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US Pediatric Boards Edited > nutrition/fluids > Flashcards

nutrition/fluids Flashcards

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1
Q

What is the other name for vitamin E?

A

Tocopherol

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2
Q

What is the other name for vitamin K?

A

Phylloquinone

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3
Q

What is the other name for vitamin b1?

A

Thiamine

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4
Q

What is the other name for vitamin B2?

A

Riboflavin

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5
Q

What is the other name for vitamin B3?

A

Niacin

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6
Q

What is pantothenic acid?

A

Vitamin B5

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7
Q

What is pyridoxine ?

A

Vitamin B6

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8
Q

What is the vitamin name for folate?

A

Vitamin B9

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9
Q

What is another name for vitamin B12?

A

Cyanocobalamin

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10
Q

What is the formal name for vitamin C?

A

Ascorbic acid

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11
Q

What can intoxication of vitamin A cause?

A

Pseudo tumor cerebri

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12
Q

What is the most common cause of blindness in young children worldwide?

A

Vitamin A deficiency

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13
Q

What can retinol deficiency cause?

A

Xerophthalmia (dry eyes)
Nyctalopia (night blindness)
Complete blindness

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14
Q

What is the cause of beri beri?

A

B1 deficiency

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15
Q

What are the symptoms of beri beri?

A 
Mental confusion
Peripheral paralysis
Muscle weakness
Tachycardia 
Cardiomegaly
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16
Q

Who is at risk for riboflavin deficiency?

A

Premies on phototherapy

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17
Q

What are the 3 typically symptoms of vitamin B2 deficiency?

A

Anemia, angular stomatitis, seborrheic dermatitis

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18
Q

What can occur with niacin toxicity?

A

Vasodilation

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19
Q

What are the symptoms of vitamin B3 deficiency?

A

Dermatitis, diarrhea and dementia = pellagra

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20
Q

What symptom is associated with vitamin b6 toxicity?

A

Neuropathy

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21
Q

What are symptoms of vitamins b6 deficiency?

A

Swelling if tongue and rash

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22
Q

What are symptoms of vitamin b9 deficiency?

A

Larger tongue and macrocytic anemia

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23
Q

What is one symptom of vitamin B9 toxicity?

A

Irritability

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24
Q

What are symptoms of vitamin b12 deficiency ?

A

Macrocytic anemia

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25
Q

What symptoms occur with vitamin c deficiency?

A

Leg tenderness
Poor wound healing
Bleeding gums

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26
Q

What type of crisis can be triggered by calcium toxicity?

A

Hemolytic crisis in a patient with G6PD deficiency

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27
Q

What are symptoms of vitamin E deficiency in premies?

A

Hemolytic anemia

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28
Q

What are symptoms of vitamin E deficiency?

A

Neuropathy
Muscle weakness
Peripheral edema
Thromocytosis

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29
Q

What are the vitamin K dependent factors?

A

2,7,9 and 10

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30
Q

What increases risk of hemorrhagic disease in a newborn?

A

Vitamin k not given

Breast feeding

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31
Q

What treatment is appropriate in a patient with hemorrhagic disease of the newborn if bleeding actively?

A

Vitamin K + FFP

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32
Q

What is the physiological effect of vitamin D toxicity?

A

Mobilization of calcium and phosphorus from bones and deposition into soft tissue

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33
Q

How is vitamin d toxicity managed?

A

Hydration
Corrections of Na and K depletion
LASIX

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34
Q

What metabolic disturbances occur Due to excessive vitamin D?

A

Hypercalcemia

Hyperphosphatemia

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35
Q

What are some symptoms of vitamin D toxicity?

A 
Polyuria
Poly displays
Elevated BUN
Kidney stones
Renal failure
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36
Q

What is the other name for ergocalciferol?

A

Vitamin D2

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37
Q

What is the other name for cholecalciferol ?

A

Vitamin D3

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38
Q

What is the other name for activated calcitriol?

A

1,25 hydroxycalciferol

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39
Q

What are the lab findings used to diagnose rickets?

A

Low 25OH vitamin D
High PTH
Alkaline phosphatase elevated
Calcium and phosphorus may be normal

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40
Q

What are the findings in the physical exam of the head in a patient with rickets?

A

Craniotabes (delayed fontanel closure, skull thickening, frontal bossing, poor tooth enamel)

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41
Q

What occurs in the extremities secondary to rickets?

A

Wide physes of wrists and ankles

Femoral / tibial bowing

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42
Q

What occurs on the trunk in patients with rickets?

