nutrition Flashcards
nutrients
chemicals utilized by the body for energy
micronutrients
vitamins and minerals
macronutrients
carbs, proteins, fats
energy measurement
measured in calories
- energy required to raise 1kg of water by 1 degree celsius
anabolism
synthesis of storage
catabolism
breakdown of storage with inadequate intake
BMR
energy for body maintenance
- 10 kcal/lb
GI absorption
villi in small intestine and large intestine
nutrition absorption
occurs in duodenum, jejunum, and ileum
water absorption
occurs in the large intestine
malnutrition
less than 40 nutrients required for normal function
organic failure to thrive
‘cachexia’ due to pathology
cachexia
organ disease
- accelerated BMR, high cytokines which affect normal hunger triggers causing a low appetite
non organic failure to thrive
caused by poverty or neglect
marasmus failure to thrive
lack of calories and protein
- infants
- no body fat
- no fluid buildup
- no fatty liver
- prominent ribs
- irritable
- muscle wasting
- very hungry
kwashiorkor failure to thrive
diet deficient of protein/child stops breastfeeding
- ages 6 months - 3 years
- body fat
- fluid build up causing swelling
- enlarged fatty liver
- non prominent ribs
- lethargic
- no muscle wasting
- poor appetite
similarities of marasmus and kwashiorkor failure to thrive
low immunity, dehydration, hypothermia, altered VS, hypoalbuminemia
enteral nutrition
for patients who need increased calories or cannot eat regular food
- NG, NJ, G-tubes
polymeric preparation for enteral nutrition
proteins, lipids, and carbs- high calorie intact nutrients
- eg. Ensure
Oligomeric preparation for enteral nutrition
easily digestible components- amino acids and peptides
- hydrolyzed nutrients
bolus feeds
mimics normal meals
intermittent feeds
similar to bolus but at a slower infusion such as 30-60 min
continuous feeds
easy to digest and absorb and is ideal for recovery
- avoids dumping syndrome which can cause an osmotic shift
parenteral nutrition
goes into bloodstream
TPN
IV–> ‘central line’ (subclavian vein) is ideal
- goal is to increase nutritional intake
side effects of TPN
fluid overload causing an infection
- electrolyte imbalances causing hyperglycemia
starvation
stored fat–> fatty acids –> main energy source–> increase in serum ketones –> gluconeogenesis (no glucose)
- depletion of intracellular minerals
refeeding syndrome
occurs post-nutritional starvation
- glucose surge –> insulin secretion –> low plasma levels –> water shift into cells –> non functional metabolism –> massive hemostatic change
signs and symptoms of refeeding syndrome
Thirsty
Increased HR
Exhaustion
Blurred vision
Hypothermia
Elevated liver enzymes
Electrolyte shift out of blood and into cells
Thiamine deficiency (delirium and dizziness)
refeeding treatment
before feeding give vitamins (thiamine, B)
slow feeding with slow increase (0.0418 MJ/kg/day)
slow rehydration
monitor electrolytes
vitamin D deficiency aka osteoporosis
fragile bones due to increased bone resorption
- most common cause is menopause due to low estrogen which normally drives calcium deposition
- other causes are thyroid hormone deficiency, age, genetics, high ETOH or caffeine intake
osteoporosis treatment
vitamin D and calcium
bisphosphonates- suppress osteoclast activity to decrease the rate of bone resorption
bisphosphonates
treat osteoporosis by suppressing osteoclast activity
“nate”
Alendronate (Fosamax), Risedronate (Actonel)
bisphosphonates; treat osteoporosis
calcium gluconate
vitamin medication
calcitriol (calcijex)
vitamin medication
- activates vitamin D3
vitamin C function, source, and deficiency
acts as an antioxidant, immunologic and repairs tissue
- acquired from fruits and veggies
- deficiency is called scurvy and occurs due to a restrictive diet
vitamin A (retinol) function, source, and deficiency
visual pigmentation and epithelial cell synthesis
- acquired from carotene rich foods such as green vegetables, carrots, milk, and eggs)
- deficiency is called avitaminosis and it is due to GI illness such as celiac
vitamin K 1 and 2 function, source, and deficiency
aids in bone building and blood clotting
- K2 is acquired from GI synthesis
- K1 acquired from cheese, cooked spinach, cooked broccoli, and cooked spinach
- deficiency is called VKDB and starts in newborns
vitamin B12 function, source, and deficiency
aids in CNS function, cell metabolism, and RBC maturation
- acquired from meat, seafood, and milk
- deficiency is called cobalamin and it occurs due to vegan diets
vitamin B complex function, source, and deficiency
