nutrition/fluids Flashcards
1
Q
What is the other name for vitamin E?
A
Tocopherol
2
Q
What is the other name for vitamin K?
A
Phylloquinone
3
Q
What is the other name for vitamin b1?
A
Thiamine
4
Q
What is the other name for vitamin B2?
A
Riboflavin
5
Q
What is the other name for vitamin B3?
A
Niacin
6
Q
What is pantothenic acid?
A
Vitamin B5
7
Q
What is pyridoxine ?
A
Vitamin B6
8
Q
What is the vitamin name for folate?
A
Vitamin B9
9
Q
What is another name for vitamin B12?
A
Cyanocobalamin
10
Q
What is the formal name for vitamin C?
A
Ascorbic acid
11
Q
What can intoxication of vitamin A cause?
A
Pseudo tumor cerebri
12
Q
What is the most common cause of blindness in young children worldwide?
A
Vitamin A deficiency
13
Q
What can retinol deficiency cause?
A
Xerophthalmia (dry eyes)
Nyctalopia (night blindness)
Complete blindness
14
Q
What is the cause of beri beri?
A
B1 deficiency
15
Q
What are the symptoms of beri beri?
A
Mental confusion Peripheral paralysis Muscle weakness Tachycardia Cardiomegaly
16
Q
Who is at risk for riboflavin deficiency?
A
Premies on phototherapy
17
Q
What are the 3 typically symptoms of vitamin B2 deficiency?
A
Anemia, angular stomatitis, seborrheic dermatitis
18
Q
What can occur with niacin toxicity?
A
Vasodilation
19
Q
What are the symptoms of vitamin B3 deficiency?
A
Dermatitis, diarrhea and dementia = pellagra
20
Q
What symptom is associated with vitamin b6 toxicity?
A
Neuropathy
21
Q
What are symptoms of vitamins b6 deficiency?
A
Swelling if tongue and rash
22
Q
What are symptoms of vitamin b9 deficiency?
A
Larger tongue and macrocytic anemia
23
Q
What is one symptom of vitamin B9 toxicity?
A
Irritability
24
Q
What are symptoms of vitamin b12 deficiency ?
A
Macrocytic anemia
25
What symptoms occur with vitamin c deficiency?
Leg tenderness
Poor wound healing
Bleeding gums
26
What type of crisis can be triggered by calcium toxicity?
Hemolytic crisis in a patient with G6PD deficiency
27
What are symptoms of vitamin E deficiency in premies?
Hemolytic anemia
28
What are symptoms of vitamin E deficiency?
Neuropathy
Muscle weakness
Peripheral edema
Thromocytosis
29
What are the vitamin K dependent factors?
2,7,9 and 10
30
What increases risk of hemorrhagic disease in a newborn?
Vitamin k not given
| Breast feeding
31
What treatment is appropriate in a patient with hemorrhagic disease of the newborn if bleeding actively?
Vitamin K + FFP
32
What is the physiological effect of vitamin D toxicity?
Mobilization of calcium and phosphorus from bones and deposition into soft tissue
33
How is vitamin d toxicity managed?
Hydration
Corrections of Na and K depletion
LASIX
34
What metabolic disturbances occur Due to excessive vitamin D?
Hypercalcemia
| Hyperphosphatemia
35
What are some symptoms of vitamin D toxicity?
```
Polyuria
Poly displays
Elevated BUN
Kidney stones
Renal failure
```
36
What is the other name for ergocalciferol?
Vitamin D2
37
What is the other name for cholecalciferol ?
Vitamin D3
38
What is the other name for activated calcitriol?
1,25 hydroxycalciferol
39
What are the lab findings used to diagnose rickets?
Low 25OH vitamin D
High PTH
Alkaline phosphatase elevated
Calcium and phosphorus may be normal
40
What are the findings in the physical exam of the head in a patient with rickets?
Craniotabes (delayed fontanel closure, skull thickening, frontal bossing, poor tooth enamel)
41
What occurs in the extremities secondary to rickets?
Wide physes of wrists and ankles
| Femoral / tibial bowing
42
What occurs on the trunk in patients with rickets?
