Nutrition Assessment Flashcards
1
Q
Zinc deficiency decreases ___ mobilization in the ___
A
-Retinol
-Liver
2
Q
Zinc deficiency decreases zinc-dependent enzyme conversion of ___ to ___
A
-Retinol
-Retinal
3
Q
Because zinc deficiency effects on ___, a zinc deficiency could precipitate and secondary vitamin __ deficiency
A
-Retinol
-Vitamin A
4
Q
High levels of enteric zinc may cause a ___
deficiency due to increased metallothionein (a metal binder) production
A
Copper
5
Q
High levels of ___ and ___ compete with zinc for absorption
A
Calcium, Iron
6
Q
Crohn’s disease involves what area of the GI tract most commonly?
A
The small intestine
7
Q
What are 3 possible mechanisms for malnutrition in Crohn’s disease?
A
- Malabsorption from diseased small bowel mucosa
- Increased nutrient requirements from active inflammation
- Reduced oral food intake due to abdominal discomfort and diarrhea
8
Q
Depending on severity of disease, malnutrition (along with low weight) has been reported in ___% to ___% of individuals with Crohn’s disease.
A
20-85%
9
Q
___-___% of inpatients and more than ___% of outpatients with Crohn’s disease reported experiencing significant
weight loss
A
65-75% & 50%
10
Q
What does elevated C-reactive protein reflect?
A
An inflammatory status
11
Q
Albumin may decrease during ___ and ___
A
-Inflammation
-Hypovolemia
12
Q
Albumin is a better predictor of ___ than it is reflective of nutrition status
A
Clinical outcomes
13
Q
Positive acute phase proteins like ___ increase during inflammation
A
CRP
14
Q
Negative acute phase proteins such as ___ and ___ decrease during inflammation
A
-Albumin
-Pre-albumin
15
Q
Why might calcium levels appear low when serum albumin is low?
A
Calcium binds to albumin in the blood. Lower albumin means less bound calcium, leading to a lower apparent total calcium level.
16
Q
What are the 6 conditionally essential amino acids?
A
- Arginine
- Cysteine
- Glutamine
- Glycine
- Proline
- Tyrosine
17
Q
Conditionally essential amino acids are synthesized from ___ under normal conditions, but require a dietary source in order to meet ___ needs causes by certain conditions.
A
-Other amino acids
-Increased
18
Q
In what conditions is arginine considered a conditionally essential amino acid?
A
Inflammatory conditions, wound healing, TBI
19
Q
The conditionally essential amino acid ___ is a key component of immune modulating enteral formulas
A
Arginine
20
Q
The ASPEN critical care guideline support the use of immune modulating formulas (with arginine) in what populations?
A
Trauma, TBI
21
Q
What does SIAD (formerly SIADH) stand for?
A
Syndrome of inappropriate antidiuretic hormone
22
Q
Name one of the most common causes of hyponatremia
A
SIAD
23
Q
SIADH is a disorder of ___ and ___ balance caused by the inappropriate release of ___ hormone.
A
-Sodium
-Water
-Antidiuretic hormone
24
Q
The result of SIADH is an ___ in total body water which causes ___ hyponatremia.
A
-Increase
-Dilutional
25
What are two urine levels that are elevated in SIADH? Due to what mechanism?
-Sodium and osmolality concentrations are elevated
-Due to excessive water reabsorption
26
In SIADH, to compensate for expansion of extracellular fluid, ___ secretion is inhibited while ___ increases.
-Aldosterone
-Atrial natriuretic peptide (ANP)
27
Compensatory responses of SIADH serve to maintain ___, but at the same time further worsen ___.
-Euvolemia
-Hyponatremia
28
Standard treatment of SIADH involves restricting ___ intake
and increasing ___ intake, if the patient has symptomatic hyponatremia.
-Fluid
-Sodium
29
If increased sodium and fluid restriction are ineffective for SIADH treatment, what 2 drugs may be used?
Loop diuretics and/or vasopressin-2 receptor agonists
30
___ is the most abundant amino acid in the body, accounting for more than 50% of the intracellular free amino acid
pool in muscle.
Glutamine
31
Glutamine is a vital fuel for rapidly dividing cells, including the ___ cells.
Intestinal epithelium
32
A fall in glutamine concentration is associated with atrophy of ___.
Intestinal mucosa
33
Why are resections of the duodenum and proximal jejunum generally better tolerated
Ileal compensation and adaptation occur
34
Why is ileal resection generally poorly tolerated
Adaptive hyperplasia in the remaining jejunum is limited
Hyperplasia = increased cell production
35
What is the role of the ileo-cecal valve?
