Nutrition

Question 1

How long is a prolonged air leak?

Next step in management?

Answer 1

> 4 days

VATS and pleurodesis

Question 2

How many calories are in carbs?
protein?
fat?

Answer 2

Carbs = 3.4kcal/g 
Protein = 4kcal/g 
Fat = 9kcal/g

Question 3

What is the equation for nitrogen balance?

What is a positive and negative balance?

Answer 3

Nitrogen balance = (Protein/6.25) - (24hr urine N + 4g)

Positive balance = anabolic
Negative balance = catabolic

Question 4

~1g of Nitrogen needed for every __ kcal?

Answer 4

150 kcal

Question 5

What is an elemental diet?

What condition is it good for?

Answer 5

free amino acids / small chain peptides. Low in fat.

mal-absorptive conditions

Question 6

What makes up the following?
Maltose
Sucrose
Lactose

Answer 6

Maltose = 2 glucose molecules

Sucrose = glucose + fructose

Lactose = glucose + galactose

Question 7

What is fuel for the following?
Colonocytes
Enterocytes

Disaccharides and trisaccharides cannot be broken down by what?

Answer 7

Short-chain fatty acids
Glutamine

Amylase

Question 8

What can become conditionally essential amino acids during stress?

Answer 8

Glutamine and Arginine

Question 9

What can help wound healing in patients with chronic steroid use?

Answer 9

Vitamin A supplementation

Question 10

Malabsorption of Vit D leads to?

Answer 10

Osteomalacia. Not osteoporosis.

Question 11

What does Vit E deficiency lead to?

Answer 11

peripherial neuropathy, spinocerebellar ataxia, thrombocytosis, and hemolytic anemia

Question 12

Zinc deficiency leads to?

Answer 12

poor healing, wasting, and rash

Question 13

Niacin deficiency leads to?

Answer 13

pellagra with Diarrhea, Dementia, Dermatitis

Question 14

Chromium deficiency leads to?

Answer 14

hyperglycemia, confusion and peripheral neuropathy

Question 15

Copper deficiency leads to?

Answer 15

PANcytopenia, neuropathy with ataxia

Question 16

Selenium deficiency leads to?

Answer 16

cardiomyopathy, hypothyroidism, and neuro changes

Question 17

What are BCAA’s?

Where are they metabolized?

Answer 17

LIV - Leucine, isoleucine, valine
Metabolized in muscle
Are also essential amino acids

Question 18

Non-essential amino acids start with …? And also include?

Answer 18

C, A, or G + serine, tyrosine, and proline

Question 19

High nutrient levels of ___ trigger ___

Answer 19

Arginine - enhances immune function

Leucine - muscle protein synthesis

Glutamine - citric acid cycle

Tyrosine - used in signal transduction

Question 20

Pulmonary formulas have low __ ? Why can this be problematic?

Hepatic formulas have low __ ?

Diabetic diet starts with what kind of diet? What if glycemic control is needed?

Answer 20

carbs - can be a disadvantage when weaning from vents tho, depleted glycogen

Aromatic amino acids and high BCAA’s - catabolism has increased BCAA utilization

Regular diet then if glycemic control is needed a diabetic formula is used.

Question 21

Hypotensive ICU patients on pressors are at risk for what with early enteral feedings?
If severe malnutrition in this setting then use what kind of nutrition?

Answer 21

Intestinal ischemia

Parenteral nutrition

Question 22

What is the only essential fatty acid?

What symptoms do you see in deficiency?

Answer 22

LinolEIC
A cis-polyUNsaturated 18 carbon fatty acid.

Scaly dermatitis, heart dysfunction, and increased risk of infections.

Question 23

What’s the most accurate method for calculating energy needs in a patient?

Answer 23

Indirect calorimetry is the gold standard.

O2 & CO2 inhaled and exhaled is measured
Not reliable when inhaled O2 is above 60%

Question 24

What’s a simple but effective formula for calculating calorie requirements for a patient?
What about in an obese patient?

Answer 24

REE in kcal/day = 25 * kg.

If obese then use adjusted weight which =
ideal weight + 25% of excess weight