Nutrition Flashcards
What is the most sensitive test for malnutrition?
Albumin
Anergy secondary to malnutrition is mediated through what cells?
T-cells
What elements are increased in tumor lysis syndrome?
Potassium
Phosphorus
Uric acid
Which element is DECREASED in tumor lysis syndrome?
Calcium
Which electrolyte abnormality is LEAST consistent with tumor lysis syndrome?
Hypercalcemia, calcium is DECREASED with tumor lysis
Which element is most INCREASED with massive transfusion?
Potassium
Which element is most DECREASED with massive transfusion?
Calcium
What are the benefits of enteral feeds compared to TPN?
Trophic to small gut, decreased risk of infection compared to TPN
What non-essential amino acid is essential in patients with critical illness?
Glutamine
What is an essential fatty acid in critical illness?
Linolenic acid
What causes cholestasis associated with TPN?
Excessive carbohydrate calories
What is the most common METABOLIC abnormality with TPN?
Hyperglycemia
What is the equation used to calculate basal energy expenditure?
Harris-Benedict
666+(9.6kg)+(1.7cm)-(4.7*yrs)
Which factor is Basal energy expenditure most dependent on?
Weight
What is the most common ELECTROLYTE abnormality with TPN?
HYPOphosphatemia
Where is iron absorbed?
Duodenum
What cofactor is required for iron absorption?
Vitamin C
Night blindness, weakened immunity, diarrhea, and alopecia are common when deficient in what nutrient?
Zinc
Where is folate absorbed?
Duodenum
What trace element is needed for the creation of red blood cells?
Copper
Postoperative hyponatremia is secondary to what physiologic changes?
Increased ADH and free water retention
What is the most common cause of HYPERkalemia?
Renal failure, lab error
What are EKG manifestations of HYPERkalemia?
Peaked T-waves, flat p waves, prolonged QRS
What is the best ACUTE treatment for HYPERkalemia with EKG changes?
Glucose, insulin, calcium (stabilize cardiac myocytes)
What is the best continued treatment for hyperkalemia to deplete stores?
Kayexalate, saline diuresis, dialysis
How do you calculate FeNa?
[(urine Na x Plasma Cr)/(Plasma Na x Urine Cr)] x 100
What electrolyte abnormality is common with malignant hyperthermia?
HYPERkalemia
A patient with stage IIIB SCCC presents with ureteral obstruction, K>7, cr: 9.0, and peaked t-waves. What is the best INITIAL step?
Glucose/insulin
(calcium gluconate if an answer choice is more appropriate to stabilize cardiac myocytes
What is the most common cause of HYPOkalemia?
Vomiting, diarrhea, malnutrition, alkalosis
Which vitamin is required for magnesium absorption?
Vitamin D
Which patients are prone to become hypermagnesemic?
Patients with renal failure or acidosis
What EKG changes are present in patients who are hypermagnesemic?
Widened PR and QRS
What is the treatment for hypermagnesemia?
IV calcium
Which patients are prone to become hypomagnesemic?
Patients who have received cisplatin, on diuretics, or radiation enteritis
Radiation enteritis can result in bradycardia secondary to loss of what electrolyte?
Magnesium
What are some symptoms of low magnesium?
Similar to hypocalcemia: weakness, tetany, QT prolongation
What is the most reversible cisplatin toxicity?
Hypomagnesemia
Where is calcium absorbed?
Duodenum
What forms does calcium circulate in?
45% ionized, 40% protein bound, 15% bound tightly to other ions
What are common causes of hypercalcemia in cancer patients?
Lytic bone lesions, secretion of PTH-like peptides, thiazide diuretics
What are symptoms of hypercalcemia?
Short QT, weakness, confusion, nausea/vomiting
What are options for treatment of hypercalcemia?
Hydration, lasix, calcitonin (rapid onset 48 hrs duration of action), zolendronic acid
What is the most common EKG finding of hypercalcemia?
Shortened QT internal
What are causes of hypocalcemia in cancer patients?
Malnutrition, hypomagenesemia, tumor lysis syndrome
What are clinical signs of hypocalcemia?
Chvosteks sign, prolonged QT and ST
What is the most common electrolyte abnormality with TPN?
Hypophosphatemia
What are the symptoms of hypophosphatemia?
Weakness, mental status changes
What hormone mediates the release of phosphate?
PTH
Where is phosphorous stored?
Bone
What are common causes of metabolic acidosis?
GI loss, ketoacidosis, lactic acidosis, ASA, Tylenol or methanol ingestion, renal tubular acidosis
Which causes of metabolic acidosis cause an anion gap?
Lactic, ASA, Tylenol, DKA
What is the expected change in PH associated with a change of 10 pCO2?
0.08
What are causes of high anion gap?
Lactic acidosis (sepsis), DKA, ASA, ESRD
Which patient will likely have a non-gap acidosis?
Renal tubular acidosis and a patient with a transverse colon conduit
What is the LEAST likely to produce acidosis?
Vomiting
