Nutrition

Question 1

5 steps of MUST includes

Answer 1

Step 1 : BMI SCORE
Step 2 : Weight loss score
Step 3 : Acute disease effect score
Step 4 : overall risk of malnutrition
Step 5 : management guidelines

Question 2

What are the nutritional requirement?REE / BEE

Answer 2

• In normal people = 1 (20 kcal / day)
• mild to moderate sepsis = 1.4 times.
• severe sepsis = 1.8 times.
• Severe burns = 2 times.

Question 3

Best position to insert ryles tube/nasogastric tube(NG TUBE)

Answer 3

Sitting with neck slightly flexed

Question 4

What are the various ways of feeding gastrostomy?

Answer 4

1) Stam method (more leakage)
2) witzel method (less leakage)
3) PEG ( percutaneous endoscopic Gastrectomy) method includes push , pull , introducer method

Question 5

What are the various ways of feeding jejunostomy?

Answer 5

1. Stam method
2. Witzel method

Question 6

Principles of enteral nutrition

Answer 6

• Start gradually and then increase the volume.
• Start from 20-30 ml/hr and gradually build it up.
• Before next meal: Always aspirate first.
• If >200 cc of aspirate comes, withhold next feed.
• Break of 4-5 hours: During night time.
• After every tube feed, flush the tube with saline for patency of tube.

Question 7

What is the most common overall complication of enteral nutrition?

Answer 7

Tube related

Question 8

What is the most common feeding problem in enteral nutrition

Answer 8

Osmotic diarrhea

Question 9

What are the indications for parenteral nutrition?

Answer 9

• Prolonged ileus > 12 hrs.
• Short bowel syndrome:
1. Net absorbers : >100cm of jejunum. They can absorb water & sodium.
2. Net secretors : <100cm of jejunum.
• High output faecal fistula
(>500cC output in 24hrs).
• Acute episodes of IBD
• Initial phase of acute severe
pancreatitis.

Question 10

Best route for parenteral nutrition

Answer 10

Central line

Question 11

Most commonly used vein in centerline

Answer 11

IJV

Question 12

Most commonly used vein in TPN

Answer 12

SCV (preferred because it has less risk of infection)

Question 13

Central line tip is at

Answer 13

At the junction of SVC and right atrium

Question 14

TPN provides how many kilo calories

Answer 14

2000 kcal

Question 15

Composition of TPN

Answer 15

20:30:50 (protein : fat : carbohydrates )

Question 16

Why In a patient with respiratory failure, COPD, low osmolar TPN is preferred

Answer 16

High osmolar fluid contain high carbohydrate, high CO2 production , respiratory quotation >1 , increases risk of thrombosis

Question 17

In renal failure TPN should be

Answer 17

Low quantity TPN with high carbohydrate is used

Question 18

Most common micro nutrient deficiency in feeding regime

Answer 18

Zinc

Question 19

What is refeeding syndrome?

Answer 19

• Develops when large quantities of TPN are given in a chronically malnourished patient.
• malnourished: catabolic state. On giving large quantities of TPN: Shifts to anabolic state.

Question 20

Metabolic abnormalities seen in refeeding syndrome is

Answer 20

Hypocalcemia
Hypophosphatemia
Hypomagnesemia + Fluid overload -> Arrhythmias, CHF
Hypokalemia
Hyponatremia

Question 21

Refeeding syndrome can be prevented by

Answer 21

I. Gradually increase the quantity of feeds.
2. Thiamine supplementations.
3. Strict monitoring of serum electrolytes.

Question 22

Colloids examples

Answer 22

Gelofusine , Haemacel , Hetarch

Question 23

Early sign of post up volume overload is

Answer 23

Weight gain (>1 kg/ day)

Question 24

What is the most common complication of supplementary nutrition ( enteral or parental)

Answer 24

Over feeding

Question 25

Which lines are easier to insert?

Answer 25

IJV Are easier to insert compared to SCV ROUTE

Question 26

Following TPN1 expect weight gain after how much time

Answer 26

5-7 days

Question 27

Central line should be changed

Answer 27

Only if there is infection

Question 28

Calories of dextrose, amino acid and fat

Answer 28

Dextrose: 4 kcal
AA : 4 kcal
Fat : 9 kcal

Question 29

Monitoring of patient on TPN

Answer 29

• Daily weight: > Ig/ day gain - Fluid overload
• BUN/LFT: Once weeKly.
• Serum electrolytes: Every 2 - 3 days.