Nutrition Flashcards
adult maintenance fluid requirements
1500 ml + 20ml/kg over 20 kg
weight change concerning for malnutrition
> 10% in past 6 months
Mifflin-St. Jeor Equation
equation used to calculate fluid needs for obese patients
concentration of protein
4 kcal/g
concentration of lipids
9 kcal/g
calorie density of lipid solutions
20% = 2 kcal/ml 30% = 3 kcal/ml
concentration of dextrose/CHO
3.4 kcal/g
most detrimental consequence of refeeding syndrome
hypophosphatemia
fat soluble vitamins
A, D, E, K
water soluble vitamins
B, C
required dose of folate for pregnancy
800 mg
dietary sources of vitamin K
green leafy vegetables
vitamin D deficiency
serum concentration <30ng/mL
Components of enteral nutrition solution
proteins
fiber
micronutrients
water
protein-nitrogen balance
6.25 g of protein contains 1 g of nitrogen
nepro, novasource renal, magnacal renal
enteral formulas for renal failure
low protein, high amino acids, designed to minimize BUN
hepatic AID
enteric formula for hepatic failure
high conc of branched amino acids, low conc of aromatic amino acids, decrease risk for hepatic encephalopathy
pulmocare, novasource pulmonary, nutrivent
enteral formulas for pulmonary disease
low conc of carbs, high conc of fats, minimize accumulation of CO2
glucerna, diabetisource
enteral formulas for diabetes
low carbohydrates, high fat/fiber, better glc control
maximum concentration of TPN that can be delivered peripherally in adults and peds
adults - 10% dextrose
peds - 900 mOsm/L dextrose/10%, 4% amino acids, 40 mEq/L K, no Ca
peds monitoring for TPN protein
BUN, LFTs, albumin, pre-albumin
peds monitoring for TPN lipids
triglycerides, bilirubin
lipids infusion rate in infants
max 0.15 g/kg/h
infused over 18-24 h (over 12 h in older children and adults)
peds monitoring for TPN carbohydrates
serum glc, urine glc
GIR (glucose infusion rate)
((rate)(concentration))/6(weight in kg)
optimal calcium/phosphate ratio
preterm infants - 2.6 mEq Ca: 1 mMol PO4
who needs vitamin K supplementation?
TPN infusion > 2 weeks
similac special care, enfamil premature formula
premature formulas
neosure, enfacare
transitional formulas
similac, enfamil, enfaml enspire, enfamil AR, similac for spit up
term formulas
enfamil gentlease, enfamil sensitive, similac total comfort, enfamil reguline
allegy formulas
isomil, prosobee
soy formulas
progestimil, alimentum, nutramigen, enflora LGG
casein hydrolysate formulas
puramino, neocate, elecare
elemental formulas
contraindication to receiving parenteral lipids
egg allergy
treatment for high gastric residuals
metoclopramide, erythromycin
what peds need iron supplementation?
preterm infants w/o formula or breastmilk fortifier, other infants at high risk/anemic, term infants at 4 mo if exclusively breastfedw
what peds need vitamin D supplementation?
preterm if not on formula/fortifier, all term breastfed infants
what peds need multivitamins?
preterm if not on formula/fortifier, high risk infants >6mo
s/s of vitamin D deficiency
rickets, osteomalacia, osteoporosis, cancer, DM, HTN, HF, infections
groups at risk for thiamine deficiency
chronic alcoholics post bariatric surgery HIV/AIDS DM malnourished
s/s of thiamine deficiency
beriberi syndrome
- dry (neurotoxicity) - sensory disturbances, peripheral neuropathy, depression
- wet (cardiovascular) - dyspnea, tachycardia, cardiac failure
wernicke-korsakoff syndrome
- wernecke’s encephalopathy - reversible neuro disorder w/ confusion, nystagmus, ataxic gate
- korsakoff’s - irreversible neuro disorder w prolonged memory impairment
tx for thiamine deficiency
50-100 mg IV, then or PO
high dose - 100-500 mg IV or PO q8 x3-5 d
groups at risk for vitamin B12 deficiency
bariatric surgery
vegetarians
IBD
s/s of vitamin B12 deficiency
tingling, weakness, numbness, fatigue, memory loss
affects tissues w high turnover rate - hematopoietic/nervous systems
assessment of vitamin B12 deficiency
serum normal level 200-900 pg/ml
schilling test
tx for B12 deficiency
cyanocobalamin 100 mcg IM/SC weekly x4 weeks, then monthly
B12 1000 mcg PO QD
s/s of folic acid deficiency
megaloblastic anemia
tx for folic acid deficiency
folic acid supplementation can reverse hematopoietic manifestations but not neuro s/s
oral/IV 1 mg QD
400 mg OTC
normal plasma folate
4-20 ng/ml
s/s of vitamin B6 deficiency
peripheral neuropathy, glossitis, confusion
groups at risk for B6 deficiency
protein malnutrition, malabsorption, ETOH, hyperthyroidism
what is the most accurate biomarker of nutritional status?
pre-albumin
advantages of breast milk
immunologic properties reduce risk of immune-mediated diseases
psych and cognitive advantages
emotional bonding
excellent bioavailability of certain component
american academy of pediatrics recommendation for breastfeeding
exclusive breastfeeding for the first 6 months of life and continuation for the second 6 months
formula for infant w milk allergy
similac alimentum advance
meds w enteral feeding interactions
decreased absorption - levothyroxine, fluroquinolones, carbamazepine, phenytoin
obstruction - sucralfate, sevelamer
clotting - warfarin
what amino acid supplementation is used for infants in the first year of life?
trophAmine
harris-benedict equation
used to determine total caloric needs
contraindications for enteral nutrition
GI obstruction ileus severe malabsorption severe GI bleeding IBD
polymeric tube feeds are used for
patients with normal digestive process
partially hydrolyzed/oligomeric tube feeds are used for patients
with malabsorptive processes
how long can TPN run through PIV?
2 weeks
component of parenteral nutrition
fluids dextrose amino acids fats electrolytes micronutrients
what trace element is not in TPN that needs to be supplemented?
vitamin K
supplement if on TPN >1 week
schofield equation
used to calculate caloric needs for peds
peds indications for TPN
premature neonates resp distress congenital GI anomalies abdominal wall defects necrotizing enterocolitis chronic diarrhea IBD metabolic error pancreatitis, chylothorax, obstruction hypermetabolic - trauma, cancer anorexia cystic fibrosis chronic renal failure hepatic failure
conditionally essential amino acids
**peds don’t break down all aminos - give more cysteine, taurine, tyrosine
accumulation of other aminos - give less phenylalanine and methionine
conditions that decrease calcium/phos solubillity
increased pH
increased temperature
increased concentration
increased exposure time
what is the benefit of adding cystine to premature formula?
increasing the potential amount of calcium and phos
what is the benefit of adding cystine to premature formula?
increasing the potential amount of calcium and phos
multivitamins for peds
<11 - MVI with A, D, E, K
>11 - MVI-12 + vitamin K supplement
