Nutrition Flashcards
5 steps of MUST includes
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
What are the nutritional requirement?REE / BEE
• In normal people = 1 (20 kcal / day)
• mild to moderate sepsis = 1.4 times.
• severe sepsis = 1.8 times.
• Severe burns = 2 times.
Best position to insert ryles tube/nasogastric tube(NG TUBE)
Sitting with neck slightly flexed
What are the various ways of feeding gastrostomy?
1) Stam method (more leakage)
2) witzel method (less leakage)
3) PEG ( percutaneous endoscopic Gastrectomy) method includes push , pull , introducer method
What are the various ways of feeding jejunostomy?
- Stam method
- Witzel method
Principles of enteral nutrition
• 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.
What is the most common overall complication of enteral nutrition?
Tube related
What is the most common feeding problem in enteral nutrition
Osmotic diarrhea
What are the indications for parenteral nutrition?
• 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.
Best route for parenteral nutrition
Central line
Most commonly used vein in centerline
IJV
Most commonly used vein in TPN
SCV (preferred because it has less risk of infection)
Central line tip is at
At the junction of SVC and right atrium
TPN provides how many kilo calories
2000 kcal
Composition of TPN
20:30:50 (protein : fat : carbohydrates )
Why In a patient with respiratory failure, COPD, low osmolar TPN is preferred
High osmolar fluid contain high carbohydrate, high CO2 production , respiratory quotation >1 , increases risk of thrombosis
In renal failure TPN should be
Low quantity TPN with high carbohydrate is used
Most common micro nutrient deficiency in feeding regime
Zinc
What is refeeding syndrome?
• 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.
Metabolic abnormalities seen in refeeding syndrome is
Hypocalcemia
Hypophosphatemia
Hypomagnesemia + Fluid overload -> Arrhythmias, CHF
Hypokalemia
Hyponatremia
Refeeding syndrome can be prevented by
I. Gradually increase the quantity of feeds.
2. Thiamine supplementations.
3. Strict monitoring of serum electrolytes.
Colloids examples
Gelofusine , Haemacel , Hetarch
Early sign of post up volume overload is
Weight gain (>1 kg/ day)
What is the most common complication of supplementary nutrition ( enteral or parental)
Over feeding
Which lines are easier to insert?
IJV Are easier to insert compared to SCV ROUTE
Following TPN1 expect weight gain after how much time
5-7 days
Central line should be changed
Only if there is infection
Calories of dextrose, amino acid and fat
Dextrose: 4 kcal
AA : 4 kcal
Fat : 9 kcal
Monitoring of patient on TPN
• Daily weight: > Ig/ day gain - Fluid overload
• BUN/LFT: Once weeKly.
• Serum electrolytes: Every 2 - 3 days.
