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Neo Boards GF > Nutrition/FEN > Flashcards

Nutrition/FEN Flashcards

1
Q

What is growth rate (g/day) at 16 weeks? 21? 29? 37?

A

16 - 5 g/day
21 - 10 g/day
29 - 20 g/day
37 - 35 g/day

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2
Q

What in fetus increases with advancing GA and birth weight?

A 
Intracellular water
Protein
Fat
Ca, Ph, Mg
Iron
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3
Q

What decreases in fetus with inc GA and BW?

A

TBW
Extracellular water
Sodium content
Chloride content

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4
Q

What is the fetal energu expenditure?

A

35-55 kcal/kg/day

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5
Q

What is neonatal resting metabolic rate? Total energy requirements?

A

Resting metabolic rate = 40-60 kcal/kg/day

Total = 90-120 kcal/kg/day

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6
Q

What is whey:casein ratio in colostrum? Mature milk? Preterm formula?

A

Colostrum - 80:20
Mature milk - 55:45
Preterm formula - 60:40

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7
Q

What are essential amino acids?

A 
Lysine
Phenylalanine 
Threonine
Tryptophan 
Methionine 
Histidine
Valine
Leucine
Isoleucine
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8
Q

What are the 4 amino acids considered essential in premature infants?

A

Cysteine
Tyrosine
Arginine
Taurine

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9
Q

What are the 2 essential fatty acids?

A

Linoleic

Linolenic

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10
Q

What is significant of triene:tetrene ration?

A

Ratio > 0.4 suggests fatty acid deficiency

If low linoleic acid -> low arachidonicnacid. Then oleic acid -> eicosatrienoic acid.

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11
Q

In breast milk fat, palmitic acid is present in what position?

A

Beta position -> more easily absorbed than alpha which is in cows milk

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12
Q

What are symptoms of essential fatty acid deficiency?

A 
Hemorrhagic dermatitis
Skin atrophy
Scaly dermatitis
Weakness
Impaired vision
Edema
High BP
Poor growth
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13
Q

What is the predominant carbohydrate in breast milk and most formulas?

A

Lactose

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14
Q

What are goals for TPN nutrient proportions?

A

Kcal 100 /kg/day (105-115 for <1000g)
Fat 30-50%
Carb 35-65%
Protein 7-15%

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15
Q

What is the primary source of fetal energy?

A

Maternal glucose (via facilitated diffusion) - 2/3 fetal energy source
Placental lactate 1/4
Maternal amino acids - remainder (via active transport)

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16
Q

What type of casein is most common in human milk?

A

Beta casein (produces curd in stomach)

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17
Q

What are the whey proteins?

A 
Alpha-lactalbumin
Lactoferrin
Secretory IgA
Serum albumin
*IgA and lactoferrin make up 30% of all milk protein
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18
Q

What are the calories per gram of TPN components?

A

Glucose - 3.4 kcal/g
Fat - 9 kcal/g
Protein - 4 kcal/g

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19
Q

What is the most prevalent fatty acid in IL?

A

Linoleic (44-62%)

Second - palmitic (7-14%)

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20
Q

What does IL not have?

A

Omega oils and arachidonic acid

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21
Q

What is the most important amino acid for fat metabolism?

A

Carnitine
IV can improve ability to use IL for energy
Can add up to 10 mg/kg/day

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22
Q

What tpn changes are necessary with renal dysfunction?

A

Leave out Selenium and Chromium (Cr)

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23
Q

What proportion of fat in BM is TGs?

A

98%
Made from medium chain fatty acids and long chain fatty acids
Most abundant: Oleic (18:1) and Palmitic acid (16:0)

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24
Q

What fluid compartment increases as GA increases?

A

Intracellular fluid (TBW and ECF decrease as GA increases)

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25
Q

What compartment is early weight loss in newborns?

A

ECF primarily

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26
Q

How to correct free H2O deficit?

A

4ml/kg water for every 1 meq/L increase in Na above 145. If >170, give 3 ml/kg free water

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27
Q

What proportion of evaporative water loss is from skin? Respiratory tract?

A

Skin: 2/3

Resp tract: 1/3

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28
Q

What is the main hormonal determinant of water excretion in kidney? Where is it made? Secreted? Act?

A

ADH aka vasopressin
Made in hypothalamus (supraoptic snd paraventricular nuclei)
Stored in secretory granules in posterior pituitary, then secreted if plasma osmality occurs.
Acts on collecting tubules to reabsorb water

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29
Q

What are sx of SIADH? How to rx?

A

Water retention, hyponatremia. Urine osmolality is inappropriately high. Low UOP.
Rx: water restriction, if Na <120, replace with NaCl. Consider furosemide.

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30
Q

What are sx and rx for nephrogenic DI?

