Nutrition Flashcards
From what % of weight loss is a patient considered malnourished
10%
After what duration of anorexia / hyporexia is nutritional support recommended
- Anorexia for 3-5 days
- Hyporexia (= eating less than 75% RER) for 1 week
(And any patient who has lost over 10% of body weight or has a low BCS or muscle atrophy)
What are the actions of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) on inflammation
- Substitute omega-6 fatty acids (= arachidonic acid), limiting the arachidonic cascade and leading to production of less inflammatory eicosanoids
- Inhibit the pro inflammatory transcription factor NF-kB responsible for expression of cytokines and chemokines
- Inhibit TLR-4
- Contribute to synthesis of resolvins and protectins which are anti-inflammatory
What antioxidants can be provided in the nutrition? Is there a proven benefit in critically ill patients?
- Vitamin C
- Vitamin E
- Selenium
+/- glutathione by N-acetylcysteine
Contradictory results, could have a benefit in the most critical patients but meta-analysis showed no benefit and potential harm of NAC in sepsis
What conditionally essential amino-acids could theoretically be beneficial in critically ill patients
Arginine and glutamine
No evidence of benefit but could modulate immune system
Arginine contra-indicated in sepsis since it is an NO precursor
Why are sick patients at higher risk of malnutrition
Sick patients catabolize lean body mass (proteins, muscles) when they have insufficient calorie intake vs healthy patients catabolize fat (and glycogen)
What are risk factors that can indicate a patient might need nutritional support
- Food intake <80% RER (high risk if >5 days)
- Weight loss
- BCS < 4/9
- Muscle mass score <2
- Severe vomiting / diarrhea
- Hypoalbuminemia
- Expected course of illness (high risk if >3 days)
What % of proteins should patients receive in their diet
- Dogs: 25-35% of total energy
- Cats: 30-40% of total energy
What is the recommended volume per tube feeding
10 mL/kg (but some can tolerate 30-40 mL/kg)
What is typically the % of RER that can be achieved with peripheral parenteral nutrition
40-70% (dextrose and amino-acids need to be decreased to keep osmolarity < 850 mOsm/L)
What are complications of of parenteral nutrition
- Metabolic
- Hyperglycemia
- Hypertriglyceridemia
- Electrolyte disturbances - Mechanical
- Catheter dislodgement
- Catheter occlusion
- Thrombophlebitis - Septic (<7%)
True or false: The use of parenteral nutrition vs enteral nutrition increases mortality and infections and it should be avoided
False.
Actually not that many complications, infections <7%, and similar mortality. Should be considered when enteral nutrition is not possible.
Name 5 mechanisms by which glutamine improves outcome in critical illness
- Tissue protection
- Antiinflammatory and immune modulation
- Preservation of metabolic function
- antioxidant effects
- Attenuation of inducible nitric oxide synthase activity
What are some mechanisms by which probiotics may have positive effects?
- Restoration of gastrointestinal barrier function
- Modification of the gut flora
- Release of probiotic antimicrobial factors
- Competing for epithelial adherence
- Immunomodulation
When should the use of parenteral nutrition be considered when an animal is already receiving enteral nutrition?
When enteral nutrition cannot reach 50% of needs
What is the most common metabolic complication of enteral nutrition?
Hyperglycemia
When should a feeding tube be placed (% of voluntary eating)?
When voluntary food intake does not meet 80% of RER
When should discontinuation of nutritional support begin
When patient consumes 75% of RER without much coaxing
What are the components of parenteral nutrition?
- Amino acids
- Dextrose
- Lipids
- +/- Electrolytes & trace minerals
- Vitamins
What metabolic derangements characterize refeeding syndrome?
- Hypophosphatemia & hypokalemia due to insulin surge associated with rising glucose levels from refeeding
- Hypomagnesemia
- Thiamine deficiency
