Nutrition

Question 1

Why are vitamins and minerals required in the body?

Answer 1

They play a key role as co-factors or co-enzymes in mot metabolic reactions

Question 2

Give examples of water soluble vitamins

Answer 2

Vit C - ascorbic acid
Vit B1 - Thiamine 
Vit B2 - Riboflavin 
Vit B3 - Niacin / Nicotinic acid
Vit B5 - Pantothenic acid 
Vit B6 - Pyridoxine 
Vit B7 - Biotin 
Vit B9 - Folic acid 
Vit B12 - Cyanocobalamin

Question 3

Give examples of fat soluble vitamins

Answer 3

Vit A - retinol
Vit D - Cholecalciferol
Vit E - 𝜶 tocopherol
Vit K - Phytomendione

Question 4

Where are water soluble vitamins absorbed?

Answer 4

In the duodenum

Question 5

Where are fat soluble vitamins absorbed?

Answer 5

In the ileum

Question 6

What absorbs Vit B12?

Answer 6

Intrisic factor in the ileum

Question 7

Apart from the diet, what is another source of Vit D?

Answer 7

Sunlight

Question 8

What does Vit A deficiency cause?

Answer 8

Poor night vision

Question 9

What does Vit B1 deficiency cause?

Answer 9

Wernickes encephalopathy

Question 10

What does Vit B7 deficiency cause?

Answer 10

Hair loss

Anaemia

Question 11

What does Vit B9 deficiency cause?

Answer 11

Megaloblastic anaemia

Neural tube defects

Question 12

What does Vit B12 deficiency cause?

Answer 12

Pernicious anaemia

Peripheral neuropathy

Question 13

What does Vit C deficiency cause?

Answer 13

Painful joints

Scurvy

Question 14

What does Vit D deficiency cause?

Answer 14

Rickets

Osteoporosis

Question 15

What does Vit K deficiency cause?

Answer 15

Abnormal clotting

Question 16

What do folic acid supplements do in pregnancy?

Answer 16

Prevent neural tube defects - spina bifida

Question 17

What dose of folic acid should given to a woman with no previous history of neural tube defects?

Answer 17

400mcg OD until 12th week

Question 18

When should a woman be given a dose of 5mg folic acid?

Answer 18

• Previous history of neural tube defects

- Epilepsy / on anti-epileptics

Question 19

What are minerals and trace elements required for?

Answer 19

• Formations of bones and teeth
• Body fluids and tissues
• Enzyme systems
• Nerve function
• Blood constituents

Question 20

Give examples of minerals

Answer 20

• Calcium
• Magnesium
• Phosphorous
• Sodium
• Potassium
  Required in large amounts

Question 21

Give examples of trace elements

Answer 21

Iron
Zinc
Iodine
Fluoride 
Selenium 
Copper

Question 22

What does potassium and magnesium deficiency cause?

Answer 22

Cardiac arrhythmias

Question 23

What does calcium and magnesium deficiency cause?

Answer 23

Osteoporosis
Muscle cramps
Tetany

Question 24

What does zinc deficiency cause?

Answer 24

Hair loss

Poor wound healing

Question 25

What does iron deficiency cause?

Answer 25

Anaemia

Question 26

What is Wilson's disease?

Answer 26

Build up of copper and excessive copper deposits due to an enzyme deficiency

Question 27

What are the problems associated with supplements?

Answer 27

``` Toxicity / accumulation Supplements are expensive Complacency No control because of legal status Difficult to offer advice as they are not medicines ```

Question 28

What does folic acid interact with?

Answer 28

Methotrexate

Question 29

What does vitamin C interact with?

Answer 29

Iron

Question 30

What are the consequences of malnutrition

Answer 30

- Weakness and loss of muscle mass - Apathy and depression - Reduced immune system - Poor wound healing - Increased morbidity and mortality

Question 31

What are the normal feeding aims?

Answer 31

Energy: 25-35 kcal / kg / day Protein: 0.8 - 1.5g / kg / day Fluid: 30 - 35ml / kg / day

Question 32

What are the methods that can be used to feed patients?

Answer 32

- Normla diet - Enteral nutrient - IV fluids - Parenteral nutrition

Question 33

How is enteral nutrition administered?

Answer 33

Via gastrointestinal tract

Question 34

What are the benefits of EN?

Answer 34

- More physiological - Less risk of infection - Maintain GIT - Gut bacteria translocation - Lower cost - Easier for home patients - Patient ease - Calorie control

Question 35

Which patients would benefit from EN?

Answer 35

- Patients with eating / swallowing difficulties - Severe intestinal malabsorption - Increased nutritional requirements - Eating disorders - Self neglecting patients

Question 36

What are the routes of EN administration?

Answer 36

Oral Naso gastric tube Percutaneous endoscopic gastronomy (tube passed through abdominal wall) Percutaneous endoscopic jejunostomy

Question 37

What are the problems associated with EN?

Answer 37

- diarrhoea - regurgitation - abdominal distention - blocked feeding tube - problems with the pump - taste/acceptability - dislocation

Question 38

How should drugs be administered in EN patients?

Answer 38

- Use liquid preparation where possible - Give each drug separately - Flush with >20ml water before and after - Crushed tablets may block tube - Not MR or e/c

Question 39

Which drug directly interact with EN feed?

Answer 39

``` Ciprofloxacin Albumin antacids Theophylline Phenytoin Penicillamine ```

Question 40

When should TPN be used?

Answer 40

- When EN is not an option - When patient can't take food in orally - Digestion / absorption problems - Unavailable GIT

Question 41

What are short term indications for TPN?

Answer 41

- waiting for feeding tubes - bowel obstruction - excisional surgery - ICU patients with multi-organ system failure - severe pancreatitis - pre-term neonates - acute intestinal failure

Question 42

What are long term indications for TPN?

Answer 42

- radiation enteritis - Crohns disease - motility disorders - bowel infarction - cancer surgery - chronic intestinal failure

Question 43

How is short term TPN administered?

Answer 43

via cannula (Venflon)

Question 44

How is long term TPN administered?

Answer 44

Peripherally inserted central catheter (PICC) Hickman line Central line : intrajugular, subclavian, femoral

Question 45

What needs to be monitored when a patient is on TPN?

Answer 45

``` Clinical history U&Es Glucose Vitamins LFTs FBS Trace elements Fluid balance Weight ```

Question 46

What are TPN complications?

Answer 46

- air embolism / insertion problems - catheter blockage - line infections - metabolic problems - bone disease - re-feeding syndrome

Question 47

What is re-feeding syndrome?

Answer 47

It is characterised by abnormalities in fluid balance, glucose metabolism, vitamin deficiency, hypophosphatemia, hypermagnesaemia and hypokalaemia

Question 48

How is re-feeding syndrome prevented?

Answer 48

By introducing feed at no more than 50% of the normal requirements. Start at 10kcal / kg / day and increase slowly to meet full needs by 4-7 days

Question 49

What supplements should be given in re-feeding?

Answer 49

Oral thiamine 200-300mg daily Vitamin B co-strong 1-2 three times daily Multivitamin