A

Insensticity to ADH
Pee out way too much, FTT
High Na and hypotonic urine with hypertonic serum.
Rx: hydration, thiazide diuretics (to help ability to concentrate urine), K supplement

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31
Q

What is the main difference in electrolyte composition between stomach and small intestine/bile?

A

Stomach - low Na, low K, high Cl
Small int/bile - high Na, low K, med/high Cl
Of note, diarrhea — mich higher K, some/low Na, some/low Cl

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32
Q

How to calculate plasma osmolality?

A

Plasma osm= 2 (Plasma Na) + glucose/18 + BUN/2.8

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33
Q

How to calculate Na deficit?

A

Na deficit = (Na desired - Na current) x 0.6 x weight (kg)

*premie has higher tbw, use 0.8 instead

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34
Q

What are signs of hypokalemia on EKG?

A

U wave (small wave right after t wave), ventricular arrhythmia, depressed ST segment, AV conduction defect

35
Q

Where does most of bicarbonate reabsorption occur?

A

60-80% bicarb reabsorotion occurs in proximal tubule

36
Q

What is the pathophysiology of Type I RTA? Prognosis? Rx?

A

Cannot secrete H in distal tubule, normal bicarb threshold
Sx: will have high urine pH, more kidney stones
Rx: bicarb
Prog: with rx, good outcome. Less likely to resolve

37
Q

What is the pathophysiology of type II RTA? Sx? Rx?

A

Low or absent proximal tubular bicarb reabsorption. Lower renal threshold.
Urine pH low if bicarb stores are used up
Rx: bicarb supplementation, vit D
Prog: recovery 2-3 years

38
Q

What is the cause and sx of Bartter syndrome? Rx?

A

Hypertrophy and hyperplasia of renal juxtaglomerular apparatus, 2/2 defect in Cl transport in ascening loop
Causes inc renin, aldosterone -> low K, met alk. Normal PTH. Kidney stones
Sx: FTT, dehydration. Normal Ca.
Rx: K supp, sometimes thiazide diuretics and indomethacin

39
Q

What is pathophys of type IV RTA? Sx? Rx?

A

Aldosterone deficiency/resistance
Sx: high K (only RTA with high K), high Cl, met acidosis. Most common is early childhood RTA (tubule insensitivity)
Poor growth, FTT if not treated
Rx: aldosterone, bicarb supp

40
Q

When does the number of nephrons finish?

A

34-35 weeks (after that the size increases)

41
Q

What impact does growth restriction have on nephron number?

A

Decreases nephron number

42
Q

When does urine production begin? What is urine flow rate ar 22, 30, 40 weeks?

A

10-12 weeks GA
22 wks: 2-5 ml/hr
30 wks: 10-20 ml/hr
40 wks: 25-50 ml/hr

43
Q

What is the max osmality of urine for preterm infants? Term infants? Adults?When does it reach adult value?

A

Preterm - 500 mOsm/L
Term - 800 mOsm/L
Adult - 1200 mOsm/L (by 6-12m)

44
Q

Why is preterm infants urine concentrating ability decreased?

A
  1. Tubule insensitivity to vasopressin
  2. Short loop of Henle
  3. Low osmolality of medullary interstitium (due to limited Na reabsorption in thick asc loop)
  4. Low serum urea
45
Q

What limits the dilutional aspect of neonate urine?

A

GFR. Low GFR limits dilutional ability (cant handle large free water load)

46
Q

How does renal blood flow change during gestation?

A

Increases due to increased systemic BP and decreasing renal vascular resistance
25 weeks - 2-3% cardiac output (20 ml/min)
Term - 5-18% cardiac output (60 ml/min)

47
Q

When does GFR reach adult levels?

A

1 year (although doubles 2 weeks after birth)

48
Q

How to calculate FENa?

A

FENa=(Urine Na x plasma Cr)/ (Urine cr x plasma Na) * 100

49
Q

What is normal FENa? Pre renal? Intrisic renal failure?

A

Normal <1%
Pre renal 1-2.5%
Intrinsic >3%

50
Q

At what GA should FENa be normal?

A

34 weeks

51
Q

Where is most protein, Na and Ph reabsorbed?

A

Proximal tubule (2/3 Na, 80% Ph)

52
Q

What is impact of angiotensin II?

A

Acts to stimulate ADH and Aldosterone
Decrease renal perfusion, inc Na and Water reabsorption
Made from angiotensin I from lung endthelium (via ACE)

53
Q

What makes angiotensin I?

A

Renin (from juxtaglomerular cells in response to hypovolemia) acts on liver to convert angiotensinogen to angiotensin I

54
Q

What does aldosterone do?

