitamin A/D/E/K and vitamin B12 deficiency (terminal ileum is affected, leading to issues with Vit B12 absorption–pernicious anemia)
Does fluoride pass through breast milk?
No, not even if MOP drinks fluorodinated water
When do you worry about supplying fluoridinated water?
Starting at 6 months old.
Calculate the fluid reqs for a 25kg child who also has a 5% fluid deficit.
100/50/20 rule First 10kg, 100ml/kg= 1000mL Second 10kg, 50ml/kg= 500mL Last 5kg, 20ml/kg= 100mL Total maintenance= 1600mL
25kg x 0.05 deficit= 1.25L or 1250mL
1600mL + 1250mL = 2850mL over 24 hours
Kwashiorkor rash?
Generalized rash with “flaky paint dermatitis”; red-brown raised scales that easily peels off with underlying layer of blanching erythema due to severe protein malnutrition
Why are premature infants more susceptible to Vit E deficiency?
Transfer of Vit E through the placenta occurs during the third trimester; premature infants are therefore susceptible to hemolytic anemia 2/2 Vit E deficiency, especially in the 2nd month of life.
What vitamin should be supplemented in strict vegans?
Vitamin B12
True or False. Women with breast implants are unable to breast-feed their children.
FALSE. Breast implantation does not destroy alveolar tissue that produces the milk.
True or False. A contraindication to breast-feeding is moms with breast implants.
FALSE. No studies to show leaching of silicone into milk to support negative effects of breast feeding while having implants.
True or False. You can start a soy formula in a preterm infant.
FALSE. Soy formulas can only be used in term infants.
In which infants can you recommend soy formulas?
Term infants, infants of vegan families (no animal products–therefore no cow’s milk), and infants with galactosemia
Vitamin A deficiency symptoms?
Eye-issues; concerns about impending blindness
Vitamin A excess symptoms
Neurological symptoms due to increased ICP; pseudotumor cerebri, papilledema, headaches, vomiting, dry mucous membranes (eyes/mouth), hyperostosis of bones (thin, wavy thickening of bones)
Vitamin K deficiency issues?
Hemorrhagic disease of the newborn– newborns lack gut enzymes to make Vitamin K
What should you give to a newborn with hemorrhagic disease?
Vitamin K AND FFP (contains Vitamin K dependent factors that can act to stop bleeding)
Vitamin E deficiency?
Hemolytic anemia
Decreased reflexes
Associated with receiving TPN
Vitamin D excess?
Hypercalcemia with Ca2+ induced diuresis, hyperphosphatemia, increased kidney stones
Widening of physis (growth plates– wrists and ankles), frontal bossing, pigeon chest, ricketic rosary, pigeon chest– what vitamin deficiency?
Vit D– rickets
Which vitamin deficiency can be associated with cardiomegaly?
Thiamine (Vitamin B1 deficiency– Beriberi)
Pellagra is commonly seen in children who each a diet rich in what type of food?
Corn
Vitamin B1 (Thiamine) deficiency?
Peripheral vasodilation related to B1 deficiency–high output cardiac failure.
Ataxia, neuropathy/encephalopathy/delirium (Wernicke’s)
Korsakoff syndrome- retrograde and anterograde amnesia
Riboflavin (B2) deficiency?
Angular chelitis, glossitis
Pyridoxine deficiency is associated with which drug regimen?
B6 deficiency, associated with isoniazid therapy for TB; look for neuro symptoms
Biotin deficiency?
B7 deficiency– associated with alopecia, rash and neuro-findings (ataxia)
Folate deficiency?
Vitamin B9 (macrocytic anemia, swollen red tongue), NTD defects in newborns of mothers deficient in folate Associated with a history of goat milk ingestion (poor in folic acid)
Zinc deficiency?
Associated with weaning off of breast milk (MBM has zinc-binding ligand); severe scaly and erythematous dermatitis around natural orifices
True or False. Acrodermatitis enteropathica is a disorder that just describes overall Zinc deficiency.
FALSE. It describes an inherited (AR) form of Zinc deficiency due to Zinc transporter defect. Results in diarrhea, FTT, alopecia AND rash of zinc deficiency.
Energy requirement calculation formula
Same as fluid calculations, except use kcal for mL:
100kcal/kg for first 10kg, then 50kcal/kg for next 10kg, then 25 kcal/kg beyond that
Essential fatty acid deficiencies findings
Linoleic and alpha-linolenic acid deficiencies
Alopecia, scaly dermatitis, and thrombocytopenia
Tocopherol is another name for which Vitamin? Deficiency? Toxicity?
Vitamin E
Deficiency: Hemolytic anemia
Toxicity: Hepatotoxicity
Infant fed a solely evaporated milk diet; what deficiency and disorder would you expect to see?
Lacking in Vitamin C (scurvy);
irritability, gum swelling, petechiae, ground glass appearance of cortical bone
Laboratory signs of chronic alcohol abuse?
Elevated GGT and increased MCV
