Nutrition Flashcards
FDA requirement for supplements
safe, but does not determine effectiveness
what are the fat soluble vitamins
A, E, K, D
role of vitamin A
vision
role of vitamin E
antioxidant
role of vitamin K
required for synthesis of clotting factors
when may vit K need to be supplemented
warfarin (supratherapeutic INR)
infants
sign of deficient vitamin K
hemorrhagic disease
role of vitamin D
calcium absorption, bone health
what is required for Vit D activation?
which precursor is monitored?
2 hydroxylation to activate
25(OH)D is monitored
risk for vit D deficiency
limited sun exposure
kidney dysfunction
breastfed infant without supplementation
what vit D level is considered deficient
<12 ng/mL
what vit D level is considered inadequate
<20 ng/mL
what vit D level is considered toxic
> 50 ng/mL
preventative vit D dosing
600-1000U (15-25 mcg) QD
high dose VIt D treatment is used if
Vit D <12ng/mL, symptomatic, or concomitant hypocalcemia
high dose VIt D treatment dosing
50,000 U (1250 mcg) QW for 6-12 weeks
low dose vit D treatment is used if
levels 12-20 ng/mL without symptoms or concomitant hypocalcemia
low dose vit D treatment dosing
800-1000 U (20-25 mcg) QD for 3-4 months
not responding –> increase to 2000 U QD
maintenance dose of vit D
600-2000 U (15-50 mcg) QD
populations that may need higher vit D doses
obesity, malabsorption, gastrectomy
what are the water soluble vitamins
thiamine/B1, riboflavin/B2, niacin/B3, pyridoxine/B6, cyanocobalamin/B12, folate/B9, vitamin C
role of thiamine/B1
energy metabolism
major sign and risk factor for thiamine deficiency
wernicke’s
alcohol use disorder
role of riboflavin
component of 2 enzymes involved in energy production, cell function, growth, and development
role of niacin
energy and development/function of cells
sign of deficient niacin
pellagra
role of pyridoxin
various
signs of deficient B6
anemia, weakness, insomnia, cns dysfunction, peripheral neuropathy
role of cyanocobalamin
various
signs of deficient B12
megaloblastic anemia, peripheral neuropathy
role of folate
makes dna and genetic material
sign of deficient B9
megaloblastic anemia
risks for deficient B9
poor diet, alcoholism, malabsorptive disorder
when is folate supplement recommended
women of childbearing age and pregnancy
role of vitamin c
antioxidant
sign of vit C deficiency and who may need more supplementation
scurvy, smokers
recommended supplement if pregnant
and what supplement to avoid
prenatal
avoid vit A (high conc teratogenic)
what supplement is recommended in breastfeeding
iodine, choline
what supplement is recommended for bariatric surgery
bariatric multivitamin
vit a/d/e/k/b1/b12/folate etc.
essential nutrients for elderly that may need supplementation
b12, b6, d, and calcium
supplement for age-related macular degeneration
AREDs2
which supplements might breastfed infants need
vitamin D and iron
deficiencies in alcohol use disorder
thiamine, pyridoxine, folate
outpatient supplement for AUD
multivit with thiamine, pyridoxine, and folate
inpatient treatment for wernickes
200-500mg IV thiamine TID for 2-7 days then 250 mg IV QD for 3-5 days
maintenance supplement for wernickes
100 mg thiamine po qd
deficiency caused by antiepileptics
calcium
deficiency caused by isoniazid
b6
deficiency caused by loops
K and Mg
deficiency caused by metformin
B12
deficiency caused by methotrexate
folate
deficiency caused by orlistat
beta-carotene, fat-soluble vitamins
deficiency caused by PPIs
Mg, B12
when is enteral nutrition considered
after 7 days if hospitalized
consider earlier if ICU
when to use enteral vs parenteral
if the gut works use it
how to administer meds with an NG, ND or G tube
crush and flush
DDIs where EN feeds need to be held 1-2 hours before and after dosing
phenytoin, quinolones, levothyroxine, warfarin
typical kcal/ml range of EN formulas
1-1.8kcal/ml
higher = more concentrated
EN requirements for fluid restricted diets
lower volume formula
EN requirements for renal disease
lower K and phosphate
EN requirements for DM
more fat and fiber, fewer carbs
EN requirements for burn/trauma patients
high protein
EN requirements for pancreatitis
low fat
bolus EN G tube administration rate
200-400 mL over 15-60 minutes
continuous EN administration rate
start at 20mL/hr and uptitrate Q4H
what to use if you have a clogged EN tube
cola, pancreatic enzymes, and sodium bicarb
when to initiate PN in adults
nourished, stable– 7 days
nutritionally at risk– 3-5 days
baseline malnourished– ASAP
when to initiate PN in peds
infants– 1-3 days
children– 4-5 days
when to initiate PN in neonates
very LBW– promptly after birth
preterm/critically ill- whenever needed
what is refeeding syndrome
severe reduction in K, phosphate, and Mg due to intracellular shift/repletion of stores during rapid initiation of nutrition
max mOsm/L of EN that can be used in a peripheral line
900 mOsm/L
minimum % of 3-in-1 components for stability
AA 4%, dextrose 10%, ILE2%
what must be used if medications are added to a PN
1.2 um filter
concerns with 3-in-1 PN
creaming & cracking
how many kcal does protein provide
4kcal/gram
how many kcal does dextrose provide
3.4 kcal/gram
mOsm/% of protein
100
mOsm/% of dextrose
50
common lipid product and its kcal content
intralipid 20%
2kcal/mL
what must be used when administering lipids in PN
1.2 um filter
what may be a contraindication to lipid product
egg, soybean, and fish allergy
max infusion rate for lipids in PN
peds: 0.15 g/kg/hr
adults: 0.11 g/kg/hr
monitoring for lipids in PN
IFALD, TGs, and EFAD
when adding electrolyte to PN, consider precipitation of ____… and add what first to minimize risk
calcium phosphate precipitation
add phosphate first
