nutrition & lytes Flashcards
1
Q
daily caloric need
A
20-25 Cal/kg/day
25-30 mild stress
30-35 higher stress
2
Q
fat/protein/carb/dextrose calories?
A
9/4/4/3.4 Cal/g
3
Q
avg protein/fat/carb % intake?
A
20% protein
30% fat
50% carbs
4
Q
protein needs
A
1 g protein/kg/day
5
Q
caloric intake for 70 kg male?
A
1.5-1.7Cal/day.
6
Q
pregnancy and lactation increase caloric requirement how much?
A
300 Cal/day pregnancy
500 Cal/day lactation
7
Q
burn nutritional requirement
A
25 Cal/day + 30Cal/day(X % burn)
1-1.5 g/kg/day + 3 g/day(X % burn) protein
= 35-40 kcal/kg/day and 2-2.5 g/kg/day protein
8
Q
Harris Benedict equation for basal energy expenditure
A
weight, height, age, gender.
9
Q
max glucose administration in TPN?
A
3 g/kg/hr.
10
Q
coloncyte nutrition
A
short chain fatty acids! = MC butyrate
11
Q
small bowel nutrion
A
glutamine
12
Q
immunonutrition = lower infectious complication
A
omega 3 FA, glutamine, arginine
13
Q
respiratory quotient
A
CO2 produced / O2 consumed
14
Q
RQ > 1
A
overfeeding… issues with ventilator
15
Q
RQ < 0.7
A
starvation; ketosis and fat oxidation… give carbs
16
Q
pure fat utilization RQ
A
= 0.7
17
Q
pure protein utilization RQ
A
= 0.8
18
Q
pure carb utilization RQ
A
= 1.0
19
Q
glycogen stores breakdown
A
2/3 skeletal muscle, 1/3 in liver
20
Q
starvation timeline.
A
24-36 hours glycolysis (from glycogen stores)
then ketosis
21
Q
which amino acids increase in stress?
A
alanine and phenylalanine
22
Q
GNG precursors (in liver)
A
alanine»_space; lactate, pyruvate, glycerol
23
Q
obligate glucose users
A
peripheral nerves, adrenal medulla, RBCs and WBCs
24
Q
how much nitrogen in protein
A
6.25 g of protein has 1 g of nitrogen
25
protein synthesis in 1 day by average 70 kg male?
250 g/day of protein
26
Tg breakdown to what?
glycerol and fatty acids
27
essential fatty acids?
linolenic acid and linoleic acid.e
28
essential amino acids?
BCAA=leucine isoleucine valine
+ histidine, lysine, methionine, phenylalanine, threonine, tryptophan
29
lipid solutions adjunct to TPN
10% lipid = 1.1 Cal/cc
20% is 2 Cal/cc
30
TPN breakdown
10% amino acid
25% dextrose
electrolytes
31
chromium deficiency sx
hyperglycemia, encephalopathy, neuropathy
32
selenium def sx
cardiomyopathy, weakness
33
copper def sx
pancytopenia, neuropathy, ataxia
34
zinc def sx
wound healing
35
B6 def sx
sideroblastic anemia, glossitis, p. neuropathy, nasolabial seborrheic dermatitis
36
B1 def sx
Wernicke's (nystagmus, opthalmoplegia, ataxia, confusion), Beriberi (wet=HF), peipheral neuropathy
37
B2 def riboflavin
edematous mucous membranes, angular stomatitis, glossitis, seborrheic dermatitis
38
niacin def B3
pellagra: diarrhea, sun dermatitis, dementia, mouth inflammation, HA, psychosis/delirium/catatonia
39
essential fatty acid def
dermatitis, hair loss, tpenia
40
A def
night blindness, xeropthlamia, keratomalacia, Bitot spot, follicular hyperkeratosis, infection prone
41
D def
rickets, osteomalacia, osteoporosis, craniotabes, rachitic rosary
42
E def
neuropathy, ataxia, retinal degernation, hemolytic anemia, infertility
43
b9 folate def
megaloblastic anemia, sensory predominant neuropathy
44
b12 cobalamin def
megaloblastic PERNICIOUS anemia, p neuropathy with impaired proprioception, slowed mentation, optic neuropathy
45
biotin B7 def
AMS, myalgia, dysesthesia, anorexia, papulosquamous dermatitis
46
K def
coagulopathy
47
C def
scurvy, ecchymosis bleeding gums, depression, dry skin, wound healing
48
cori cycle
glucose converted to lactate in muscle
lactate goes to liver converted to pyruvate and then to glucose via GNG via glucose 6 phosphatase (cannot be GNG in skeletal cuz enzyme isnt there)
49
metablic syndrome needs 3 to dx:
1. obesity
2. insulin resistance
3. high Tg > 100
4. low HDL < 50
5. HTN < 130/85
50
hyperMg @ 6 mEq/L
electrocardiographic changes such as peaked T waves, PR prolongation, QRS widening may occur.
