Nutrition

Question 1

how many kcal/ounce is breast milk?

Answer 1

20 kcal/oz
1 oz= 30 mL

Question 2

what are the parameters for a pediatric patient to be considered faltering (failure to thrive)?

Answer 2

falling by 2 major percentiles or weight <3-5% percentile

Question 3

What supplements are recommended for all breastfed babies?

Answer 3

vitamin D3 (400 IU or 10 mcg)
premature neonates may require iron supplementation (2mg/kg/day)
may require zinc supplementation

Question 4

How do you calculate fluid requirements in pediatric patients?

Answer 4

Holliday-Segar Method
100mL/kg for 1st 10 kg
1000 mL + 50 mL/kg for 10-20 kg
1500 mL + 20 mL/kg for >20 kg

Question 5

What are the caloric requirements for pediatric patients?

Answer 5

preterm infant 100-120+ kcal/kg/day
<6 months = 85-105
6-12 months 80-100

Question 6

What are the protein requirements for pediatric patients?

Answer 6

3-4g/day for low birth weight/preterm neonate
2-3g/day for infant

Question 7

What are the caloric needs per day for an ICU/surgery patient?

Answer 7

25-30 kcal/kg/day

Question 8

how many kcal is 1 g of protein?

Answer 8

4 kcal

Question 9

how many mL of fluid is required for ICU/surgery patients?

Answer 9

30-40 mL/kg/day MIVF

Question 10

What are the positive IONs that need to be balanced?

Answer 10

sodium
potassium

Question 11

What are the negative IONs that need to be balanced?

Answer 11

Chloride
acetate
Phos

Question 12

What are the additives in the TPN?

Answer 12

MVI - 10 mL
Multi-trace elements - 1 mL

Question 13

What monitoring parameters are used in PN?

Answer 13

vitals, I/O’s, CMP, weight, CBC, Mg, Phos, Ca, Prealbumin/CRP
weekly- triglycerides, nitrogen balance, PT/INR, transferrin

Question 14

What is the conversion factor for mMol and mEq of phos?

Answer 14

1 mMol phos= 1.4 mEq phos

Question 15

how much phos do you need in PN?

Answer 15

0.3 mMol/kg

Question 16

how much potassium do you need in PN?

Answer 16

0.5-1 mEq/kg

Question 17

how much calcium do you need in PN?

Answer 17

10 mEq/day (if Ca normal)

Question 18

how much magnesium do you need in PN?

Answer 18

8 mEq/day (if Mg normal)

Question 19

how much sodium do you need in PN?

Answer 19

aim for 1/2 NS (77 mEq/L) titrate to L amt

Question 20

What is the NBW equation?

Answer 20

IBW + 0.25(wt-IBW)

Question 21

What is the IBW equation?

Answer 21

(males) 50 kg + (2.3 x inches over 60”)
(females) 45.5 kg + (2.3 x inches over 60”)

Question 22

What is the TEE equation?

Answer 22

TEE= REE x 1.2

Question 23

What is the RQ goal?

Answer 23

0.85-0.95
1-1.2 = overfeeding
0.67-0.82 = underfeeding

Question 24

What is the normal prealbumin range? and how does CRP affect it?

Answer 24

15-40 mg/dL
if CRP high and prealbumin is decreased then its due to inflammation
if CRP normal AND prealbumin is decreased then its due to malnutrition

Question 25

How do you prevent refeeding syndrome?

Answer 25

limit carbs to 100-150 gm limit fluids to 800 mL/day

Question 26

what are the clinical findings if refeeding syndrome is suspected?

Answer 26

Hypophosphatemia, hypomagnesemia, hypokalemia

Question 27

What is the nitrogen balance equation?

Answer 27

N(in)= 24 hr protein intake / 6.25 N(out)= 24 hours UUN = factor (4g) Nitrogen balance = N(in) - (N)out

Question 28

What is the 70/30 rule?

Answer 28

70% of non protein calories need to be carbohydrates 30% of non protein calories need to be lipids