Pigeon chest, rachitic rosary
43
Other than lack of adequate sunlight, what could cause rickets?
Chronic liver disease causes decreased vitamin D absorption due to low bile salts
44
What is caused from zinc deficiency?
Acrodermatitis enteropathica
45
What is caused by copper deficiency?
Menkes kinky hair
46
Where is 25-OH vitamin D hydroxylated?
Liver
47
Where is 1,25 OH vitamin D hydroxylated?
Kidneys
48
How many kcal are required for a preterm and full term infant per day?
Both require 100-120kcal/kg/day
49
What is the appropriate protein requirement for a premature infant and term infant ?
3,5 g/kg per day (preterm)
| 2.5 g/kg per day (term)
50
What are 4 important components of renal solute load?
Sodium, potassium, chloride and phosphorus
51
What is an essential fatty acid?
Linoleic acid
52
What is the recommended concentration of iron in iron fortified formula?
12mg/L
53
When should iron supplementation occur?
4-6 months old
| Also before 6 months in high risk (LBW, preterm)
54
What should you do for a child on iron supplements who develops constipation?
Add fruit juice to increase osmotic load - iron does NOT cause constipation
55
What is the definition of milk protein allergy?
IgE mediated response that can cause rash, vomiting and irritability
56
What is milk intolerance?
Non igE mediated response to milk to can cause rash or vomiting
57
What is the difference between lactose intolerance and milk protein allergy?
Lactose intolerance does not cause rash or vomiting
58
What is Fpies?
Food protein induced enterocolitis syndrome / non igE mediated protein intolerance
59
How does FPIES present?
Within first 3 months with heme positive stools
60
What is the treatment for FPIES?
Switch to protein hydrosylate formula or eliminate milk protein from mothers diet
61
What symptoms may be seen with deficiency of essential fatty acids?
Scaly dermatitis, alopecia and thrombocytopenia
62
How do you treat fatty acid deficiency?
IV lipids
63
What should you consider in an infant recently weaned from breast milk with facial dermatitis and thin hair?
Zinc deficiency
64
What might be the diagnosis in an infant with dry skin, poor wound healing perioral rash?
Zinc deficiency
65
How do newborns absorb fat?
They have decreased bile acids and can not absorb long chain triglycerides
66
In terms of total triglycerides, what is the difference between premie formula and breast milk?
Premie formula has 50% medium chain triglycerides and breast milk has 12% plus high linolenic acid
67
How does TPN affect bone demineralization ? What labs would be abnormal?
Inadequate phosphorus due to prolonged TPN >1 month (May have normal calcium and phosphorus levels but high alkaline phosphatase)
68
What is higher in colostrum than in mature breast milk?
```
Arachidonic acid
DHA
Zinc
Protein ( immunoglobulins )
Enzymes to increase digestion
Carotene
```
69
Which type of breast milk is highest in fat?
Hind milk ( end of feeding )
70
What essential vitamin is low in colostrum? Why is this important ?
Ergocalciferol ( increases risk for rickets)
71
What can happen to an infant placed on cows milk prior to age one? Why?
Hypocalcemia - cows milk has significantly high phosphorus which leads to low calcium
72
What 6 drugs are contraindications to breast feeding?
```
Metronidazole
Diazepam
Thyroid meds
Chemotherapy
Sulfonamides
Tetracycline
```
73
What 4 medical conditions would be contraindicated for breast feeding?
Tb
Cmv
HIV
Errors of metabolism (in baby)
74
What are 4 conditions that ARE NOT contraindications to breast feeding?
Mastitis
Candidiasis
Contact dermatitis
Fibrocystic breast disease
75
What is the whey to casein ratio in breast vs cows milk?
Breast: 70% whey, 30% casein
| Cows milk: 20% whey, 80% casein
76
What is the difference between iron I'm breast milk vs formula?
Breast milk is lower in iron but has higher absorption
77
What is the difference between protein concentration in breast milk vs formula ?
0. 9 g in breast milk
3. 5 g in cows milk formula
1. 4 g in modified formula
78
What is so special about the whey protein in breast milk?