51
hyperMg @ 15 mEq/L
Cardiac arrest
52
hyperMg overall sx
flushing, hypotension, hyporeflexia, and respiratory depression.
53
mgmt hyperMg
calcium gluconate, diuresis, or dialysis, with intravenous furosemide being the diuretic of choice because it increases magnesium excretion
54
hyperK EKG changes >6
peaked T waves, followed by increased PR intervals and widened QRS complexes.
55
Mg effect on K
magnesium helps drive the sodium-potassium ATPase pump.
56
hypomagnesemia rx induced
proton pump inhibitors; diuretics, both loop and thiazide, amphotericin B; and cisplatin. Gastrointestinal disease, chronic diarrhea, and alcohol use disorder can also lead to low levels of magnesium.
57
hypoCa EKG changes
prolonged QT interval (proportional to the imbalance)
58
hyperK EKG changes
Peaked narrow T waves and wide QRS are EKG changes
59
hypoK EKG changes
T wave flattening or inversion, depressed ST segments, U waves and a prolonged QT interval.
60
hypophos and administration of insulin
insulin/Dfluids can drive phos into cells
61
hypophos sx
significant weakness of skeletal and smooth muscle
can affect the eyes as well as the diaphragm
respiratory insufficiency in patients on ventilators
impaired cardiac contractility --- ** reverses
62
burn care energy expenditure
indirect calorimetry
63
obese energy expenditure
penn state equation
64
hypoNa fast correction
OK above 120 mEq/L otherwise c/f central pontine myelinolysis
otherwise <0.5 mEq/L/hr or slower
65
lithium toxicity
Hyperca, HyperMg, HypoCalciuria. KIDNEYS INCREASE REABSORPTION in LOOP. Nephrogenic DI
and increase PTH for some reason
worsens in RNY bc more Li absorbed
66
after RNY what increases absorption
Digoxin
Lithium
Penicillin
Atorvastatin
67
after RNY what decreases absorption
Phenytoin
erythromycin
warfarin
ampicillin
tamoxifen
cyclosporine
levonorgestrel
imatinib
tacrolimus
68
highest risk of malnutrition
weight loss > 5% in 1 mo or >10% in 6 mos, BMI < 20, critial illness, advanced age, decreased oral intake
69
causes of pseudohypoNa
hyperTg
multiple myelnoma
hyperglycemia 1.6 for 100
amyloidosis
70
CCB toxicity treatment
IV Cagluc
HIGH DOSE insulin
atropine if bradycardic
LEVO if shock
DOBUT or EPI if suspected cardiogenic shock
71
LR constituents
Na 130
K 4
Cl 109
Ca 2.7
Lactate 28
72
best maintenance fluids for adult, kids, neonate
adult: D51/2NS + 20 mEq K
peds: D5NS + 20 mEq K
neonate D51/4NS + 20 mEq K
73
SIADH
high ADH. hyperNa. low UOP
tx: fluid restrict, slow diuresis, >>>> severe: conivaptan, tolvaptan (compettiive antagonist to V2)
74
DI (neurogenic)
low ADH. hypoNa. lots UOP.
