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ABSITE > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Baseline daily calorie requirement

A

20-25 kcal/kg/d

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2
Q

Baseline daily protein requirement

A

1g/kg/d

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3
Q

Fat % of caloric intake

A

30%

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4
Q

Protein % of caloric intake

A

20%

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5
Q

Carb % of caloric intake

A

50%

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6
Q

kcal of protein per gram

A

4kcal/g

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7
Q

kcal of fat per gram

A

9kcal/g

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8
Q

kcal of carb per gram

A

4kcal/g

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9
Q

Harris-Benedict equation for BMR (basal metabolic rate)

A

M: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age) + 5
W: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age) - 161

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10
Q

Caloric requirement after trauma, surgery, or sepsis

A

25-30 kcal/kg/d

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11
Q

Caloric requirements after burns

A

25 kcal/kg/d + (30 kcal/d x % burn)

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12
Q

Protein requirement after burns

A

1 g/kg/d + (3 g/d x % burn)

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13
Q

Predicted increase in caloric requirements due to elective surgery

A

1.2x

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14
Q

Predicted increase in caloric requirements due to multisystem trauma

A

1.3-1.5x

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15
Q

Predicted increase in caloric requirements due to sepsis

A

1.5-1.8x

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16
Q

Predicted increase in caloric requirements due to burns

A

1.5-2.0x

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17
Q

What is body’s state after surgery or critical illness

A

Catabolic state

Proteolysis, inadequate intake results in body turning to protein sources

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18
Q

Protein requirement for critically ill patient

A

1.5 g/kg/d

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19
Q

Protein requirement for head injury or burn patient

A

2 g/kg/d

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20
Q

Protein sparing effect

A

Delivery of small amount of carbs or fat (~400kcal/d) decreases proteolysis

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21
Q

Cause of insulin resistant during starvation

A

Inhibition of glucose oxidation. Increased gluconeogenesis causing hyperglycemia

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22
Q

Blood glucose goal during surgery

A

140-180 mg/dL

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23
Q

Benefits of enteral nutrition

A

stimulates IgA, prevents bacterial translocation, preserves upper respiratory tract, lessens inflammatory response

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24
Q

Timing for enteral feeding after admission/surgery

A

24-48 hours

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25
Q

Situations where enteral feeding is contraindicated

A
  1. Bowel perf
  2. obstruction
  3. Discontinuity
  4. Significant HD instability on pressors
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26
Q

When to start parenteral nutrition

A

after 7 days without nutrition and inability to tolerated enteral nutrition

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27
Q

Respiratory quotient

A

if elevated, makes weaning off the vent more challenging due to extra carbon dioxide made that must be expired (increased respiratory rate)

ratio of CO2 produced and oxygen consumed

measure of energy expenditure

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28
Q

Complications with parenteral nutrition

A
  1. Electrolyte disturbances (refeeding syndrome)
  2. Liver dysfunction (steatosis, cholestasis)
  3. Line infection
  4. GI dysfunction (mucosal atrophy from disuse, loss of brush border enzymes, bacterial overgrowth, decreased gut immunity)
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29
Q

Nitrogen balance

A

helps determine balance of anabolism and catabolism. Positive nitrogen balance is ideal –> pt getting enough protein

(Protein intake / 6.25) - (UUN + 4)

6.25g of protein in 1g nitrogen
UUN = 24-h urine urea nitrogen

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30
Q

Fat utilization respiratory quotient

A

0.7

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31
Q

protein utilization respiratory quotient

A

0.8

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32
Q

carb utilization respiratory quotient

A

1.0

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33
Q

RQ > 1

A

Overfeeding/Lipogenesis

Excess carbs

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34
Q

RQ < 0.7

A

Starvation/Ketosis & fat oxidation

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35
Q

Markers for long-term nutrition

A

Albumin

Transferrin

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36
Q

Markers for short-term nutrition

A

Prealbumin

Retinol-binding protein

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37
Q

Half life of albumin

A

20 days

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38
Q

Half life of prealbumin

39
Q

Half life of transferrin

40
Q

Half life of retinol-binding protein

41
Q

Most accurate marker of nutritional status in stable patients

42
Q

Respiratory quotient

A

CO2 produced / O2 consumed

43
Q

Nitrogen balance equation

A

Total protein intake (g) / 6.25 - UUN + 4g

44
Q

Urinary urea nitrogen (UUN)

A

Nitrogen lost in urine in 24 hours

45
Q

Upper esophageal sphincter

A

Open/relaxes w/ swallowing, allows entry of food bolus into esophagus

46
Q

Lower esophageal sphincter

A

Open/relaxes w/ swallowing, allows entry of food bolus into stomach

47
Q

Mechanics above food bolus

A

contraction of circular smooth muscle layer squeezes bolus forward

48
Q

Mechanics below food bolus

A

contraction of longitudinal smooth muscle layer widens lumen to receive bolus

49
Q

Stomach wall mechanics

A 
Muscularis externa (3 layers: circular, longitudinal, oblique) contraction helps break food into smaller bits
Inner lining: simple columnar epithelium with goblet cells, secrete mucus
longitudinal folds (rugae): allows stomach to increase storage capacity
50
Q

Vent volumes decrease after placement of NGT placed to suction

A

Means NGT was placed nasotracheal position.