The ileocecal valve slows intestinal transit allowing for greater absorption of nutrients
36
The colon has critical roles in ___ and nutrient absorption. Therefore, patients lacking a colon are at greater risk of ___.
-Fluid
-Dehydration
37
The colon is capable of salvaging ___ through anaerobic ___ ___ of undigested carbohydrates into absorbable ___.
-Calories
-Bacterial fermentation
-Short-chain fatty acids (SCFAs)
38
Valproic acid, an ___ drug, has been shown to induce ___ deficiency (because the nutrient is an essential ___ in the metabolism of valproic acid and ___ elimination).
-Anti-epileptic drug
-Carnitine
-Co-factor
-Ammonia
39
How does valproic acid deplete hepatic carnitine stores?
Forms valproate carnitine, inhibiting carnitine transport to the plasma membrane
40
Consider carnitine replacement in patients with elevated ___ concentration, ___ or valproate concentration above ___ mcg/mL
-Ammonia
-Hepatotoxicity
-450
41
Valproic acid also increases the metabolism of vitamin ___ and may reduce serum levels.
Vitamin D
42
PKU is an inborn error of ___ metabolism caused by a deficiency of the hepatic enzyme ___ hydroxylase
-Phenylalanine
-Phenylalanine
43
Phenylalanine hydroxylase catalyzes the hydroxylation of ___ to ___
Phenylalanine to tyrosine
44
In the absence of phenylalanine hydroxylase, phenylalanine levels become extremely ___ and tyrosine becomes ___.
-High
-Deficient
45
Treatment for PKU includes a ___ diet and supplementation of ___.
-Phenylalanine-free diet
-Tyrosine
46
The Mifflin-St. Jeor equations, when using actual body weight with an activity factor, have demonstrated greater accuracy with ___ and ___ people when compared to the Harris-Benedict equation.
Healthy obese and non-obese people
47
The ___ and ___ equations were developed to estimate energy requirements in critically ill patients, not healthy adults.
Ireton-Jones and Penn State equations
48
What biologic function has aluminum been shown to have?
Aluminum has not been shown to have any biologic function.
## Footnote
Aluminum is primarily a contaminant in many parenteral nutrition (PN) components.
49
What are the potential effects of aluminum toxicity?
Abnormalities of hematopoietic, bone, and neurologic functions.
## Footnote
Toxicity occurs upon accumulation of aluminum in the body.
50
How can complications of aluminum intake be avoided?
By minimizing the use of aluminum-containing agents such as antacids and sucralfate.
## Footnote
This is especially critical in vulnerable populations.
51
In which populations is it particularly important to limit aluminum contaminants in PN solutions?
Premature neonates and patients with significant renal dysfunction.
## Footnote
These groups are at a higher risk for aluminum toxicity.
52
What is the treatment for aluminum toxicity?
Deferoxamine (an agent that chelates aluminum)
## Footnote
Deferoxamine is an agent that chelates aluminum.
53
What is the appropriate treatment for ascites?
Fluid and sodium restriction
## Footnote
Ascites is often treated by limiting fluid and salt intake to manage symptoms and prevent complications.
54
What is the recommended protein intake for patients with cirrhosis?
1.0 – 1.5 g/kg/d
## Footnote
Adequate protein intake is crucial for patients with cirrhosis to support body functions and prevent malnutrition.
55
What type of tube feed formula would be most appropriate to avoid further salt and fluid overload in patients with ascites?
Maximally concentrated solutions (provides the best opportunity to avoid further salt and fluid overload while providing necessary substrate for anabolism)
## Footnote
Concentrated solutions help provide necessary nutrients while minimizing excess fluid intake.
56
Where is iron primarily absorbed in the body?
In the duodenum and jejunum
57
In what state is iron absorbed?
In the ferrous state
58
The ___ form of iron is insoluble in aqueous solutions and, therefore, not absorbed
Ferric
59
What role does gastric acid play in iron absorption?
It maintains dietary iron in the ferrous state
60
What is a common risk for patients on long-term parenteral nutrition?
Increased risk of developing anemia, leukopenia, neutropenia, and skeletal abnormalities.
61
What type of anemia is caused by deficiencies of iron or copper?
Microcytic hypochromic anemia
62
Microcytic hypochromic anemia is characterized by ___ red blood cells that are ___ in color due to ___ heme pigment.