A

Pigeon chest, rachitic rosary

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43
Q

Other than lack of adequate sunlight, what could cause rickets?

A

Chronic liver disease causes decreased vitamin D absorption due to low bile salts

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44
Q

What is caused from zinc deficiency?

A

Acrodermatitis enteropathica

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45
Q

What is caused by copper deficiency?

A

Menkes kinky hair

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46
Q

Where is 25-OH vitamin D hydroxylated?

A

Liver

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47
Q

Where is 1,25 OH vitamin D hydroxylated?

A

Kidneys

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48
Q

How many kcal are required for a preterm and full term infant per day?

A

Both require 100-120kcal/kg/day

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49
Q

What is the appropriate protein requirement for a premature infant and term infant ?

A

3,5 g/kg per day (preterm)

2.5 g/kg per day (term)

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50
Q

What are 4 important components of renal solute load?

A

Sodium, potassium, chloride and phosphorus

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51
Q

What is an essential fatty acid?

A

Linoleic acid

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52
Q

What is the recommended concentration of iron in iron fortified formula?

A

12mg/L

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53
Q

When should iron supplementation occur?

A

4-6 months old

Also before 6 months in high risk (LBW, preterm)

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54
Q

What should you do for a child on iron supplements who develops constipation?

A

Add fruit juice to increase osmotic load - iron does NOT cause constipation

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55
Q

What is the definition of milk protein allergy?

A

IgE mediated response that can cause rash, vomiting and irritability

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56
Q

What is milk intolerance?

A

Non igE mediated response to milk to can cause rash or vomiting

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57
Q

What is the difference between lactose intolerance and milk protein allergy?

A

Lactose intolerance does not cause rash or vomiting

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58
Q

What is Fpies?

A

Food protein induced enterocolitis syndrome / non igE mediated protein intolerance

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59
Q

How does FPIES present?

A

Within first 3 months with heme positive stools

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60
Q

What is the treatment for FPIES?

A

Switch to protein hydrosylate formula or eliminate milk protein from mothers diet

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61
Q

What symptoms may be seen with deficiency of essential fatty acids?

A

Scaly dermatitis, alopecia and thrombocytopenia

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62
Q

How do you treat fatty acid deficiency?

A

IV lipids

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63
Q

What should you consider in an infant recently weaned from breast milk with facial dermatitis and thin hair?

A

Zinc deficiency

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64
Q

What might be the diagnosis in an infant with dry skin, poor wound healing perioral rash?

A

Zinc deficiency

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65
Q

How do newborns absorb fat?

A

They have decreased bile acids and can not absorb long chain triglycerides

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66
Q

In terms of total triglycerides, what is the difference between premie formula and breast milk?

A

Premie formula has 50% medium chain triglycerides and breast milk has 12% plus high linolenic acid

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67
Q

How does TPN affect bone demineralization ? What labs would be abnormal?

A

Inadequate phosphorus due to prolonged TPN >1 month (May have normal calcium and phosphorus levels but high alkaline phosphatase)

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68
Q

What is higher in colostrum than in mature breast milk?

A 
Arachidonic acid
DHA
Zinc
Protein ( immunoglobulins )
Enzymes to increase digestion 
Carotene
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69
Q

Which type of breast milk is highest in fat?

A

Hind milk ( end of feeding )

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70
Q

What essential vitamin is low in colostrum? Why is this important ?

A

Ergocalciferol ( increases risk for rickets)

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71
Q

What can happen to an infant placed on cows milk prior to age one? Why?

A

Hypocalcemia - cows milk has significantly high phosphorus which leads to low calcium

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72
Q

What 6 drugs are contraindications to breast feeding?

A 
Metronidazole
Diazepam
Thyroid meds
Chemotherapy
Sulfonamides
Tetracycline
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73
Q

What 4 medical conditions would be contraindicated for breast feeding?

A

Tb
Cmv
HIV
Errors of metabolism (in baby)

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74
Q

What are 4 conditions that ARE NOT contraindications to breast feeding?

A

Mastitis
Candidiasis
Contact dermatitis
Fibrocystic breast disease

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75
Q

What is the whey to casein ratio in breast vs cows milk?

A

Breast: 70% whey, 30% casein

Cows milk: 20% whey, 80% casein

76
Q

What is the difference between iron I’m breast milk vs formula?

A

Breast milk is lower in iron but has higher absorption

77
Q

What is the difference between protein concentration in breast milk vs formula ?

A
  1. 9 g in breast milk
  2. 5 g in cows milk formula
  3. 4 g in modified formula
78
Q

What is so special about the whey protein in breast milk?