It has alpha lactalbumin, lactoferrin, lysozyme and IgA
79
Are vitamins and minerals higher or lower in breast milk when compared to formula?
Minerals
80
What is the difference in renal solute load in breast milk vs cows formula?
Lower renal solute load in breast milk
81
How many calories are in one ounce of formula? And how many mL of formula are in one ounce?
20kcal per oz
| 30 ml per oz
82
What can happen if you mix too much powder formula with a given amount of water ?
Increased protein stresses the kidneys
83
What is the max caloric content of formula?
30kcal/oz
84
What may happen if you add a lipid supplement to formula?
Diarrhea or delayed gastric emptying
85
Why are non-protein calories important in very low birth weight infants?
To avoid negative nitrogen balance from high proteins
86
What is the average daily weight gain for a full term newborn?
20-30grams per day
87
What is the average daily weight of a premie?
15-20 grams per day
88
What is the term "overweight " defined as?
BMI between 85-95th %
89
What are the chances that an obese 6 year old will be obese as an adult?
25% chance
90
What is the difference between an obese child secondary to overeating vs a hormonal reason?
If overeating, will usually be tall with advanced bone age
| If hormonal problem, will usually be short with delayed bone age
91
What syndromes should you consider in a child who is obese with small hands, hypogonadism and delayed development?
Prader Willi or Bardet Biedel
92
What can occur in a child who drinks many diet sodas?
High risk for osteopenia due to high phosphoric acid
93
What should you beware of in a child taking goats milk?
Folate deficiency
94
What should breast feeding mothers who are vegan taken as a supplement?
Vitamin B12
95
What is the term for protein deficiency?
Kwashiorkor
96
What are physical signs of protein deficiency?
Pitting edema, rash, thin hair, pallor
97
What term describes general nutritional deficiency?
Marasmus
98
What are physical signs of marasmus?
Muscle wasting but no edema
| Normal hair
99
What is the most common cause of NG feeds?
Diarrhea
100
What is the most severe complication of NG feeding?
vomiting and aspiration
101
How do you supply adequate nutrition in a child with heart failure ?
High caloric density while restricting fluids ( increase formula concentration)
102
How do you manage nutrition in a child with renal disease?
70% of calories should be carbohydrates. Lipids <20% and protein <2g/kg/day, with low phosphorus
103
How should you manage a child who presents with vomiting and diarrhea with mild dehydration ?
Oral rehydration and regular diet
104
Calculation for serum osmolality...
2 x Na + BUN/2.8 + glucose/18
105
What is the formula to correct acid bicarb for metabolic acidosis?
Weight x 0.3 x base deficit
106
How can you determine metabolic acidosis vs alkalosis from looking the bicarb ?
Bicarb > 25 = alkalosis
| Bicarb < 25 = acidosis
107
How can you determine respiratory alkalosis vs acidosis by looking at the abg ?
PCO2 > 40 = resp acidosis
| PCO2 < 40 = resp alkalosis
108
What medications can cause metabolic alkalosis?
Loop and thiazides diuretic s
109
How does the body compensate for metabolic alkalosis?
Hypoventilation
110
What ph and co2 levels do u expect to see in a patient with incomplete compensation for metabolic acidosis?
Low ph and low co2
111
What steps should you take to initially treat metabolic acidosis?
Adequate ventilation
Isotonic fluids
Sodium bicarb if severe (ph<7.1)
112
How does pyloric stenosis cause acid base imbalance?
Vomiting leads to low hydrogen and chloride --> bicarb reabsorption and metabolic alkalosis
113
What acid base inbalance occurs with hypoxia?
Hyperventilation leads to low co2 and alkalosis --> kidneys excrete bicarb to compensate
114
What diuretics can cause metabolic acidosis?
Acetal planned and spironolactone
115
What is the most common cause of non-gap metabolic acidosis in children ?
Diarrhea
116
What are three main causes on acidosis of normal anion gap?
Loss of bicarb (diarrhea, kidney dysfunction)
Addition of hydrochloric acid
Renal tubular dysfunction
117
What is the pathophysiology of distal tubular acidosis?
