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Final > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Basic daily energy requirement

A

25-35 kcal/kg/day

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2
Q

Daily protein requirement

A

0.8-1.5 g/kg/day (of which 0.13-0.24 g nitrogen/kg/day)

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3
Q

Daily free water requirement

A

30-35 mL/kg/day

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4
Q

Daily sodium requirement

A

1-2 mmol/kg/day

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5
Q

Daily potassium requirement

A

1 mmol/kg/day

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6
Q

Daily chloride requirement

A

1 mmol/kg/day

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7
Q

Magnesium and Calcium requirement

A

0.1 mmol/kg/day

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8
Q

Phosphate requirement

A

0.4 mmol/kg/day

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9
Q

List 7 advantages of commencing early feeding in the ITU

A

Reduction in:
Overall complications
Readmissions
Length of stay
Infections/sepsis/antibiotic use
Pressure ulcers
Ventilation days
?Mortality

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10
Q
A
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11
Q

Describe the advantages of post pyloric feeding

A

Reduction in ventilator-associated pneumonia
Useful in gastric outlet obstruction

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12
Q

At what point should you consider starting TPN

A

Day 8 of starvation as reduced mortality as compared with early TPN on day 3

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13
Q

How can you combat the fatty acid deficiency inherent to TPN?

A

Make up 3% of TPN calorie delivery with linoleic acid

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14
Q

Which compounds are affected by refeeding syndrome?

A

Reduction in:
Phosphate
Magnesium
Potassium
Glucose
Thiamine
Vitamins

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15
Q

What features should prompt for TPN use?

A

Non functioning GI tract
Ileus/poor absorption
Proximal high output / enterocutaneous fistula
Short gut syndrome
Oral mucositis

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16
Q

What is “trophic enteral feed”?

A

A slow feed used in conjunction with TPN designed to prevent gastric atrophy
Usually run at 10-30mL/hr

17
Q

What percentage of nutrition should be supplied by EN before discontinuing TPN?

A

50%

18
Q

What are the disadvantages of TPN?

A

High Cost
No maintenance of GI Tract
Risks inherent to CVC
Specific risks of TPN:
- Large fluid load
- Liver function derangement
- Cholestasis
- Trace element deficiency (esp. copper, zinc, chromium)
- Fatty acid deficiency
- Hypovolaemia from osmotic diuresis
- Hypercarbia
- Hyperchloraemic metabolic acidosis
- HONK
- Hyperglycaemia (during infusion)
- Hypoglycaemia (during withdrawal)
- Hypernatraemia
- Hypophosphataemia
- Lipidaemia

19
Q

What percentage of muscle mass is lost per day on the ICU?

A

1-2%/day

20
Q

List the names of some formulas used to estimate calorie requirement in the critically unwell (4)

A

Pre-calculated:
- ACCP
- ESPEN

Formulaic (all include age, gender and weight):
- Schofield equation (includes stress factor)
- Ireton Jones equation (trauma/burns)
- Penn State equation (temp, MV)
- Harris Benedict equation (IBW Heigh)

21
Q

What factors increase your metabolic requirements in ITU?

A

Burns
Trauma
Surgery
Fever
Pain
Physiotherapy

22
Q

What factors decrease your metabolic requirements in ITU?

A

Hypothermia
Ventilation
Sedation
Paralysis

23
Q

What are the advantages of TPN?

A

Can be used with EN contraindicated
Can be patient specific

24
Q

What are the advantages of EN?

A

Cheap
Maintenance of the GI tract
- Structure and function
- Maintenance of immune functions
- Decreased bacterial translocation
Decreased stress ulceration
Decreased hypoglycaemia
No CVC required
Generally safer

25
Q

What are the disadvantages of EN?

A

Often intolerant in ITU setting (e.g. burns, sepsis, trauma etc)
Results in undernutrition
May require prokinetics
Misplaced NG tube can be disastrous
Diarrhoea
Nausea/Vomiting

26
Q

What are the international guidelines of feeding in ITU?

A

ESPEN - all patients to receive nutritional support within 24-48 hours, use PN if EN contraindicated
ASPEN - Early EN if possible, if not, no nutritional support for 7 days, commence PN thereafter

27
Q

What did the CALORIES trial show (NEJM 2014)

A

Looked at early EN vs early PN (both initiated within 36 hours and continued for 5 days)
No difference in 30 day mortality
50% of both groupsfailed to achieve nutritional goals

28
Q

What are your calorie goals in critical illness

A

Increased mortality if <25% or >65% calorie goals
Aim for 60-65% requirement
Approx 16 kcal/kg/day

29
Q

What are the disadvantages of post-pyloric feeding?

A

Difficult to site line (needs endoscopy)
Increased tube blockage
Increased tube displacement
Alters the gastric phase of digestion
Increased diarrhoea

30
Q

What are the sequelae of refeeding syndrome?

A

Life threatening arrhythmias
Increased O₂ consumption
Neuromuscular disturbance

31
Q

How should you treat refeeding syndrome?

A

Identification of at risk groups
Slow initial feed (50% estimatedrequirement for 2 days)
Slowly increase by 200-400 kcal/day
Aggressiveelectrolyte correction
Thiaminesupplementation

32
Q

What is refeeding syndrome?

A

Metabolic disturbance which occurs as a result of the commencement of nutrition in people who are malnutritioned

Final (21 decks)

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