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FRCA 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:

  1. Overall complications
  2. Readmissions
  3. Length of stay
  4. Infections/sepsis/antibiotic use
  5. Pressure ulcers
  6. Ventilation days
  7. ?Mortality
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10
Q

Describe the advantages of post pyloric feeding

A

Reduction in ventilator associated pneumonia. Useful in gastric outlet obstruction.

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11
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 (NEJM casear et al. 2011)

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12
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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13
Q

Which compounds are affected by refeeding syndrome

A

Reduction in:

  • Phosphate
  • Magnesium
  • Potassium
  • Glucose
  • Thiamine
  • Vitamins
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14
Q

What features should prompt for TPN use?

A

Non f(x) GI tract Ileus/poor absorption Proximal high output / enterocutaneous fistula Short gut syndrome Oral mucositis

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15
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

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16
Q

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

A

50%

17
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
18
Q

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

A

1-2%/day

19
Q

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

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)

20
Q

What factors increase your metabolic requirements in ITU?

A

Burns Trauma Surgery Fever Pain Physiotherapy

21
Q

What factors decrease your metabolic requirements in ITU?

A

Hypothermia Ventilation Sedation Paralysis

22
Q

What are the advantages of TPN?

A
  • Can be used with EN contraindicated
  • Can be patient specific
23
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
24
Q

What are the disadvantages of EN?

A
  • Often intollerent in ITU setting (e.g. burns, sepsis, trauma etc.)
  • Results in undernutrition
  • May require prokinetics
  • Misplaced NG tube spells disaster
  • Diarrhoea
  • Nausea/Vomiting
25
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 is possible, if not, no nutritional support for 7 days, commense PN thereafter
26
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 groups failed to achieve nutritional goals
27
Q

What are your calorie goals in critical illness

A
  • Increased mortality in achieving < 25% or > 65% calorie goals
  • Aim for 60-65% requirement
  • Approx 16 kcal/kg/day
28
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
29
Q

What are the sequelae of refeeding syndrome?

A
  • Life threatening arrhythmias
  • Increased O2 consumption
  • Neuromuscular disturbance
30
Q

How should you treat refeeding syndrome?

A
  • Identification of at risk groups
  • Slow initial feed (50% estimated requirement for 2 days)
  • Slowly increase by 200-400 kcal/day
  • Aggressive electrolyte correction
  • Thiamine supplementation

FRCA Final (21 decks)

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