Nutrition

Question 1

3-MinNS framework

Answer 1

• Unintentional weight loss in the past 6 months
• Nutritional intake in the past 1 week
• Muscle wasting (temple & clavicle)

Score 3 or more warrants nutritional assessment
Score 5-9 signifies risk of severe malnourishment

Question 2

Weight based energy requirement

Answer 2

25-35 kcal/kg/day

Question 3

Protein requirement

Answer 3

Normal: 0.8 g/kg/day
CKD: 0.6-0.8 g/kg/day
HD/PD: 1.2 g/kg/day
CRRT: up to 2 g/kg/day

Question 4

Feature of Glucerna

Answer 4

1 kcal/mL
10 g of protein per serving (250 mL)
Low glycemic index

Question 5

Feature of Fresubin

Answer 5

1.5 kcal/mL
High protein content - 20 g/serving (200 mL)

Question 6

Feature of Nepro

Answer 6

General: 1.8 kcal/mL
220 mL per serving
HP: For dialysis, high protein (18 g/serving)
LP: Pre-dialysis, low protein, K, P (10 g/serving)

Question 7

Feature of NutriFriend

Answer 7

1.0 kcal/mL
Contains Omega-3 fatty acids (EPA/DHA)

Question 8

Complications of enteral feeding

Answer 8

• Tube occlusion
• Drug-nutrient interaction
• Tube migration
• Microbial contamination & infections
• Aspiration
• GI upset
• Refeeding syndrome

Question 9

Strategies to increase tolerance to enteral feeding

Answer 9

• Continuous > bolus
• Isotonic > hypertonic
• Post-pyloric feeding > pre-pyloric
• Use pro-kinetic agents
• Semi-elemental/elemental feeds if patients have absorptive issues

Question 10

Metabolic complications of parenteral nutrition

Answer 10

• Refeeding syndrome
• Hyper/hypoglycemia
• Fluid overload
• Intestinal failure associated liver disease
• Metabolic bone disease

Question 11

NICE criteria for identifying patients at high risk of refeeding syndrome

Answer 11

One of:
- BMI < 16
- Weight loss >15% in past 3 months
- Little-no nutrition >10 days
- Low K, Mg, P before feeding

Two of:
- BMI < 18.5
- Weight loss >10% in past 3 months
- Little-no nutrition >5 days
- History of alcohol abuse, drug use (insulin, chemo, antacids, diuretics)