A

It has alpha lactalbumin, lactoferrin, lysozyme and IgA

79
Q

Are vitamins and minerals higher or lower in breast milk when compared to formula?

A

Minerals

80
Q

What is the difference in renal solute load in breast milk vs cows formula?

A

Lower renal solute load in breast milk

81
Q

How many calories are in one ounce of formula? And how many mL of formula are in one ounce?

A

20kcal per oz

30 ml per oz

82
Q

What can happen if you mix too much powder formula with a given amount of water ?

A

Increased protein stresses the kidneys

83
Q

What is the max caloric content of formula?

A

30kcal/oz

84
Q

What may happen if you add a lipid supplement to formula?

A

Diarrhea or delayed gastric emptying

85
Q

Why are non-protein calories important in very low birth weight infants?

A

To avoid negative nitrogen balance from high proteins

86
Q

What is the average daily weight gain for a full term newborn?

A

20-30grams per day

87
Q

What is the average daily weight of a premie?

A

15-20 grams per day

88
Q

What is the term “overweight “ defined as?

A

BMI between 85-95th %

89
Q

What are the chances that an obese 6 year old will be obese as an adult?

A

25% chance

90
Q

What is the difference between an obese child secondary to overeating vs a hormonal reason?

A

If overeating, will usually be tall with advanced bone age

If hormonal problem, will usually be short with delayed bone age

91
Q

What syndromes should you consider in a child who is obese with small hands, hypogonadism and delayed development?

A

Prader Willi or Bardet Biedel

92
Q

What can occur in a child who drinks many diet sodas?

A

High risk for osteopenia due to high phosphoric acid

93
Q

What should you beware of in a child taking goats milk?

A

Folate deficiency

94
Q

What should breast feeding mothers who are vegan taken as a supplement?

A

Vitamin B12

95
Q

What is the term for protein deficiency?

A

Kwashiorkor

96
Q

What are physical signs of protein deficiency?

A

Pitting edema, rash, thin hair, pallor

97
Q

What term describes general nutritional deficiency?

A

Marasmus

98
Q

What are physical signs of marasmus?

A

Muscle wasting but no edema

Normal hair

99
Q

What is the most common cause of NG feeds?

A

Diarrhea

100
Q

What is the most severe complication of NG feeding?

A

vomiting and aspiration

101
Q

How do you supply adequate nutrition in a child with heart failure ?

A

High caloric density while restricting fluids ( increase formula concentration)

102
Q

How do you manage nutrition in a child with renal disease?

A

70% of calories should be carbohydrates. Lipids <20% and protein <2g/kg/day, with low phosphorus

103
Q

How should you manage a child who presents with vomiting and diarrhea with mild dehydration ?

A

Oral rehydration and regular diet

104
Q

Calculation for serum osmolality…

A

2 x Na + BUN/2.8 + glucose/18

105
Q

What is the formula to correct acid bicarb for metabolic acidosis?

A

Weight x 0.3 x base deficit

106
Q

How can you determine metabolic acidosis vs alkalosis from looking the bicarb ?

A

Bicarb > 25 = alkalosis

Bicarb < 25 = acidosis

107
Q

How can you determine respiratory alkalosis vs acidosis by looking at the abg ?

A

PCO2 > 40 = resp acidosis

PCO2 < 40 = resp alkalosis

108
Q

What medications can cause metabolic alkalosis?

A

Loop and thiazides diuretic s

109
Q

How does the body compensate for metabolic alkalosis?

A

Hypoventilation

110
Q

What ph and co2 levels do u expect to see in a patient with incomplete compensation for metabolic acidosis?

A

Low ph and low co2

111
Q

What steps should you take to initially treat metabolic acidosis?

A

Adequate ventilation
Isotonic fluids
Sodium bicarb if severe (ph<7.1)

112
Q

How does pyloric stenosis cause acid base imbalance?

A

Vomiting leads to low hydrogen and chloride –> bicarb reabsorption and metabolic alkalosis

113
Q

What acid base inbalance occurs with hypoxia?

A

Hyperventilation leads to low co2 and alkalosis –> kidneys excrete bicarb to compensate

114
Q

What diuretics can cause metabolic acidosis?

A

Acetal planned and spironolactone

115
Q

What is the most common cause of non-gap metabolic acidosis in children ?

A

Diarrhea

116
Q

What are three main causes on acidosis of normal anion gap?

A

Loss of bicarb (diarrhea, kidney dysfunction)
Addition of hydrochloric acid
Renal tubular dysfunction

117
Q

What is the pathophysiology of distal tubular acidosis?

