Nutrition Flashcards
Refeeding syndrome abnormalities
Hypophosphatemia*
Hypomagnesemia
Hypokalemia
Thiamine deficiencies
Consequences of hypophosphatemia
Decreased cardiac contractility
Arrhythmias
Decreases oxygen release to tissues causing secondary organ failure
Acute respiratory failure
Consequences of thiamine deficiency
Wernicke’s (memory impairment, ophthalmoplegia, ataxia)
Korsakoff (antero/retrograde amnesia, confabulation), permanent
Classic triad of W-K: ophthalmoplegia, gait disturbances, mental status changes
Cardiac tissue dysfunction
Weight gain goals for
1. 0 to 3 mo
2. 3 to 6 mo
3. 6 to 12 mo
4. 1-2 yrs
5. 2-5 yrs
0 to 3 mos = 25-35 g/day
3 to 6 mos = 15-20 g/day
6 to 12 mos = 10-20 g/day
1-2 yrs = 2-3 kg
2-5 yrs = 1-2 kg
Dry vs wet beriberi
Thiamine deficiency
Dry beriberi: CNS involvement → Wernicke encephalopathy (triad of ocular abnormalities (nystagmus, ophthalmoplegia), confusion, and gait changes such as ataxia) → Korsakoff syndrome (severe memory impairment, personality changes)
Wet beriberi: CVS involvement → dilated cardiomyopathy, tachycardia, high-output congestive heart failure, peripheral edema
Vitamin A toxicity
Teratogenic
Liver toxicity
Headache
Increased ICP (with papilledema)
Vomiting
Bone and joint pain
Vitamin B6 toxicity
Peripheral neuropathy
Ataxia
Dizziness
Photosensitivity
Vitamin C toxicity
GI disturbances
Kidney stones
Excess iron absorption (if excess iron, consider arrhythmia)
Vitamin D toxicity
Hypercalcemia
Bone pain
Nephrolithiasis
Muscle weakness
Ataxia
Confusion
GI symptoms (nausea, diarrhea, constipation), arrhythmias
Kwashiorkor vs Marasmus
Kwashiorkor: protein deficiet
Marasmus: caloric deficit
Best form of feeding in short gut
Breastfeeding
Then hydrolyzed (elemental) or partially hydrolyzed formula with MCT
5 reducing sugars
1 to know that is NOT
Reducing: glucose, galactose, lactose, fructose, ribose
NOT: sucrose
Fat absorption
Hydrolysis by gastric lipase initially, then pancreatic lipase + co-lipase
FFAs, short, and medium chain FAs can pass directly into enterocyte
Long ones require breakdown of micelle and binding proteins
Protein absorption
Breakdown is initiated by pepsin (activated by stomach acid)
Proteins to amino acids occurs in the small intestine
Carbohydrate absorption
Initiated by salivary amylase
Pancreatic amylase completes carb digestion in duodenum
Broken down to monosaccharides by brush border enzymes
Which vitamin is stored for the longest time before showing signs of deficiency?
Vitamin B12
Zinc deficiency
Acrodermatitis enteropathica
Vesicullobullous, etc lesions, reddish hair, ocular changes, glossitis, growth delay
AR disorder
Sources: meat, shellfish, grains, legumes, cheese
5 deficiencies in vegan diet
B12
Iron
Calcium
Vitamin D
Zinc
B12 deficiency
Strict vegetarian or vegan diets, ileal resections
Dairy, eggs
Sx: irritability, hypotonia, dev delay, parenthesias, neuritis, hyperpigmentation of knuckles/palms, megaloblastic anemia
Deficiency with goat’s milk
Folate
Folate deficiency
Leafy greens, nuts, grains, meats
Absorbed in jejunum
Anemia, neural tube defects
How much vitamin D for infants who are
1. Breastfeeding
2. Formula feeding
in high and low risk groups
- Low risk: 400, high: 800
- Low risk: none, high: 400
Risk factors for vitamin D deficiency
Low intake of vit D foods, food insecurity, low SES
Lack of supplementation during pregnancy or infancy
Communities north of 55th parallel, extensive sunblock or coverage, darker skin
Obesity
Maternal smoking, multiple pregnancies, certain meds
5 contraindications to breastfeeding
Galactosemia
Maternal HIV
Maternal HTLV
HSV on breast
Active TB < 2 weeks of tx
Vitamin D deficiency Rickets
Ca, vit D, PTH, Phos, ALP
Low Ca
Low vit D (25-OHD)
High PTH
Low phos
Increased ALP
Contraindications to soy formula
Prems < 1800g
To prevent colic or allergy
CMPA (cross reactive with cow’s milk)
Congenital hypothyroidism
Vitamin C deficiency
Citrus fruits and juices, peppers, berries, tomatoes, cauliflower, leafy greens
Tenderness in legs, irritability, gum changes, pseudoparalyssi, anemia, petechiae/purpura, poor wound healing
Benefit of WHO chart over CDC
WHO is based on primarily BF infants
Breastfed infants grow faster in first 6 mo and slower in second 6 mo
New charts will find more underweight in first 6 mo, overweight in second 6 mo
What to think about if IDA is not responding to iron?
Think about vitamin C deficiency! Helps with iron absorption