-Small
-Pale
-Decreased
63
What type of anemia is associated with deficiencies of B12 or folate?
Macrocytic anemia
64
Macrocytic anemia is characterized by ___ red blood cells
Large
65
List the 11 symptoms of copper deficiency
1. Sensory ataxia
2. Lower extremity spasticity
3. Paresthesia in extremities
4. Leukopenia
5. Neutropenia
6. Hypercholesterolemia
7. Increased erythrocyte turnover
8. Decreased ceruloplasmin
9. Decreased erythrocyte copper/zinc superoxide dismutase (SOD)
10. Abnormal EKG patterns
11. Myeloneuropathy
66
67
Conditions such as organ failure, cancer, rheumatoid arthritis, and sarcopenic obesity are examples of ___ to ___ inflammation and are ___ disease states
-Mild
-Moderate
-Chronic
## Footnote
Chronic inflammation can lead to various long-term health issues.
68
Conditions such as major infection, burns, trauma, and closed head injury are examples of ___ inflammation and are ___ disease states
-Marked (or high)
-Acute
## Footnote
Severe inflammation can significantly impact nutritional status.
69
True or False: Anorexia nervosa is considered an inflammatory state.
False
## Footnote
Anorexia nervosa is characterized by a lack of appetite and is not linked to inflammation.
70
What enzyme does the salivary gland release that initiates hydrolysis of carbohydrates?
Alpha amylase
## Footnote
Alpha amylase begins the breakdown of carbohydrates when food enters the mouth.
71
What factors influence the degree of hydrolysis of carbohydrates in the mouth?
Time food is chewed and nature of the food
## Footnote
The effectiveness of alpha amylase depends on how long the food is chewed and its characteristics.
72
Which enzyme is released from the pancreas and is important in the digestion of fat?
Lipase
## Footnote
Lipase plays a crucial role in breaking down fats during digestion.
73
Where are lactase and maltase located?
Brush border cells of the small intestine
## Footnote
These enzymes are essential for carbohydrate digestion in the small intestine.
74
What is the role of lactase and maltase in digestion?
Important in intraluminal carbohydrate digestion
Note:
Intraluminal carbohydrate digestion, which primarily occurs in the small intestine, involves the breakdown of carbohydrates by pancreatic amylase into smaller disaccharides and monosaccharides within the intestinal lumen.
## Footnote
They assist in the breakdown of carbohydrates within the lumen of the small intestine.
75
Hyperhomocysteinemia is associated with an increased risk of ___ ___.
Coronary atherosclerosis
## Footnote
Hyperhomocysteinemia refers to elevated levels of homocysteine in the blood.
76
Which 3 supplements have been shown to reduce plasma homocysteine concentrations?
1. Folic acid
2. Vitamin B6
3. Vitamin B12
## Footnote
These vitamins play a role in the metabolism of homocysteine.
77
Is hyperhomocysteinemia known to be a causative factor of atherosclerosis?
No, it is not known whether hyperhomocysteinemia is a causative factor of atherosclerosis or simply a marker of vascular disease
## Footnote
This uncertainty highlights the need for further research.
78
What is a primary complication of hyperphosphatemia?
Soft tissue and vascular calcification
## Footnote
Calcification occurs when the product of serum calcium and phosphorus exceeds 55 mg2/dL2.
79
Calcification occurs when the product of serum calcium and phosphorus exceeds ___ mg2/dL2
55
80
List 2 symptoms (other than soft tissue and vascular calcification) of hyperphosphatemia
Secondary hyperparathyroidis and renal osteodystrophy
81
Lingual lipase and gastric lipase have a ___ role in fat digestion in healthy adults
Limited role
82
Which organ secretes bile acids that aid in fat digestion?
The liver
83
What enzymes produced by the pancreas assist in fat digestion?
Lipase and colipase
84
What process do bile acids, lipase, and colipase aid in?
Micellar solubilization and absorption of dietary fat
85
How is Vitamin B12 released from ingested proteins?
Via the action of HCl and pepsin in gastric secretions
86
What does free Vitamin B12 bind to after being released from proteins?
R-protein.
87
___ is necessary for absorption of Vitamin B12 in the ileum.
Intrinsic factor
88
Individuals with impaired HCl production, such as those taking proton pump inhibitors may have impaired vitamin ___ absorption
B12
89
Wernicke's encephalopathy is often an ___ related condition due to ___ deficiency
-Alcohol-related
-Thiamine
## Footnote
Wernicke's encephalopathy is associated with severe thiamin deficiency.