A

Inability of distal tubule to excrete H+ and acidify the urine –> ph >5.5

118
Q

What can mimick RTA type 1?

A

Potassium sparing drugs (spironolactone)

119
Q

What can mimick RTA type 2?

A

Carbonic anhydrase inhibitors like acetazolamide

120
Q

What is the pathophysiology of Proximal RTA?

A

Inability of proximal tubule to absorb bicarb which leaves high bicarb in urine

121
Q

Where does reabsorption of bicarb occur?

A

Proximal tubule

122
Q

Between RTA type 1 and 2, which is distal and which is proximal?

A

Type 1 = distal

Type 2 = proximal

123
Q

Where does secretion of hydrogen occur in the kidneys?

A

Collecting duct

124
Q

What causes type 4 RTA?

A

Aldosterone resistance (deficiency) causing hyperkalemia

125
Q

What are the conditions associated with elevated anion gap metabolic acidosis ?

A

MUDPILES = methanol, uremia, dka, paraldehyde, iron/INH, lactic acid, ethanol/ethylene glycol and salicylates

126
Q

What should you consider in an infant who appears healthy at birth but later develops poor feeding, lethargy and seizures?

A

Inborn error of metabolism - organic acidemia

127
Q

What condition causes high ammonia but no metabolic acidosis?

A

Urea cycle defects

128
Q

What occurs With volume on a cellular level when there is hypernatremia?

A

If high sodium, water is dawn out of intracellular compartment into the extra cellular space causing increased volume

129
Q

In a child with diabetes insipidus, what is the serum and urine osmolality?

A

High serum osmolality but dilute urine

130
Q

How is nephrogenic diabetes insipidus transmitted?

A

X linked - only in males

131
Q

What is the best study to order in order to determine which type of hyponatremia a patient has?

A

Fractional excretion of sodium

132
Q

With diabetes insipidus, do you get high or low sodium?

A

High sodium

133
Q

What may occur to sodium if there is excessive GI losses?

A

Hyponatremia–> Kidneys retain sodium –> low urine sodium (<10)

134
Q

What is the cause of hyponatremia secondary too increased water retention ?

A

SIADH

135
Q

What will the urine in a child with siadh be like?

A

High osmolality (>300) and high sodium (>25)

136
Q

What is the first treatment of siadh?

A

Fluid restriction

137
Q

What are the serum sodium and potassium levels in a child with siadh?

A

Low Na, normal K

138
Q

What are the 5 main causes of SIADH?

A 
Surgery
Infection
Pulmonary disorder
Endocrine disorder
Neurological disorder
139
Q

What are two potential medications for SIADH?

A

Demeclocycline (only if >8y/o)
Lithium
A

140
Q

What is the initial step in a hemodynamically unstable child with low urine output?

A

Isotonic fluid bolus 20/kg

141
Q

What medication can cause siadh ?

A

Vincristine

142
Q

How do diuretics affect sodium?

A

Thiazides and metolazone both block renal sodium reabsorption causing hyponatremia

143
Q

What is dilutional hyponatremia? What lab findings are common?

A

Water intoxication
Sodium is NORMAL
Urine Na is high

144
Q

How does third spacing occur after extensive surgery?

A

Endothelial damage / leakage

Hypoalbuminemia and low oncotic pressure

145
Q

What happens to sodium levels with third spacing?

A

Low urine sodium (<10)
Edema
Hyponatremia

146
Q

What is the measures and total body sodium in conditions with edema due to low oncotic pressure (ie. nephrotic syndrome)?

A

Measured sodium is low BUT total body sodium is actually high

147
Q

What are some classic symptoms of hypokalemia?

A

Muscle pain, weakness, paralysis

Constipation, ileus, polyuria

148
Q

What are the 3 main causes of hypokalemia?

A

Poor intake
Gi losses
Renal losses

149
Q

If a child comes to your office with 3 days of vomiting and is weak, what should you consider?

A

Hypokalemia

150
Q

What are 4 possible EKG findings secondary to hypokalemia ?

A

Flattened T waves
ST depression
PVC
U wave

151
Q

How do you treat hypokalemia in an emergency situation?

A

KCl 1 mEq/L over an hr (max 40)

152
Q

If mild hypokalemia and dehydration, what is the appropriate management?

A

Fluid replacement with added K

153
Q

If hypokalemia in a child with acidosis, what should you treat with?

A

Potassium acetate

154
Q

What electrolyte abnormality causes prolonged QT interval?

A

Hypocalcemia and hypomagnesemia

155
Q

What are 4 main causes of hyperkalemia?