Remove NGT

51
Q

Obstruction after feeding tube placement

A

Balloons migrate distally to obstruction

52
Q

Buried Bumper Syndrome

A

Complication after PEG placement, bumper is overgrown by hypertrophic gastric mucosa, embedded into gastric wall
Likely secondary to enforced tightening of PEG causing an ulcer
Can’t see bumper endoscopically

53
Q

Indications of Buried Bumper Syndrome

A

PEG tube can’t be mobilized, secretion along tube, upper ABD pain

54
Q

MC causes of new-onset feeding intolerance

A

Gastroparesis (assoc w/ DM, PNA, sepsis)
Ileus
Sepsis/Infections

55
Q

Tx of gastroparesis

A 
prokinetic agents (metoclopramide, erythromycin)
NJ tube feeds
56
Q

Results of excessive protein

A

azotemia, hypertonic dehydration, hyperammonemia, metabolic acidosis

57
Q

MC assoc w/ undernutrition

A

Enteral feeding

58
Q

MC assoc w/ overfeeding

59
Q

Components of TPN

A

amino acids, lipids, dextrose, trace elements, vitamins, electrolytes

60
Q

Risk of DVT w/ CVC placement

A

Fem > IJ > SC

61
Q

Dx of Hyperosmolar hyperglycemia state (HHS)

A 
Glucose > 600mg/dL
Osmolality >320 mOsm/kg
Profound dehydration
pH > 7.4
Bicarb > 15 mEq/L
Ketonuria and Low ketonemia
BUN > 30 mg/dL
Creat > 1.5 mg/dL

Relative insulin deficiency but no ketosis due to presence of insulin inhibiting hormone-sensitive lipase mediated fat tissue breakdown

62
Q

NUTRIC Score

A 
APACHE II score
SOFA score
Comorbidities
IL-2
# ICU admissions

Score >6 assoc w/ higher mortality, acquire more aggressive therapy

63
Q

Immunonutrients

A 
Arginine
Glutamine
Branched-chain amino acids
omega-3 fatty acids
nucleotides
64
Q

Arginine

A

Precursor of polyamides, nucleic acids, amino acids involved in connective tissue synthesis, nitric oxide
Secretagogue for growth hormone, prolactin, insulin
Increases # T cells, enhances T-cell function
Improves wound healing

Increases mortality in septic elderly men

decreases risk of postop infxn, improves wound healing in pts with GI malignancy undergoing elective surgery

65
Q

Glutamine

A

Most prevalent AA in human body
Made in skeletal muscle
Precursor of purines, pyrimidines, nucleotides, amino sugars, glutathione
Most important substrate for renal ammoniagenesis
Protects structural and functional integrity of intestinal mucosa
Maintains, augments cell immune functions

66
Q

Branched-chain amino acids

A

Precursor of glutamine

67
Q

Omega-3 fatty acids

A

Antagonize production of inflammatory eicosanoids from arachidonic acid
precursor of alternative family of eicosanoids
Anti-inflammatory
prevents immunosuppression

68
Q

Nucleotides

A

impair de novo synthesis in catabolic states
precursors of RNA/DNA
Protects structural and functional integrity of intestinal mucosa
Maintains or augments cell immune functions, especially those assoc w/ cell-mediated immunity

69
Q

how many kcal in gram of carb

A
  1. 0 kcal/g (enteral)

3. 4 kcal/g (parenteral)

70
Q

Gold standard for determining resting energy expenditure in hospitalized patients

A

Indirect calorimetry

71
Q

Long-chain fatty acids (LCFAs)

A

12+ carbons

Undergo esterification inside enterocytes, enter circulation through lymphatics as chylomicrons

72
Q

Short-chain fatty acids (SCFAs)

A

Enter directly into portal circulation, transported into liver by albumin carriers

Made in colon by action of bacteria.

Substrates for colonocytes

Pts w/ colostomy and distal rectal pouches might develop diversion colitis in distal rectal pouch b/c lack of SCFAs as nutrition in mucosa. Tx w/ SCFAs enemas

73
Q

Fuel source for stomach, enterocytes, pancreas, spleen

74
Q

fuel source for hepatocytes

A

amino acids

75
Q

fuel source for colonocytes

A

SCFA (butyrate, acetate)

76
Q

fuel source for cardiac myocytes

77
Q

fuel source for skeletal myocytes, brain, kidney

78
Q

Fuel source for peripheral nerves, adrenal medulla, RBCs, PMNs

79
Q

Fuel source for neoplastic cells

A

Glutamine, glucose

80
Q

Omega 3 FAs

A

Found in fish
Modulate leukocyte function, regulate cytokine release via nuclear signaling and gene expression

Eicosapentanoid acid (EPA)
Docosahexaenoic acid (DHA)

metabolized into prostaglandins called resolvins and neuroprotectins

81
Q

Omega 6 FAs

A

Found in safflower oil, corn, cottonseed, soybean oil

assoc w/ higher inflammatory response

precursors to leukotrienes, thromboxane, prostaglandins (vasoconstrictive, induce platelet aggregation)

82
Q

Vit A deficiency

A

Xerophthalmia, rashes

83
Q

Vit A excess

A

Nausea, vomiting, brain edema, hepatomegaly

84
Q

Vit D Deficiency

A

Hypocalcemia, hypophosphatemia

85
Q

Vit D excess

A

Confusion, polyuria, polydipsia, vomiting, muscle weakness

86
Q

Vit E deficiency

A

hemolytic anemia, neuromuscular disorders

87
Q

Vit E excess

A

possible platelet dysfunction, inhibit wound healing

88
Q

Vit K deficiency

A

Elevated INR, coagulopathy

89
Q

Vit K excess

A

hemolytic anemia, kernicterus

90
Q

Refeeding syndrome

A

D/t conversion of fat -> carb metabolism

hypophosphatemia

91
Q

Beneficial for wound healing in malnourished or immunosuppressed patients

A

Vit A - stimulates fibroplasia, collagen cross-linking, epithelialization. may reverse inhibitory effects of glucocorticoids on inflammatory phase of wound healing

92
Q

Vit C

A

essential for wound healing, hydroxylation of lysine and proline in collagen synthesis

93
Q

Vit C deficiency

A

Scurvy

Impaired wound healing

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