Inability of distal tubule to excrete H+ and acidify the urine --> ph >5.5
118
What can mimick RTA type 1?
Potassium sparing drugs (spironolactone)
119
What can mimick RTA type 2?
Carbonic anhydrase inhibitors like acetazolamide
120
What is the pathophysiology of Proximal RTA?
Inability of proximal tubule to absorb bicarb which leaves high bicarb in urine
121
Where does reabsorption of bicarb occur?
Proximal tubule
122
Between RTA type 1 and 2, which is distal and which is proximal?
Type 1 = distal
| Type 2 = proximal
123
Where does secretion of hydrogen occur in the kidneys?
Collecting duct
124
What causes type 4 RTA?
Aldosterone resistance (deficiency) causing hyperkalemia
125
What are the conditions associated with elevated anion gap metabolic acidosis ?
MUDPILES = methanol, uremia, dka, paraldehyde, iron/INH, lactic acid, ethanol/ethylene glycol and salicylates
126
What should you consider in an infant who appears healthy at birth but later develops poor feeding, lethargy and seizures?
Inborn error of metabolism - organic acidemia
127
What condition causes high ammonia but no metabolic acidosis?
Urea cycle defects
128
What occurs With volume on a cellular level when there is hypernatremia?
If high sodium, water is dawn out of intracellular compartment into the extra cellular space causing increased volume
129
In a child with diabetes insipidus, what is the serum and urine osmolality?
High serum osmolality but dilute urine
130
How is nephrogenic diabetes insipidus transmitted?
X linked - only in males
131
What is the best study to order in order to determine which type of hyponatremia a patient has?
Fractional excretion of sodium
132
With diabetes insipidus, do you get high or low sodium?
High sodium
133
What may occur to sodium if there is excessive GI losses?
Hyponatremia--> Kidneys retain sodium --> low urine sodium (<10)
134
What is the cause of hyponatremia secondary too increased water retention ?
SIADH
135
What will the urine in a child with siadh be like?
High osmolality (>300) and high sodium (>25)
136
What is the first treatment of siadh?
Fluid restriction
137
What are the serum sodium and potassium levels in a child with siadh?
Low Na, normal K
138
What are the 5 main causes of SIADH?
```
Surgery
Infection
Pulmonary disorder
Endocrine disorder
Neurological disorder
```
139
What are two potential medications for SIADH?
Demeclocycline (only if >8y/o)
Lithium
A
140
What is the initial step in a hemodynamically unstable child with low urine output?
Isotonic fluid bolus 20/kg
141
What medication can cause siadh ?
Vincristine
142
How do diuretics affect sodium?
Thiazides and metolazone both block renal sodium reabsorption causing hyponatremia
143
What is dilutional hyponatremia? What lab findings are common?
Water intoxication
Sodium is NORMAL
Urine Na is high
144
How does third spacing occur after extensive surgery?
Endothelial damage / leakage
| Hypoalbuminemia and low oncotic pressure
145
What happens to sodium levels with third spacing?
Low urine sodium (<10)
Edema
Hyponatremia
146
What is the measures and total body sodium in conditions with edema due to low oncotic pressure (ie. nephrotic syndrome)?
Measured sodium is low BUT total body sodium is actually high
147
What are some classic symptoms of hypokalemia?
Muscle pain, weakness, paralysis
| Constipation, ileus, polyuria
148
What are the 3 main causes of hypokalemia?
Poor intake
Gi losses
Renal losses
149
If a child comes to your office with 3 days of vomiting and is weak, what should you consider?
Hypokalemia
150
What are 4 possible EKG findings secondary to hypokalemia ?
Flattened T waves
ST depression
PVC
U wave
151
How do you treat hypokalemia in an emergency situation?
KCl 1 mEq/L over an hr (max 40)
152
If mild hypokalemia and dehydration, what is the appropriate management?
Fluid replacement with added K
153
If hypokalemia in a child with acidosis, what should you treat with?
Potassium acetate
154
What electrolyte abnormality causes prolonged QT interval?
Hypocalcemia and hypomagnesemia
155
What are 4 main causes of hyperkalemia?
