Nutrition Flashcards
Why are vitamins and minerals required in the body?
They play a key role as co-factors or co-enzymes in mot metabolic reactions
Give examples of water soluble vitamins
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
Give examples of fat soluble vitamins
Vit A - retinol
Vit D - Cholecalciferol
Vit E - 𝜶 tocopherol
Vit K - Phytomendione
Where are water soluble vitamins absorbed?
In the duodenum
Where are fat soluble vitamins absorbed?
In the ileum
What absorbs Vit B12?
Intrisic factor in the ileum
Apart from the diet, what is another source of Vit D?
Sunlight
What does Vit A deficiency cause?
Poor night vision
What does Vit B1 deficiency cause?
Wernickes encephalopathy
What does Vit B7 deficiency cause?
Hair loss
Anaemia
What does Vit B9 deficiency cause?
Megaloblastic anaemia
Neural tube defects
What does Vit B12 deficiency cause?
Pernicious anaemia
Peripheral neuropathy
What does Vit C deficiency cause?
Painful joints
Scurvy
What does Vit D deficiency cause?
Rickets
Osteoporosis
What does Vit K deficiency cause?
Abnormal clotting
What do folic acid supplements do in pregnancy?
Prevent neural tube defects - spina bifida
What dose of folic acid should given to a woman with no previous history of neural tube defects?
400mcg OD until 12th week
When should a woman be given a dose of 5mg folic acid?
- Previous history of neural tube defects
- Epilepsy / on anti-epileptics
What are minerals and trace elements required for?
- Formations of bones and teeth
- Body fluids and tissues
- Enzyme systems
- Nerve function
- Blood constituents
Give examples of minerals
- Calcium
- Magnesium
- Phosphorous
- Sodium
- Potassium
Required in large amounts
Give examples of trace elements
Iron Zinc Iodine Fluoride Selenium Copper
What does potassium and magnesium deficiency cause?
Cardiac arrhythmias
What does calcium and magnesium deficiency cause?
Osteoporosis
Muscle cramps
Tetany
What does zinc deficiency cause?
Hair loss
Poor wound healing
What does iron deficiency cause?
Anaemia
What is Wilson’s disease?
Build up of copper and excessive copper deposits due to an enzyme deficiency
What are the problems associated with supplements?
Toxicity / accumulation Supplements are expensive Complacency No control because of legal status Difficult to offer advice as they are not medicines
What does folic acid interact with?
Methotrexate
What does vitamin C interact with?
Iron
What are the consequences of malnutrition
- Weakness and loss of muscle mass
- Apathy and depression
- Reduced immune system
- Poor wound healing
- Increased morbidity and mortality
What are the normal feeding aims?
Energy: 25-35 kcal / kg / day
Protein: 0.8 - 1.5g / kg / day
Fluid: 30 - 35ml / kg / day
What are the methods that can be used to feed patients?
- Normla diet
- Enteral nutrient
- IV fluids
- Parenteral nutrition
How is enteral nutrition administered?
Via gastrointestinal tract
What are the benefits of EN?
- More physiological
- Less risk of infection
- Maintain GIT
- Gut bacteria translocation
- Lower cost
- Easier for home patients
- Patient ease
- Calorie control
Which patients would benefit from EN?
- Patients with eating / swallowing difficulties
- Severe intestinal malabsorption
- Increased nutritional requirements
- Eating disorders
- Self neglecting patients
What are the routes of EN administration?
Oral
Naso gastric tube
Percutaneous endoscopic gastronomy (tube passed through abdominal wall)
Percutaneous endoscopic jejunostomy
What are the problems associated with EN?
- diarrhoea
- regurgitation
- abdominal distention
- blocked feeding tube
- problems with the pump
- taste/acceptability
- dislocation
How should drugs be administered in EN patients?
- 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
Which drug directly interact with EN feed?
Ciprofloxacin Albumin antacids Theophylline Phenytoin Penicillamine
When should TPN be used?
- When EN is not an option
- When patient can’t take food in orally
- Digestion / absorption problems
- Unavailable GIT
What are short term indications for TPN?
- waiting for feeding tubes
- bowel obstruction
- excisional surgery
- ICU patients with multi-organ system failure
- severe pancreatitis
- pre-term neonates
- acute intestinal failure
What are long term indications for TPN?
- radiation enteritis
- Crohns disease
- motility disorders
- bowel infarction
- cancer surgery
- chronic intestinal failure
How is short term TPN administered?
via cannula (Venflon)
How is long term TPN administered?
Peripherally inserted central catheter (PICC)
Hickman line
Central line : intrajugular, subclavian, femoral
What needs to be monitored when a patient is on TPN?
Clinical history U&Es Glucose Vitamins LFTs FBS Trace elements Fluid balance Weight
What are TPN complications?
- air embolism / insertion problems
- catheter blockage
- line infections
- metabolic problems
- bone disease
- re-feeding syndrome
What is re-feeding syndrome?
It is characterised by abnormalities in fluid balance, glucose metabolism, vitamin deficiency, hypophosphatemia, hypermagnesaemia and hypokalaemia
How is re-feeding syndrome prevented?
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
What supplements should be given in re-feeding?
Oral thiamine 200-300mg daily
Vitamin B co-strong 1-2 three times daily
Multivitamin