90
List 5 symptoms of Wernicke's encephalopathy
1. Mental status changes
2. Confusion
3. Nystagmus (irregular eye movements)
4. Gait ataxia (abnormal walking pattern)
5. Polyneuritis (tingling/neuropathy)
## Footnote
These symptoms are indicative of neurological impairment due to thiamin deficiency.
91
Patients with malnutrition and alcohol use disorder should have ___ supplementation
Thiamine supplementation
## Footnote
Malnourishment in alcohol use disorder can lead to thiamin deficiency.
92
Thiamine plays an essential role in ___ metabolism
Glucose metabolism
## Footnote
Thiamin is crucial for converting carbohydrates into energy.
93
High dextrose infusion ___ the metabolic demand for thiamine
Increases
94
The electrolyte content of gastrointestinal secretions changes according to their ___ ___ ___ ___ ___
Location along the GI tract
## Footnote
The electrolyte composition varies in different sections of the gastrointestinal tract.
95
Jejunal and ileal fluids most closely resemble what IV fluid?
Lactated Ringer's
## Footnote
Lactated Ringer's solution is often used for fluid resuscitation and has an electrolyte composition similar to these intestinal fluids.
96
Jejunum concentration of sodium, potassium, chloride and bicarbonate
Sodium = 95-120 mEq/L
Potassium = 5-15 mEq/L
Chloride = 80-130 mEq/L
Bicarbonate = 10-20 mEq/L
97
Ileum concentration of sodium, potassium, chloride and bicarbonate
Sodium = 110-130 mEq/L
Potassium = 10-20 mEq/L
Chloride = 90-110 mEq/L
Bicarbonate = 20-30 mEq/L
98
What electrolytes (and what concentrations) are found in Lactated Ringer's?
Glucose = 0
Sodium = 130 mEq/L
Chloride = 109 mEq/L
Potassium = 4 mEq/L
Lactate = 28 mEq/L
Calcium = 2.7 mEq/L
99
What electrolytes (and what concentrations) are found in Normal saline?
Sodium - 154 mEq/L
Chloride 154 mEq/L
100
What electrolytes (and what concentrations) are found in ½ Normal saline?
Sodium = 77 mEq/L
Chloride = 77 mEq/L
101
What electrolytes (and what concentrations) are found in D5 1/2 NS?
Glucose = 50 grams/L
Sodium = 77 mEq/L
Chloride = 77 mEq/L
102
Albumin is a ___ acute phase protein.
Negative
103
Albumin levels ___ in response to stress
Decrease
104
What does hypoalbuminemia reflect more than nutritional status?
More a reflection of the degree of stress resulting from disease, injury, and inflammation
105
What are the 3 associated risks of hypoalbuminemia?
1. Increased short-term mortality
2. Longer hospital stay
3. Higher complications
106
What does hypoalbuminemia correlate strongly with?
30-day mortality.
107
EFAD usually results after ___ weeks of PN without lipid, although signs of deficiency can be seen as early as ___ - ___ days in adults
-4 weeks
-10-20 days
## Footnote
EFAD usually results after 4 weeks of PN, although signs can appear as early as 10-20 days in adults.
108
True or false: EFAD can occur more rapidly in infants and children then adults?
True
109
What are the 5 signs of essential fatty acid deficiency?
1. Scaly dermatitis
2. Alopecia
3. Thrombocytopenia
4. Anemia
5. Impaired wound healing
## Footnote
These signs indicate the body's need for essential fatty acids.
110
How can EFAD be diagnosed?
By confirming a triene:tetraene ratio greater than 0.2
## Footnote
This ratio helps in identifying the presence of EFAD.
111
What percentage of total energy should come from linoleic acid (LA) to prevent EFAD?
1% to 4%
## Footnote
LA is essential for preventing EFAD in patients receiving PN.
112
What percentage of total energy should come from alpha-linolenic acid (ALA) to prevent EFAD?
0.25% to 0.5%
## Footnote
ALA is also crucial in preventing EFAD.
113
When should trace element deficiency be monitored in patients on PN?
Trace element deficiencies need to be monitored in the light of shortages.
## Footnote
Monitoring is important due to potential shortages in essential trace elements.
114
How can you reduce the risk of trace element deficiencies in PN patient's during a shortage?
Using ASPEN dosing guidelines should reduce the risk
## Footnote
ASPEN provides recommendations for safe and effective PN administration.
115
What are the 4 symptoms of vitamin D deficiency?