Excess intake
Renal failure
Acidosis (redistribution)
Cell breakdown
156
What is the common EKG finding with hyperkalemia?
Peaked T waves
| If K>10...absent p waves, wide QRS
157
What should you consider in a patient with wide QRS with muffled heart sounds or absence of pulses?
Hyperkalemia (severe)
158
How do you treat severe hyperkalemia in a patient showing signs of electromagnetic dissociation (distant heart sounds, non palpable pulses)?
Immediate IV calcium chloride
159
What 5 options can you use to treat mild hyperkalemia?
```
Glucose + insulin
Sodium bicarb
Albuterol
LASIx
Oral polystyrene resin
```
160
What happens to potassium during alkalosis?
H+ moves extracellular to compensate but then K+ moves into the cell causing low serum K
161
What happens to potassium levels during acidosis?
H+ moves into the cell and K+ moves into extra cellular fluid causing high measured K
162
What two lab findings would you find in a patient using loop diuretics?
Hypokalemia
| Alkalosis
163
What is the equation for FeNa?
Urine Na / serum Na
Divided by
Urine creatinine / plasma creatinine
164
What is a low FeNa value and what does it indicate?
<1.5
| Pre renal azotemia
165
When is hypertonic 3% saline indicated ?
In severe hyponatremia, after normal saline given with no improvement
166
What could be the diagnosis in a patient with dehydration that was rehydrated with water?
Hyponatremia dehydration (sodium <135)
167
What type of electrolyte disturbance can lead to cerebral pontine Damage?
Hyponatremia
168
Which type of electrolyte disturbance leads to tearing of bridging blood vessels and intracranial hemorrhage?
Hypernatremia which causes fluid shift to the extra cellular space and shrinkage of brain cell
169
What is the treatment for hypernatremia >170?
Assume 10% dehydration and slowly correct sodium over 48-72 hours at a rate of 0.5mEq/L/hr
170
What clinical findings would be seen in a patient with hypernatremic dehydration?
Doughy skin, irritable, high pitched cry, seizures
171
What is the equation for replacing low sodium?
Desired minus measured sodium x kg x 0.6 plus maintenance (3meq/kg/d)
172
What are the signs associated with 5% dehydration?
Tachycardia
Decreased tears
Decreased urine output
173
How do you correct 5% dehydration?
50ml/kg + maintenance
| Give half over 8 hours and remainder over 16 hours
174
What are signs of 10% dehydration?
Tachycardia
Sunken eyes
Poor skin turgor
Sunken fontanelle
175
How do you treat 10% dehydration?
NS bolus then
| 100cc/kg + maintenance over 24 hours
176
What is the max you can decrease the sodium level in a 24 hr period? Why?
10-12
| To avoid cerebral swelling
177
What are signs of 15% dehydration?
Shock and delayed cap refill
178
What is the treatment of 15% dehydration?
```
NS bolus (repeat until improvement)
Over 24 hours give maintenance plus 150ml/kg
```
179
When is oral rehydration fluid used? What does this have and how should it be given?
If moderate to severe dehydration
75 mEq/L of sodium
Give 50 ml/kg over 1-4 hours
180
What is the classic electrolyte disturbance in pyloric stenosis ?
Hypochloremic hypokalemic metabolic alkalosis
181
What happens to the urine electrolytes with pyloric stenosis?
Kidneys retain chloride causing urine chloride <10
182
What is the common electrolyte disturbance associated with cystic fibrosis?
Hypochloremic hyponatremic metabolic alkalosis and dehydration
183
What is important to remember about post-op fluid management ?
Increased risk for increased ADH secretion and over hydration
184
What is similar and different between SIADH and hyponatremic dehydration?
Both have low sodium and chloride but dehydration gives high BUN
185
What's the difference and similarity between diabetes insipidus and hypernatremic dehydration?
Both have high sodium and chloride and BUN.
| Hypernatremic dehydration have high specific gravity but diabetes insipidus has low specific gravity
186
What do you do if lab findings show low sodium <120 and normal chloride ?
Repeat lab (lab error)
187
What is another name for vitamin A?
retinol