aids in cell synthesis, repair, and function as well as DNA synthesis
- acquired from a balanced diet
- B1 deficiency is beriberi and occurs due to ETOH abuse
- B3 deficiency is pellagra and occurs due to ETOH abuse
vitamin D function, source, and deficiency
skeletal calcium deposition
- deficiency is called osteoporosis in adults and rickets in children and occurs due to a deficit in intake of vitamin D or calcium
prolactin
female lactation hormone secreted from anterior pituitary and aids in milk synthesis
oxytocin
female lactation hormone secreted from posterior pituitary and aids in milk excretion and ejection
colostrum
found in breastmilk 1-3 days after delivery and is high in IgA, EGF, and is low in lactose
EGF
found in colostrum in breast milk and helps host flora build in the GI
transitional milk
3-14 days after delivery
- lactose, protein, and fat
mature milk
high in free water and is lower calorie and fat
breastmilk
56% milk fat
- 70 cal/ 100 ml
- low in vitamin D
iron
essential for hgb synthesis and mitochondrial energy production
- protein bound; when unbound it is toxic
- normal is 3.5-4 in adults and less than 3 in pediatrics
- normal loss is 1-2mg/day in adults and 0.27mg/day in pediatrics
transferrin
in blood and helps w/iron metabolism
ferritin
iron stored in liver and small % in plasma
source of iron for fetus
liver stores in 3rd trimester of gestation and is adequate until 6 months
source of iron for adults
recycling from old RBC and diet
iron in pediatrics
0.27mg/day
- 0.35mg/l in breastmilk
- 4-13mg/l in formula
- 10mg/day for older children
heme iron
found in meat, poultry and fish
non-heme iron
found in vegetables, grains, fruits, nuts, eggs, tofu
iron bioavailability
heme= 20%
non-heme= 5%
induced by proteins and vitamin C
inhibited by calcium
standard iron fortified formula contents, benefits, and issues
contains cow milk proteins, long chain fatty acids, nucleotides, and iron
- benefit is adequate nutrition if breastmilk not available and vitamin D fortified
- issue is long chain fatty acids are difficult to digest and it lacks immune boosters
- eg. Enfamil A
lactose free formula contents, benefits, and issues
glucose instead of lactose
- benefit is that its good for confirmed lactate deficiency
- issue is it may contain galactose/galactosemia and it contains intact proteins
- eg. Enfamil lactose free and Similac sensitive
hypoallergenic formula contents, benefits, and issues
hydrolyzed proteins and free amino acids
- benefit is that its good for milk protein allergy
- issue is that its expensive
eg. Alimentum and Enfamil nutramigen
soy formula contents, benefits, and issues
soy protein instead of milk protein
-benefit is galactosemia
- issue is low amino acids, fatty acids, and calcium
eg. Isomil, Enfamil soy
drugs not to use while breastfeeding
high Vd drugs, and highly lipophilic drugs
drugs best to use while breastfeeding
short half life drugs because it allows for clearance prior to breastmilk synthesis
infant contraindications for breastfeeding
galactosemia and lactose intolerance
galactose
monosaccharide that is metabolized lactose and is present in dairy
- milk, cheese, butter, yogurt, whey
galactosemia
hepatic GALT enzyme is deficient causing alternate metabolism and leading to active toxic metabolites such as galactitol
- tested for if suspected
S&S of galactosemia
vomiting, poor weight gain, fatigue, hypoglycemia
complications of galactosemia
failure to thrive- no weight gain (later sign)
hypoglycemia- causes brain damage
cataracts, low albumin (jaundice and bleeding disorders)
e-coli sepsis (opportunistic due to high galactose)
treatment of galactosemia
soy protein formula with calcium supplements
treatment of liver damage due to galactosemia
phototherapy for bilirubin
vitamin K and FFP for bleeding
lactose intolerance
lactase enzyme deficiency in the brush border of duodenum causing an inability to hydrolyze lactose
- high incidence especially in asian and south american ethnicities
congenital lactose intolerance
inherited trait
primary lactose intolerance
decreasing levels of lactase with age which is most common to occur after 2yrs of age
secondary lactose intolerance
associated with other illnesses
S&S of lactose intolerance
fluid shift into intestine causing watery stool
fermentation by bacteria causing gas and bloating
low appetite
lactose intolerance treatment
lactose free formula is first choice and soy formula is second choice
tests hydrogen gas concentration high post lactose ingestion