1. Muscle weakness
2. Fatigue
3. Bone pain
4. Depression
## Footnote
These symptoms can significantly impact a patient's quality of life.
116
What are the 3 effects of vitamin E deficiency?
1. Numbness and tingling
2. Muscle weakness
3. Impaired coordination
## Footnote
Vitamin E is vital for neurological and muscular functions.
117
What are 3 typical symptoms of iron deficiency?
1. Pallor
2. Fatigue
3. Microcytic anemia
## Footnote
Iron deficiency can lead to severe health issues if not addressed.
118
Why is iron not included in standard multitrace element preparations manufactured in the United States?
Due to concerns for increased microbial growth
## Footnote
This precaution is taken to ensure patient safety in PN.
119
What supplementation should be considered if iron deficiency is expected?
-Oral iron
-Enteral iron
-Parenteral iron
## Footnote
Different forms of iron supplementation can be used based on patient needs.
120
Which iron supplement is most compatible with PN?
Iron dextran
## Footnote
Iron dextran is preferred for patients receiving PN to avoid compatibility issues.
121
RQ (or respiratory quotient) equals the amount of ___ produced divided by the amount of ___ consumed
RQ = CO2 produced/O2 consumed
122
An RQ <___ or >___ may result from hypoventilation or hyperventilation (+ several metabolic causes as well)
<0.7 or >1.0
123
An RQ of 0.71 indicates the body is using primarily ___ as fuel
Fat
124
An RQ of 0.82 indicates the body is using primarily ___ as fuel
Protein
125
An RQ of 0.85 indicates the body is using primarily ___ as fuel
Mixed substrate utilization (protein, fat and carbs)
126
An RQ of 1.0 indicates the body is using primarily ___ as fuel
Carbohydrate
127
REE measured under steady state conditions closely approximates true ___ ___ ___
24-hour energy expenditure
128
The addition of a stress or activity factor may not be necessary and could result in ___.
Overfeeding
129
If a patient's REE is measured while fasting or if feedings are intermittently provided, it is reasonable to allow an additional 8 - 10% factor to account for ___.
Thermogenesis
130
Fill in the blank: The additional activity/stress factor to account for thermogenesis is _______.
8 - 10%
131
During fasting, fuel oxidation gradually shifts from ___ to mainly ___ as the oxidative source
-Carbohydrates
-Lipids
132
During fasting - what process increases to provide the body with fatty acids?
Lipolysis increases.
133
What is the consequence of increased fatty acid oxidation during fasting?
Terminal glucose oxidation is decreased
134
How does the body maintain sufficient glucose levels during fasting?
Through endogenous glucose production by gluconeogenesis.
135
What role does glucose still play during fasting?
It is used for glycogen synthesis but to a lesser degree.
136
Thiamin is necessary for the metabolism of glucose, specifically for converting ___ to ___
-Pyruvate
-Acetyl CoA.
137
What happens in the TCA cycle in the absence of Thiamine?
Inhibition of pyruvate dehydrogenase drives carbohydrate metabolism toward lactic acid fermentation
138
What is the consequence of carbohydrate metabolism shifting towards lactic acid fermentation due to thiamine deficiency?
Resulting build-up of lactic acid.
139
What can untreated thiamine deficiency lead to?
Fatal lactic acidosis.
140
What are the symptoms of copper toxicity (3)?
Severe nausea, diarrhea, and vomiting
## Footnote
Symptoms can escalate to coma and liver failure in severe cases
141
What are more serious manifestations of acute or chronic copper toxicity (6)?
Coma, hepatic necrosis, liver failure, renal failure, vascular collapse, and death
## Footnote
These symptoms can be associated with Wilson's disease
142
Wilson's disease is a rare, inherited disorder that affects the body's ability to process ___
Copper
143
Since about 80% of copper is excreted in the bile, patients who have ___ disease should be monitored and supplementation reduced or eliminated.
Liver
## Footnote
Liver disease affects copper metabolism
144
What effect does hemodialysis have on copper levels?
Increases copper losses
## Footnote
Important for managing patients undergoing hemodialysis
145
What role does enteral zinc supplementation play in relation to copper?
Zinc competes with copper for absorption
## Footnote
This can affect copper levels in the body
146
What is the primary source of water intake (in health adults)?
The diet
## Footnote
Water intake is primarily derived from the foods and beverages consumed.
147
What accounts for the majority of fluid loss in the body?