A

Excess intake
Renal failure
Acidosis (redistribution)
Cell breakdown

156
Q

What is the common EKG finding with hyperkalemia?

A

Peaked T waves

If K>10…absent p waves, wide QRS

157
Q

What should you consider in a patient with wide QRS with muffled heart sounds or absence of pulses?

A

Hyperkalemia (severe)

158
Q

How do you treat severe hyperkalemia in a patient showing signs of electromagnetic dissociation (distant heart sounds, non palpable pulses)?

A

Immediate IV calcium chloride

159
Q

What 5 options can you use to treat mild hyperkalemia?

A 
Glucose + insulin
Sodium bicarb
Albuterol
LASIx
Oral polystyrene resin
160
Q

What happens to potassium during alkalosis?

A

H+ moves extracellular to compensate but then K+ moves into the cell causing low serum K

161
Q

What happens to potassium levels during acidosis?

A

H+ moves into the cell and K+ moves into extra cellular fluid causing high measured K

162
Q

What two lab findings would you find in a patient using loop diuretics?

A

Hypokalemia

Alkalosis

163
Q

What is the equation for FeNa?

A

Urine Na / serum Na
Divided by
Urine creatinine / plasma creatinine

164
Q

What is a low FeNa value and what does it indicate?

A

<1.5

Pre renal azotemia

165
Q

When is hypertonic 3% saline indicated ?

A

In severe hyponatremia, after normal saline given with no improvement

166
Q

What could be the diagnosis in a patient with dehydration that was rehydrated with water?

A

Hyponatremia dehydration (sodium <135)

167
Q

What type of electrolyte disturbance can lead to cerebral pontine Damage?

A

Hyponatremia

168
Q

Which type of electrolyte disturbance leads to tearing of bridging blood vessels and intracranial hemorrhage?

A

Hypernatremia which causes fluid shift to the extra cellular space and shrinkage of brain cell

169
Q

What is the treatment for hypernatremia >170?

A

Assume 10% dehydration and slowly correct sodium over 48-72 hours at a rate of 0.5mEq/L/hr

170
Q

What clinical findings would be seen in a patient with hypernatremic dehydration?

A

Doughy skin, irritable, high pitched cry, seizures

171
Q

What is the equation for replacing low sodium?

A

Desired minus measured sodium x kg x 0.6 plus maintenance (3meq/kg/d)

172
Q

What are the signs associated with 5% dehydration?

A

Tachycardia
Decreased tears
Decreased urine output

173
Q

How do you correct 5% dehydration?

A

50ml/kg + maintenance

Give half over 8 hours and remainder over 16 hours

174
Q

What are signs of 10% dehydration?

A

Tachycardia
Sunken eyes
Poor skin turgor
Sunken fontanelle

175
Q

How do you treat 10% dehydration?

A

NS bolus then

100cc/kg + maintenance over 24 hours

176
Q

What is the max you can decrease the sodium level in a 24 hr period? Why?

A

10-12

To avoid cerebral swelling

177
Q

What are signs of 15% dehydration?

A

Shock and delayed cap refill

178
Q

What is the treatment of 15% dehydration?

A 
NS bolus (repeat until improvement)
Over 24 hours give maintenance plus 150ml/kg
179
Q

When is oral rehydration fluid used? What does this have and how should it be given?

A

If moderate to severe dehydration
75 mEq/L of sodium
Give 50 ml/kg over 1-4 hours

180
Q

What is the classic electrolyte disturbance in pyloric stenosis ?

A

Hypochloremic hypokalemic metabolic alkalosis

181
Q

What happens to the urine electrolytes with pyloric stenosis?

A

Kidneys retain chloride causing urine chloride <10

182
Q

What is the common electrolyte disturbance associated with cystic fibrosis?

A

Hypochloremic hyponatremic metabolic alkalosis and dehydration

183
Q

What is important to remember about post-op fluid management ?

A

Increased risk for increased ADH secretion and over hydration

184
Q

What is similar and different between SIADH and hyponatremic dehydration?

A

Both have low sodium and chloride but dehydration gives high BUN

185
Q

What’s the difference and similarity between diabetes insipidus and hypernatremic dehydration?

A

Both have high sodium and chloride and BUN.

Hypernatremic dehydration have high specific gravity but diabetes insipidus has low specific gravity

186
Q

What do you do if lab findings show low sodium <120 and normal chloride ?

A

Repeat lab (lab error)

187
Q

What is another name for vitamin A?

A

retinol

US Pediatric Boards Edited (23 decks)

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