lactose intolerance breath test
if serum glucose level of milk lower than 500ml then it is indicative of lactose malabsorption
lactose intolerance lab test
feeding at 2 week visit wellness check
feeding every 2-3 hours for 20-30 min at a time
- 90 calories/kg/day
- void every 1-3 hours
- stool every 6-24 hours
- iron stores utilized
feeding at 6 month visit wellness check
can start solid foods at 6 months, but no cow milk until 12 months
- 100 calories/kg/day
- void every 6-24 hours
- iron supplementation required after 6 months
child expected growth and development by 1 year of age
-brain should be 2/3 of adult size
-head circumference 47cm
-myelination of nervous system nearly complete
- birth weight tripled
- single words, babbling, imitation of sounds
cow milk
not recommended until 12 months and 2 cups/day post 2 years of age helps meet vitamin D requirements
too much cow milk
will interfere with iron absorption due to calcium and will cause secondary anemia and can displace other foods from diet
RBC production
flat bone marrow in adults (pelvis, ribs, sternum)
endothelial cells, liver, and spleen in utero
- production elements are iron, vit B12, folate
RBC stimulus
cytokine hormone erythropoietin (EPO) which is produced in the kidneys
RBC elimination
spleen, liver, bone marrow
- iron and amino acids are recycled
- heme which is converted to bilirubin is through biliary excretion
RBC lifespan
120 days
anemia
impaired oxygen carrying capacity
- causes hypoxemia leading to hypoxia
- can be low hemoglobin or low RBC’s
anemia due to low production
low EPO, low RBC, low Iron
anemia due to losses
haemorrhage causing loss of RBCs or hemolysis which is destruction of RBC’s
‘iron deficiency’ anemia
nutritional deficiency due to inadequate supply or GI malabsorption
iron intake target for pediatrics
10mg/day
iron intake target for adults
20mg/day
- greater than 45 will yield GI symptoms of OD
‘iron deficiency’ anemia
ferrous sulfate (supplement)
S&S of anemia
fatigue, weak, pale, diaphoretic, tachycardic, increased CO, decreased immunity
serum iron
transferrin which is bound to plasma protein
serum ferritin
iron stores
serum hematocrit
RBC volume
cause of low serum iron and ferritin
iron deficiency and consequence will be low hemoglobin and low RBC’s
high serum iron and high ferritin
cause is hemolytic anemia (destruction of RBC) and consequence will be hypoxemia and hypoxia
low serum iron and normal ferritin
cause will be hemorrhage and consequence will be decompensation
high serum iron and normal ferritin
cause will be iron poisoning and consequence will be mitochondrial damage
Ferrous salts (PO)
90% bioavailable so it will reach bloodstream and should not take with calcium
- side effects include constipation and GI pain
Iron dextran (IV)
calculate based on lean body weight and hemoglobin
Monoferic (Monofer, Venofer) (IV)
iron by injection; “fer”
- better absorption
vomiting and GI pain as a S&S of iron poisoning
due to intestinal hemorrhage which causes mucosa damage and osmotic fluid shift leading to hemorrhage and hypovolemia
cardiac and CNS S&S of iron poisoning
due to no ATP production which causes altered Ca cellular transport leading to arrhythmias, cardiogenic shock, and altered LOC
iron poisoning treatment
deferoxamine (desferal)
deferoxamine (desferal)
treats iron poisoning
- binds iron to form non reactive complexes
hemorrhagic anemia
due to severe blood loss
acute hemorrhagic anemia
sudden loss due to injury, surgical bleed, childbirth
- once 10-30% of blood volume has been lost symptoms will present and there will be compensatory mechanisms, hypotension, and hypovolemic shock
hemorrhagic anemia treatment
crystalloid fluids, PRBC (if hemoglobin less than 7), injection iron medications
PRBC
administer if hemoglobin less than 7
- O is universal donor and can be given to everyone
allergic transfusion reaction
due to antigen recognition by immune system; antigens A, B, O, Rh
S&S of allergic transfusion reaction
IV vein redness/pain
flushed face due to vasodilation
VS changes (considered anaphylaxis)
- tachycardia, hypotension, dyspnea
Urticaria (hives)
N&V
allergic transfusion reaction treatment
NS and diuretics to enhance renal perfusion and function, antihistamines, glucocorticoids, epinephrine
lung function monitoring post allergic transfusion reaction
monitor due to hemolysis infarction and monitor VS and chest xray
renal function monitoring post allergic transfusion reaction
monitor due to hemolysis filtration and monitor I/O as well as nephrologist consult