Sensible losses from the gastrointestinal tract and kidneys
## Footnote
These are measurable losses that occur through normal bodily functions.
148
How much can insensible losses from the lungs and skin contribute to fluid loss per day?
Up to 1 L per day
## Footnote
Insensible losses are not easily measured and occur continuously.
149
Fluid gains should be in ___ with fluid losses over a period of several days
Balance
## Footnote
Maintaining a balance is essential for proper hydration and bodily function.
150
What can be used to double-check the accuracy of intake and output measurements?
Serial body weights
## Footnote
Tracking body weight changes can help verify fluid balance.
151
One method of estimating fluid requirements is to use ___ mL per kcal of energy requirement.
1 mL per kcal of energy requirement
## Footnote
This method provides a simple way to calculate daily fluid needs based on energy expenditure.
152
What is the normal length of the small intestine in adults?
300-600 cm
153
What 5 factors impact the absorptive function of the small bowel?
1. Bowel length
2. Specific segment of the bowel that was resected
3. Residual disease
4. Absence of colon and/or ileocecal valve
5. Prior gastric resection
154
In SBS when the small bowel is <___ cm to an end jejunostomy or ileostomy, parenteral nutrition and hydration is likely needed
<120 cm
155
The presence of an ileocecal valve and colon improves ___ absorption, ___ absorption and update of ___
-Fluid
-Electrolyte
-Short chain fatty acids
156
Survival without parenteral nutrition is possible with as little as ___ cm of small bowel if an ileocecal valve and colon are present.
60 cm
157
What are 7 conditions associated with an increased risk of hypophosphatemia?
1. Malnourishment with refeeding syndrome
2. DKA (Diabetic Ketoacidosis)
3. Alcohol abuse disorder
4. Respiratory alkalosis
5. Metabolic alkalosis
6. Critical illness
7. Fanconi syndrome (affects how your kidneys reabsorb certain substances)
## Footnote
These conditions can disrupt phosphate balance in the body.
158
Insulin drives potassium and phosphorus ___ of the cells, resulting in serum ___ of potassium/phos
-Into
-Depletion
## Footnote
It acts as an anabolic hormone affecting electrolyte distribution.
159
Insulin in an ___ hormone
Anabolic
160
What causes net urinary loss of phosphate in DKA?
Transcellular shift of phosphate from cells into the extracellular fluid, osmotic diuresis (due to high blood sugar levels), and reduced renal phosphate reabsorption by Na-Pi transporters
## Footnote
These factors contribute to phosphate depletion in patients with DKA.
161
Tumor lysis syndrome can result in ___ serum phosphorus levels
High
## Footnote
This condition occurs when cancer cells break down rapidly, releasing phosphorus into the bloodstream.
162
Vitamin___ deficiency is associated with hypocalcemia, osteomalacia, and osteoporosis
Vitamin D
## Footnote
Vitamin D is crucial for calcium and phosphate metabolism.
163
How can AKI affect phosphorus levels?
It can lead to high phosphorus levels due to decreased renal excretion
## Footnote
Acute Kidney Injury affects the body's ability to filter and excrete waste products, including phosphate.
164
Cheilosis (a cracking of the corners of the mouth), is observed with a deficiency of ___
Riboflavin
## Footnote
Associated with riboflavin deficiency
165
What are some symptoms of riboflavin deficiency?
-Cracking corners of the mouth (chelosis / angular stomatitis)
-Hyperemia and edema of pharyngeal and oral mucosa
-Glossitis (magenta tongue)
## Footnote
These symptoms indicate a deficiency in riboflavin
166
Glossitis is also called ___ and is associated with ___ deficiency
-Magenta tongue
-Riboflavin
167
Angular stomatitis and cheilosis are different names for conditions that generally affect what part of the body?
Lips and corners of the mouth
Note: angular stomatitis specifically refers to inflammation at the corners, while cheilosis is a broader term for lip inflammation.
168
What is the most common characteristic of Vitamin D deficiency?
Loss of bone density
## Footnote
Vitamin D is crucial for maintaining bone health
169
___ or ___ anemia is a classic feature of folic acid deficiency
Megaloblastic or macrocytic anemia
## Footnote
This type of anemia is characterized by larger than normal red blood cells
170
What condition can result from a deficiency in Vitamin C?
Scurvy
## Footnote
Scurvy is associated with symptoms like fatigue, swollen gums, and joint pain
171
Urinary urea nitrogen is used primarily to monitor adequacy of ___ intake during nutrition support.
