Nutrition Flashcards
Chloride/Acetate
Balance
Cl: 2/3
acetate: 1/3
Baseline Monitoring for PN
CMP, Phos, Mg, Ca
Hepatic Function
Prealbumin/CRP
PT/INR
blood glucose every 4-6 hours
residuals, distention, vomiting, aspiration every 4-6 hours
Daily Monitoring for PN
vital signs (BP & HR)
intake/outtake
CMP
feeding tube placement and patency
Twice Weekly Monitoring for PN
Weight
CBC
Phos, Mg, Ca
Prealbumin/CRP
increased to daily in ICU
Weekly Monitoring for PN
albumin, transferrin, nitrogen balance
liver function
triglycerides
RQ
PT/INR`
Monitoring for EN
GI
- residuals
- emesis
- stools daily
- bloating/distention
- aspiration
Metabolic
- I/O
- Weight -> 3 x per week
- Electrolytes, Glucose, BUN/SCr –> daily, twice weekly, weekly
- Mg, Phos, Ca, TG, LFT –> weekly
- Albumin, Prealbumin/CRP, N balance –> weekly
Normal Albumin
3.5-5 g/dL
Acute Renal Failure
CRRT
- increased protein requirement (Max: 2.5 g/kg/day)
HD
- 0.8-1.2 g/kg/day protein
- loss of water-soluble vitamins
Prealbumin is falsely high
Hepatic Failure
Nutritional assessment tools are inaccurate
Standard EN formulations
- branched-chain amino acid (BCAA) for encephalopathic patients refractory –> reduces accumulation of ammonia
Pulmonary Failure
Fluid restriction, calory dense formulations
- 1.5-2.0 kcal/mL
MONITOR PHOSPHATE CLOSELY
Acute Pancreatitis
Changes:
- increased protein catabolism
- increased energy expenditure
- increased insulin resistance
- increased dependence on fatty acid oxidation
NORMALLY DOES NOT REQUIRE PN
- recovery of oral intake within 3-7 days
Protein:
- 1.2-1.5 g/kg/day
- add glutamine
PARENTERAL NUTRITION DOES NOT AFFECT PANCREATIC SECRETION AND FUNCTION
Burn
Changes:
- increased basal metabolic rate and nitrogen loss
Requirements:
- Protein: 2-2.5 g/kg/day
- early feeding with EN –> start within 12 hours
Supplements:
- multivitamin
- TBSA > 10%: Vitamin C, Vitamin E, Zinc, Selenium
- TBSA > 20%: oxandrolone/growth hormones
- Vitamin D if deficient
- Vitamin A if on corticosteroids