A

Acts on kidney
Increases Na reabsorption (and Cl passively)
Secretes H and K

55
Q

What is pseudohypoaldosteronism?

A

X linked recessive
Unresponsive to aldosterone, poly in utero
High renin and aldosterone levels
Pee too much, lose Na and Cl
Treat with NaCl, sometimes indomethacin to dec UOP

56
Q

How to calculate estimated GFR?

A 
Est GFR (ml/min): 0.45 x height (cm)/ plasma Cr (mg/dL)
** preterm use 0.33 (not 0.45)
57
Q

Is proteinuria normal in newborns?

A

Yes, 75% have 5-10 mg/dL. If persistent it is abnormal

58
Q

Is hematuria normal?

A

No, always requires eval

59
Q

Which kidney is more commonly abnormal?

A

Left (more common renal agenesis and pelvic kidney)

60
Q

What is inheritance and signs of congenital nephrotic syndrome?

A 
Autosomal recessive
Type 1 (Finnish): large placenta, high AFP. Sx by 1 month, diagnosed 3 months. SGA.
Type 2 (Diffuse mesangial sclerosis): normal placenta, AFP, weight. Onset 1 year with rapid renal insufficiency and HTN
61
Q

What are signs of ARPKD?

A 
Small “snowstorm” cysts, infantile presentation
Chr 6p21 (1/40000), less common than ADPKD
62
Q

What are signs of ADPKD?

A

Usually in adulthood
Ch 16
Usually no sx at birth, but if they do 50% will die
Variable size cysts

63
Q

What is Fanconi syndrome?

A

Rare, autosomal dominant
Proximal tubule dysfunction (lose Ph, glucose, amino acids, bicarb)
Normal glomerular function

64
Q

What is cystinosis?

A

Autosomal recessive
High cystine levels in lysosome, normal plasma cystine (defect in carrier mediated transport)
Cystine crystals in cornea by slit lamp

65
Q

What is Lowe syndrome? (Aka Oculocerebrorenal syndrome)

A

X linked recessive
Prob w Golgi apparatus (defective polarized epithelial cells)
Cataracts, glaucoma. Severe dev delay. Tubular dysfunction.
Dx: high AFP, high nucleotide pyro-phosphatase in skin fibroblasts

66
Q

What is most common cause of hydronephrosis?

A

UPJ obstruction

67
Q

What genetic syndrome is horseshoe kidney associated with?

A

Turners

68
Q

How common are kidney stones in preemies?

A

Common, 25-60% in those <32 weeks GA
Most due to loop diuretic
Usually resolve over first year of life

69
Q

What are sx of B12 deficiency?

A

Megaloblastic macrocytic anemia with hypersegmented neutrophils
Poor weight gain, anemia

70
Q

What are sx of vitamin E deficiency?

A

Spur cells, high plts.
Anemia, neurologic deficits
Increased sensitivity of RBCs to hydrogen peroxide and hemolysis
*vit A is an anti oxidant

71
Q

Vit A deficiency

A

Generalized scaling
FTT
Photophobia and conjunctivitis
Abnormal

72
Q

Vit B1 deficiency (thiamine)

A

Beriberi (fatigue, irritability, constipation, cardiac failure)
Associated with maple syrup urine disease

73
Q

Vitamib B2 deficiency (riboflavin)

A

Blurred vision, photophobia, dermatitis, mucositis

Associated w glutaric aciduria type 1

74
Q

Vitamin B6 (pyridoxine) deficiency

A

Dermatitis, mucositis
Hypochtomic anemia, possible seizures
Associated w homocystinuria

75
Q

Biotin deficiency

A

Hair loss, dermatitis, scaling, seborrhea

Assoc with biotinidase deficiency, proprionic acidemia

76
Q

Vitamin C (ascorbic acid) deficiency

A

Poor wound healing, bleeding gums

Assoc with transient tyrosinemia

77
Q

Vitamin D deficiency

A

Rickets

Possible tetany

78
Q

Copper deficiency

A 
Anema (important for production of hemoglobin and RBCs)
Osteoporosis
Loss of pigment hair and skin
Neutropenia
Poor wt gain
Hypotonia with ataxia later in life
79
Q

What is effect of Selenium deficiency?

A

Cardiomyopathy

80
Q

What are sx of zinc deficiency?

A 
Acrodermatitis enteropathica
1. FTT
2. Alopecia
3. Diarrhea
Also with perianal dermatitis, rash, nail dysplasia
81
Q

How much glucose should you give for every gram of protein to maintain positive nitrogen balance?

A

6g glucose for every 1g protein

82
Q

What should you decrease in TPN if cholestasis present?

A

Manganese and Copper

83
Q

What usually causes high TGs in premature infants?

A

Decreased lipoprotein lipase activity due to trauma or infection

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