Protein
172
Urine is usually collected for a ___ period in order to quantify the amount of urinary urea nitrogen
24 hour
173
What 3 factors can alter urinary urea nitrogen?
-Compromised renal function (creatinine clearance <50)
-Low urine output
-Muscle atrophy
174
Patients with high ileostomy or small bowel fistula output at increased risk for the loss of ___ and ___.
Water and electrolytes
175
The sodium content of ileostomy output can be as high as ___ mEq/liter
120 mEq/liter
176
Hyponatremia can result when fluid replacement does not contain adequate _______ to correct for ileostomy losses.
sodium
177
Indirect calorimetry is a respiratory measurement that under proper conditions is equivalent to ___, any factor that violates these conditions is a ___ to IC.
-Metabolism
-Contraindication
## Footnote
Examples include air leaks, extracorporeal membrane oxygenation, hemodialysis, FiO2 > 60% in mechanically ventilated patients, reliance on supplemental oxygen, inability to cooperate, claustrophobia, and anxiety.
178
What does indirect calorimetry (IC) measure?
Respiratory measurement equivalent to metabolism under proper conditions
## Footnote
It aims to determine the resting metabolic rate.
179
Examples of contraindications for IC in mechanically ventilated patients include ___ leaks, hemodialysis/ECMO, FiO2 >___%
-Air leak
-60%
180
Examples of contraindications for IC in spontaneously breathing patients include: reliance on supplemental ___, inability to cooperate with measurement, and claustrophobia or anxiety about the measurement.
Oxygen
181
What are the five historical criteria used in the SGA?
1. Weight history
2. Dietary intake
3. Gastrointestinal symptoms
4. Functional status
5. Metabolic demand
## Footnote
These criteria help assess a patient's nutritional status.
182
What are the three components of physical examination in the SGA?
1. Fat depletion
2. Muscle wasting
3. Nutrition-related edema
## Footnote
These components provide objective measures of nutritional status.
183
What are the 3 categories the SGA uses to classify a patient's nutrition status?
1. Well nourished
2. Moderately malnourished
3. Severely malnourished
## Footnote
Classification is based on subjective weighting of collected data.
184
What nutrition assessment tool has been found to be a good predictor of complications in patients undergoing gastrointestinal surgery, liver transplantation, and dialysis?
The SGA
## Footnote
This highlights the importance of nutritional assessment in surgical outcomes.
185
True or False: The SGA has limited use for critically ill patients.
True
## Footnote
The effectiveness of SGA may be reduced in critically ill scenarios.
186
The NRS-2002 is a screening tool used to identify patient's are risk for malnutrition in the hospital. What 5 criteria does the NRS-2002 use?
1. Unintentional weight loss
2. BMI
3. Disease severity
4. Impaired general condition
5. Age > 70
## Footnote
This score is used to assess nutritional risk.
187
The Nutrition Risk in the Critically Ill (NUTRIC) Score identifies critically ill patients who can benefit from nutrition therapy. What 4 components are included in the NUTRIC score?
1. APACHE II score
2. SOFA (with or without IL-6)
3. Number of comorbidities
4. Days from hospital to ICU admission
## Footnote
This score helps evaluate critically ill patients' nutritional needs.
188
Nutritional Risk Index (NRI) is a tool used to assess malnutrition in hospitalized patients. What 2 components does the NRI use for its assessment?
1. Serum albumin
2. Ratio of current weight to usual weight
## Footnote
The NRI is another tool for nutritional assessment.
189
The ___ is a severity-of-disease classification system used in ICUs to predict mortality risk. It is calculated within the first 24 hours of ICU admission based on 12 physiological variables, age, and chronic health conditions.
APACHE II score
190
The ___ is a tool used in ICUs to assess the severity of organ dysfunction in critically ill patients, helping predict mortality and monitor patient progress
Sequential Organ Failure Assessment (SOFA) score
191
192
What is considered abnormal tricep skinfold thickness in hospitalized patients?
Below the 5th percentile
## Footnote
Tricep skinfold thickness is a measurement used to assess body fat and nutritional status.
193
What might cause tricep skinfold measurements to be unreliable?
Edema, obesity
## Footnote
Obesity can affect the accuracy of skinfold measurements due to the distribution of body fat.
194
Recent involuntary weight loss of ___% of usual body weight over 6 months detects obese and non-obese patients at risk for malnutrition
10%
## Footnote
This criterion applies to both obese and non-obese patients.
195
Does voluntary weight loss from a BMI of 30 to a BMI of 25 indicate malnutrition?