tx: free water, >>>> severe: DDAVP
75
MC cause of malignant vs benign hyperCa
malignant: breast ca
benign: hyperPTH
76
symptomatic level of iCa and Ca
<1 and <8 respectively
77
trousseaus sign
carpopedal spasm with BP cuff up (hypoCa)
78
tx hyperCa
NS 200-300 cc/hr + lasix after euvolemic
if malignant disease: calcitonin, bisphosphonates, steroids, dialysis
79
how to fix severe acidosis
bicarb pushes over 7.20
bc acidosis can decrease contractility
80
what to look out for as you quickly correct acidosis
hypoKALEMIA (H in, K out)
81
how does myoglobin affect kidney
converted to ferrihemate in ACIDIC environemnt... which is toxic
need to alkanize the urine and hydrate
82
how much renal mass must be affected to increase Cr and BUN
70%
83
tx tumor lysis
hydration. > rasburicase (urate to inactive allantoin), allopurinol (decrease urate production), alkalinize urine, diurese
84
Vit D creation
7-dehydrocholesterol (SUN to skin) to cholecalciferol
chole (liver) to 25-OH
25 (kidney) to 1-OH
1-OH increases calcium binding protein to increase intestinal Ca absorption
85
transferrin vs ferritin
ferritin is acute phase reactant
transferrin is not
86
what does fever do to basal metabolic rate
add 10% for each degree about 38C
87
best marker for acute nutritional status
PREALBUMIN >>>>> retinal binding protine, transferrin
88
half life albumin
18 days
89
transferrin half life
8 days
90
prealbumin half life
2 days
91
IBW male
106+ 6lb for every inch above 5 ft
92
IBW female
100lb + 5 lb for every inch above 5 ft
93
severe malnutrition 4 signs
1. anergy
2. transferrin < 200
3. albumin < 3
4. weight loss >20% in 3 mo
94
what to do if preop seevere* malnutrion
needs preop malnutrition if undergoing major thoracic or abdominal surgery
95
when does enteral feeding have SURVIVAL beneifts (3)
pancreatitis
burns
sepsis
96
postop catabolic stage vs anabolic
0-3 days catabolic
3-5 days anabolic
97
which amino acids increase in stress?
alanine (good because GNG substrate) and phenylalanine
98
where does GNG occur in late stress
KIDNEY
99
PEG week indication
4
100
refeeding syndrome sx day
4
101
ppx refeeeding syndrome
10-15 Cal/kg/day
102
majority of skeletal muscle breakdown
glutamine > alanine
103
90% of nitrogen loss
through urea (kidney - end location)
104
lipid digestion
triacylglycerides, cholesterol and lipids
to
micelles and fatty acidse
105
enzymes involved in lipid digestion
pancreatic lipase
cholesterol esterase
hospholipase
106
micelle composition
aggregate of bile salts, LCFA, and monoacylglycerides
107
MCFA and SCFA aborption
simple diffusion into enterocyte
108
chylomicron absorption
(made of 90% TAG, 10% phospholipid/cholesterol)... enters directly into LYMPHATICS
109
LCFA absorption
into LYMPHATICS too instead of enteroctyes
110
lipoprotein lipase where
ENDOTHELIUM of liver and adipose tissue
111
lipoprotein lipase function
clears chylomicrons and TAGs, breaking them down into fatty acids and glycerol
112
free fatty acid binding protein location
endothelium in the liver and adipose tissue
113
what does free fatty acid binding protein bind
SCFA and MCFA
114
what does hormone sensitive lipase HSL do
breaks down TAG to fatty acids and glycerol
stimulated by catecholamines, growth hormone, steroids
115
how does glucose and galactose get absorbed
through SECONDARY ACTIVE TRANSPORT (Na gradient made by ATPase) to then release into portal vein via enterocytes
116
how does fructose get absorbed?
fACILITATEDDIFFUSION into enterocyte and into portal vein
117
protein absorption?
proteases break down
and then SECONDARY ACTIVE TRANSPORT as free amino acids into portal vein
118
