Nutrition Flashcards
What is the way that we calculate IBW?
- Male: 50kg + (2.3 x in over 60’’)
- Female: 45.5kg + (2.3 x in over 60’’)
What is Nutrition Body Weight?
- NBW = IBW + 0.25(wt - IBW)
- USE when body weight is 130% more than IBW [<110% use actual body weight]
What are some of the ways that we are able to alleviate stress response?
- Give MACRO and MIRCO nutrients [Protein, Carbs, Fat]
- Gylcemic Control
- START EARLY
What are some of the benefit of starting early?
- DECREASE disease severity
- DECREASE complication
- DECREASE ICU stay
- INCREASE patient outcomes
What are the 5 things we look at for Nutritional Assessments?
- Risk factors for Malnutrition
- History
- Anthropometrics
- Classifications of Malnutrition
- Nitrogen Balence
What are some of the risk factors for Malnutrition?
- Under Body Weight = 20% below IBW
- Weight Loss [>10% within 6m]
- NPO >10 days [clinical use 7days]
- Gut problems
- Mechanical Issues
- Metabolic needs
- Substance Abuse
When should we start using Nutrition within the ICU?
- 48 HOURS
- Can screen to see
What are the two important screening tools that are used for Nutrition?
- NUTRIC & Nutritional Risk Score [NRS-2002]
What is important to remember about the NUTRIC scores?
- HIGH RISK: 6-10 [5-9 w/o IL-6]
- LOW RISK: 0-5 [0-4 w/o IL-6]
How is History used in Nutritional Assessments?
- Dietary [intake, swallowing, ulcers, vomiting, diarrhea…]
- Medical [GI trat connected?]
- Medications [can decrease absorption]
What is Anthropometrics in Nutritional Assessment?
- Looks at both Protein and Muscle [IBW]
What Viceral Protein is the most important within Nutrition?
- Prealbumin; 2-3 half life; 15-40mg/dL conc.
What is C-Recactive Protein?
- Positive reactant [increase by 25% during inflammation]
- ALWAYS checked with Prealbumin
- Prealbumin DECREASES; CRP INCREASES = inflammation
- Prealbumin DECREASES; CRP NORMAL = Malnutrition
What are the Classifications of Malnutrition in the Nutrition Assessment?
- Marasmus: PROTEIN/CALORIE - wasting of muscle
- Kwashiorkor: PROTEIN - not about to get enough protein to keep up
What are some of the symptoms for Maramus and Kwashiorkor?
- Marasmus: Hair loss, edema, skin folds
- Kwashiorkor: Large Belly, decreased muscle mass, fatigue
What are some of the treatments for Maramus and Kwashiorkor?
- Maramus: Macros + Vit B
- Kwashiorkor: Carbs the High Protein
What is the Nitrogen Balence?
- A measurement of urinary excertion of nitrogen as urea nitrogen [urinary urea nitrogen = UUN]
- GOAL: +3 to +5g
What is the equation to find Nitrogen Balence?
- Nitrogen Balence = Nin - Nout
- Nin = 24h protein intake / 6.25
- Nout = 24h UUN + Factor [4g]
What is the Harris-Benedict Equation?
- Just shows how well we are doing at rest
What are some of the general guidelines about Caloric needs?
- Non-stressed = 20-25 kcal/kg/day
- STRESSED = 25-30 kcal/kg/day [IMPORTANT]
What is Indirect Calorimetry?
- Shows energy expenditure [REE, RQ] at ONE point in time; within 24 hours
- TEE = REE x 1.2 [REE is given]
- RQ = Vco2 / Vo2 [RQ is given?]
For Respiratory Quotient Values, what is the most important one?
- MIXED SUBSTRATE = 0.85 - 0.95 once weekly
- Over 1 = OVERFEEDING - too much calories
- Under 1 = UNDERFEEDING - using protein for calories
What are some of the general guidelines about Proteins?
- Maintenance = 0.8 - 1 g/kg/day
- Mild to Mod = 1 - 1.5 g/kg/day
- ** Mod to Severe = 1.5 -2 g/kg/day**
What are some additional considerations about Proteins?
- “Tolerance” may be decreased in some disease states; like renal and Hepatic failure
What is the Non-Protein Caloire [NPC] Distribution?
- 70/30
- 70-90% = DEXTROSE
- 15-30% = FATS
- Gets adjusted based on tolerances; increase Blood sugar = decrease DEX & increase fats = decrease FAT
When might 100/0 NPC be used in a patient?
- During sepsis or bloodstream infections [FUNGAL]
What is the definition for Parenteral Nutrition?
- The process of supplying nutrients via IV
- EXAMPLES: TPN, PN, TNA, 3-in-1
What are some of the indications for PN?
- NPO > 7days
- Cannot absorb nutritents [ILEUS, SMALL BOWEL RESECTION]
- Fistulas [nutrition goes somewhere else]
- IBD
- Hyperemesis Gravidum [Pregnant People]
- Mucositis
What are the two route for administration for PN?
- Peripheral & Central
What are some advantages and disadvantages for Central PN?
- Advantages: Can use hypertonic, MORE calories
- Disadvantages: Risk of infection, complications [Pneumothorax, Air Embolus, thormbus]
What is the main Central route in PN?
- Venous Access [Subclavian, Internal Jugular, Femoral]
- Long Term: PICC
What type of catheter is best to use in a PN and why?
- Triple Lumen because it allows for other meds to be add; ONE lumen is ONLY for TPN
What is requirements for Proteins [how many kcal]?
- 4 kcal = 1g
What is the requirements for Carbohydrates [how many kcal]?
- 3.4kcal = 1g
- Want D10W [10% dextrose]; Max D70W [70% dextrose]
- For 100/0 [fungal] use 4-5 mg/kg/min
What is the requirements for Lipids [how many kcals]?
- ~10kcal = 1g
What are the two Lipid Emulsions that are used in PN?
- Intralipids
- SMOFlipid
What is in Intralipid?
- Soybean oil 10% [omega-6]
- Glycerin 2.25% [allergies?]
- Egg Yolk 1.2% [allergies?]
- Water
What is in SMOFlipid?
- Soybean Oil 30%
- Medium-chain triglyceride 30%
- Olive Oil 25% [omega-9]
- Fish Oil 15% [omega-3]
What is the maximum intake of lipids within PN?
- MAX: 2.5g/kg/day if TOLERATING
- 1-1.5g/kg/day in general
- PROPOFOL has 1.1kcal/ml of fat