No
## Footnote
This type of weight loss does not reflect malnutrition as it may be a planned and healthy weight reduction.
196
What is a gastrectomy?
The total or partial removal of the stomach.
197
Parietal cells in the stomach are responsible for producing ____
Intrinsic factor
198
What does intrinsic factor do (under normal circumstances)?
Binds with vitamin B12 and aids in its absorption in the small bowel.
199
What happens to intrinsic factor when the stomach is resected?
There is no longer adequate intrinsic factor to bind with B12.
200
What vitamin deficiency (potentially requiring supplementation) may result from the lack of intrinsic factor after gastrectomy?
Vitamin B12
201
The fluid requirement for healthy adults aged 18-55 is ___mL/kg
35mL/kg
## Footnote
This is the recommended fluid intake for healthy adults in this age group.
202
The fluid requirement for healthy adults aged 55-75 is ___mL/kg
30mL/kg
## Footnote
This reflects a decrease in fluid requirements as adults age.
203
The fluid requirement for healthy adults older than 75 years is ___ mL/kg
25mL/kg
## Footnote
This further reduction is based on physiological changes with aging.
204
When is a fluid requirement of less than 25ml/kg indicated?
When fluid restriction is indicated, such as in congestive heart disease or renal failure
## Footnote
Conditions like these require careful management of fluid intake.
205
The chemotherapeutic drug ___ is a folate analogue that became available in the early 1950s
Methotrexate
206
What is methotrexate structurally similar to?
Folate
207
___ competitively inhibits Dihydrofolate reductase (an enzyme that catalyses the conversation of dihydrofolate to tetrahydrofolate). Tetrahydrofolate is a cofactor in the synthesis of purine nucleotides and thymidylate). Therefore, ___ impairs malignant growth by interfering with DNA synthesis, repair and cellular replication.
-Methotrexate
-Methotrexate
208
What are the 3 functions of Vitamin A in wound healing?
1. Cellular differentiation
2. Enhancement of epithelialization
3. Collagen synthesis
## Footnote
Vitamin A plays a crucial role in various stages of wound healing
209
What is the recommended oral dosage of Vitamin A to enhance wound healing with corticosteroid therapy?
3,000 to 4,500 RAE/day
## Footnote
This dosage is specifically for patients undergoing treatment with corticosteroids
210
Short chain fatty acids (SCFA) are the primary fuel product for ___ cells
Colonic
211
An intact, plant-based carbohydrate that is nondigestible by humans is also known as ___
Fiber
212
How is dietary fiber processed in the human body?
It is digestible by intestinal microbes through the process of fermentation
213
What are the 3 SCFAs produced through fermentation?
1. Acetate
2. Butyrate
3. Propionate
214
What is the role of SCFAs (particularly acetate, butyrate and propionate) in the colon?
They serve as fuel for the colonocytes
215
What are 3 benefits SCFAs provide to colonic cells?
1. Provide energy
2. Increase mucosal growth
3. Enhance sodium and water absorption
216
An altered zinc metabolism with zinc deficiency and decreased serum zinc is noted in most forms of clinical ___ disease, especially acute ___ disease
-Liver
-Liver
## Footnote
Especially pronounced in acute liver disease.
217
A systematic review and meta-analysis concluded that a combination of ___ supplementation and lactulose over 3 to 6 months may improve the number connection test in cirrhotic patients with low grade HE, compared with lactulose only
Zinc
## Footnote
Indicates the potential for improved cognitive function.
218
___ supplementation may be considered in patients not improving on lactulose and rifaximin therapy
Zinc
## Footnote
Suggests a need for alternative treatment options.
219
What is the current status of evidence regarding zinc supplementation for HE?
The evidence is limited, and larger, well-designed, clinical trials are needed
## Footnote
Highlights the necessity for more research.
220
A prominent iliac crest pertains to subcutaneous ___ loss
Fat
## Footnote
NFPE stands for Nutritional Functional Physical Examination.
221
What is catabolism of endogenous substrate including fat stored in adipose tissue called?
Lipolysis
## Footnote
Lipolysis is the breakdown of fats and other lipids by hydrolysis to release fatty acids.
222
Hypoglycemia and ketosis are common characteristics of ___?
Starvation
## Footnote
Hypoglycemia refers to low blood sugar levels, while ketosis is a metabolic state that occurs when the body starts breaking down fat for fuel.
223
Hypermetabolism and hyperglycemia are characteristic of ___-related malnutrition.
Stress
