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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
What compartment is early weight loss in newborns?
ECF primarily
26
How to correct free H2O deficit?
4ml/kg water for every 1 meq/L increase in Na above 145. If >170, give 3 ml/kg free water
27
What proportion of evaporative water loss is from skin? Respiratory tract?
Skin: 2/3 | Resp tract: 1/3
28
What is the main hormonal determinant of water excretion in kidney? Where is it made? Secreted? Act?
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
29
What are sx of SIADH? How to rx?
Water retention, hyponatremia. Urine osmolality is inappropriately high. Low UOP. Rx: water restriction, if Na <120, replace with NaCl. Consider furosemide.
30
What are sx and rx for nephrogenic DI?
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
31
What is the main difference in electrolyte composition between stomach and small intestine/bile?
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
32
How to calculate plasma osmolality?
Plasma osm= 2 (Plasma Na) + glucose/18 + BUN/2.8
33
How to calculate Na deficit?
Na deficit = (Na desired - Na current) x 0.6 x weight (kg) | *premie has higher tbw, use 0.8 instead
34
What are signs of hypokalemia on EKG?
U wave (small wave right after t wave), ventricular arrhythmia, depressed ST segment, AV conduction defect
35
Where does most of bicarbonate reabsorption occur?
60-80% bicarb reabsorotion occurs in proximal tubule
36
What is the pathophysiology of Type I RTA? Prognosis? Rx?
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
What is the pathophysiology of type II RTA? Sx? Rx?
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
What is the cause and sx of Bartter syndrome? Rx?
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
What is pathophys of type IV RTA? Sx? Rx?
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
When does the number of nephrons finish?
34-35 weeks (after that the size increases)
41
What impact does growth restriction have on nephron number?
Decreases nephron number
42
When does urine production begin? What is urine flow rate ar 22, 30, 40 weeks?
10-12 weeks GA 22 wks: 2-5 ml/hr 30 wks: 10-20 ml/hr 40 wks: 25-50 ml/hr
43
What is the max osmality of urine for preterm infants? Term infants? Adults?When does it reach adult value?
Preterm - 500 mOsm/L Term - 800 mOsm/L Adult - 1200 mOsm/L (by 6-12m)
44
Why is preterm infants urine concentrating ability decreased?
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
What limits the dilutional aspect of neonate urine?
GFR. Low GFR limits dilutional ability (cant handle large free water load)
46
How does renal blood flow change during gestation?
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
When does GFR reach adult levels?
1 year (although doubles 2 weeks after birth)
48
How to calculate FENa?
FENa=(Urine Na x plasma Cr)/ (Urine cr x plasma Na) * 100
49
What is normal FENa? Pre renal? Intrisic renal failure?
Normal <1% Pre renal 1-2.5% Intrinsic >3%
50
At what GA should FENa be normal?
34 weeks
51
Where is most protein, Na and Ph reabsorbed?
Proximal tubule (2/3 Na, 80% Ph)
52
What is impact of angiotensin II?
Acts to stimulate ADH and Aldosterone Decrease renal perfusion, inc Na and Water reabsorption Made from angiotensin I from lung endthelium (via ACE)
53
What makes angiotensin I?
Renin (from juxtaglomerular cells in response to hypovolemia) acts on liver to convert angiotensinogen to angiotensin I
54
What does aldosterone do?
Acts on kidney Increases Na reabsorption (and Cl passively) Secretes H and K
55
What is pseudohypoaldosteronism?
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
How to calculate estimated GFR?
``` Est GFR (ml/min): 0.45 x height (cm)/ plasma Cr (mg/dL) ** preterm use 0.33 (not 0.45) ```
57
Is proteinuria normal in newborns?
Yes, 75% have 5-10 mg/dL. If persistent it is abnormal
58
Is hematuria normal?
No, always requires eval
59
Which kidney is more commonly abnormal?
Left (more common renal agenesis and pelvic kidney)
60
What is inheritance and signs of congenital nephrotic syndrome?
``` 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
What are signs of ARPKD?
``` Small “snowstorm” cysts, infantile presentation Chr 6p21 (1/40000), less common than ADPKD ```
62
What are signs of ADPKD?
Usually in adulthood Ch 16 Usually no sx at birth, but if they do 50% will die Variable size cysts
63
What is Fanconi syndrome?
Rare, autosomal dominant Proximal tubule dysfunction (lose Ph, glucose, amino acids, bicarb) Normal glomerular function
64
What is cystinosis?
Autosomal recessive High cystine levels in lysosome, normal plasma cystine (defect in carrier mediated transport) Cystine crystals in cornea by slit lamp
65
What is Lowe syndrome? (Aka Oculocerebrorenal syndrome)
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
What is most common cause of hydronephrosis?
UPJ obstruction
67
What genetic syndrome is horseshoe kidney associated with?
Turners
68
How common are kidney stones in preemies?
Common, 25-60% in those <32 weeks GA Most due to loop diuretic Usually resolve over first year of life
69
What are sx of B12 deficiency?
Megaloblastic macrocytic anemia with hypersegmented neutrophils Poor weight gain, anemia
70
What are sx of vitamin E deficiency?
Spur cells, high plts. Anemia, neurologic deficits Increased sensitivity of RBCs to hydrogen peroxide and hemolysis *vit A is an anti oxidant
71
Vit A deficiency
Generalized scaling FTT Photophobia and conjunctivitis Abnormal
72
Vit B1 deficiency (thiamine)
Beriberi (fatigue, irritability, constipation, cardiac failure) Associated with maple syrup urine disease
73
Vitamib B2 deficiency (riboflavin)
Blurred vision, photophobia, dermatitis, mucositis | Associated w glutaric aciduria type 1
74
Vitamin B6 (pyridoxine) deficiency
Dermatitis, mucositis Hypochtomic anemia, possible seizures Associated w homocystinuria
75
Biotin deficiency
Hair loss, dermatitis, scaling, seborrhea | Assoc with biotinidase deficiency, proprionic acidemia
76
Vitamin C (ascorbic acid) deficiency
Poor wound healing, bleeding gums | Assoc with transient tyrosinemia
77
Vitamin D deficiency
Rickets | Possible tetany
78
Copper deficiency
``` 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
What is effect of Selenium deficiency?
Cardiomyopathy
80
What are sx of zinc deficiency?
``` Acrodermatitis enteropathica 1. FTT 2. Alopecia 3. Diarrhea Also with perianal dermatitis, rash, nail dysplasia ```
81
How much glucose should you give for every gram of protein to maintain positive nitrogen balance?
6g glucose for every 1g protein
82
What should you decrease in TPN if cholestasis present?
Manganese and Copper
83
What usually causes high TGs in premature infants?
Decreased lipoprotein lipase activity due to trauma or infection

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