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ABSITE > nutrition & lytes > Flashcards

nutrition & lytes Flashcards

1
Q

daily caloric need

A

20-25 Cal/kg/day

25-30 mild stress
30-35 higher stress

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2
Q

fat/protein/carb/dextrose calories?

A

9/4/4/3.4 Cal/g

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3
Q

avg protein/fat/carb % intake?

A

20% protein
30% fat
50% carbs

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4
Q

protein needs

A

1 g protein/kg/day

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5
Q

caloric intake for 70 kg male?

A

1.5-1.7Cal/day.

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6
Q

pregnancy and lactation increase caloric requirement how much?

A

300 Cal/day pregnancy
500 Cal/day lactation

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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

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8
Q

Harris Benedict equation for basal energy expenditure

A

weight, height, age, gender.

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9
Q

max glucose administration in TPN?

A

3 g/kg/hr.

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10
Q

coloncyte nutrition

A

short chain fatty acids! = MC butyrate

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11
Q

small bowel nutrion

A

glutamine

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12
Q

immunonutrition = lower infectious complication

A

omega 3 FA, glutamine, arginine

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13
Q

respiratory quotient

A

CO2 produced / O2 consumed

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14
Q

RQ > 1

A

overfeeding… issues with ventilator

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15
Q

RQ < 0.7

A

starvation; ketosis and fat oxidation… give carbs

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16
Q

pure fat utilization RQ

A

= 0.7

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17
Q

pure protein utilization RQ

A

= 0.8

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18
Q

pure carb utilization RQ

A

= 1.0

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19
Q

glycogen stores breakdown

A

2/3 skeletal muscle, 1/3 in liver

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20
Q

starvation timeline.

A

24-36 hours glycolysis (from glycogen stores)
then ketosis

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21
Q

which amino acids increase in stress?

A

alanine and phenylalanine

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22
Q

GNG precursors (in liver)

A

alanine&raquo_space; lactate, pyruvate, glycerol

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23
Q

obligate glucose users

A

peripheral nerves, adrenal medulla, RBCs and WBCs

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24
Q

how much nitrogen in protein

A

6.25 g of protein has 1 g of nitrogen

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25
Q

protein synthesis in 1 day by average 70 kg male?

A

250 g/day of protein

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26
Q

Tg breakdown to what?

A

glycerol and fatty acids

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27
Q

essential fatty acids?

A

linolenic acid and linoleic acid.e

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28
Q

essential amino acids?

A

BCAA=leucine isoleucine valine
+ histidine, lysine, methionine, phenylalanine, threonine, tryptophan

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29
Q

lipid solutions adjunct to TPN

A

10% lipid = 1.1 Cal/cc
20% is 2 Cal/cc

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30
Q

TPN breakdown

A

10% amino acid
25% dextrose
electrolytes

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31
Q

chromium deficiency sx

A

hyperglycemia, encephalopathy, neuropathy

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32
Q

selenium def sx

A

cardiomyopathy, weakness

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33
Q

copper def sx

A

pancytopenia, neuropathy, ataxia

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34
Q

zinc def sx

A

wound healing

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35
Q

B6 def sx

A

sideroblastic anemia, glossitis, p. neuropathy, nasolabial seborrheic dermatitis

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36
Q

B1 def sx

A

Wernicke’s (nystagmus, opthalmoplegia, ataxia, confusion), Beriberi (wet=HF), peipheral neuropathy

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37
Q

B2 def riboflavin

A

edematous mucous membranes, angular stomatitis, glossitis, seborrheic dermatitis

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38
Q

niacin def B3

A

pellagra: diarrhea, sun dermatitis, dementia, mouth inflammation, HA, psychosis/delirium/catatonia

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39
Q

essential fatty acid def

A

dermatitis, hair loss, tpenia

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40
Q

A def

A

night blindness, xeropthlamia, keratomalacia, Bitot spot, follicular hyperkeratosis, infection prone

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41
Q

D def

A

rickets, osteomalacia, osteoporosis, craniotabes, rachitic rosary

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42
Q

E def

A

neuropathy, ataxia, retinal degernation, hemolytic anemia, infertility

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43
Q

b9 folate def

A

megaloblastic anemia, sensory predominant neuropathy

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44
Q

b12 cobalamin def

A

megaloblastic PERNICIOUS anemia, p neuropathy with impaired proprioception, slowed mentation, optic neuropathy

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45
Q

biotin B7 def

A

AMS, myalgia, dysesthesia, anorexia, papulosquamous dermatitis

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46
Q

K def

A

coagulopathy

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47
Q

C def

A

scurvy, ecchymosis bleeding gums, depression, dry skin, wound healing

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48
Q

cori cycle

A

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
Q

metablic syndrome needs 3 to dx:

A
  1. obesity
  2. insulin resistance
  3. high Tg > 100
  4. low HDL < 50
  5. HTN < 130/85
50
Q

hyperMg @ 6 mEq/L

A

electrocardiographic changes such as peaked T waves, PR prolongation, QRS widening may occur.

51
Q

hyperMg @ 15 mEq/L

A

Cardiac arrest

52
Q

hyperMg overall sx

A

flushing, hypotension, hyporeflexia, and respiratory depression.

53
Q

mgmt hyperMg

A

calcium gluconate, diuresis, or dialysis, with intravenous furosemide being the diuretic of choice because it increases magnesium excretion

54
Q

hyperK EKG changes >6

A

peaked T waves, followed by increased PR intervals and widened QRS complexes.

55
Q

Mg effect on K

A

magnesium helps drive the sodium-potassium ATPase pump.

56
Q

hypomagnesemia rx induced

A

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
Q

hypoCa EKG changes

A

prolonged QT interval (proportional to the imbalance)

58
Q

hyperK EKG changes

A

Peaked narrow T waves and wide QRS are EKG changes

59
Q

hypoK EKG changes

A

T wave flattening or inversion, depressed ST segments, U waves and a prolonged QT interval.

60
Q

hypophos and administration of insulin

A

insulin/Dfluids can drive phos into cells

61
Q

hypophos sx

A

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
Q

burn care energy expenditure

A

indirect calorimetry

63
Q

obese energy expenditure

A

penn state equation

64
Q

hypoNa fast correction

A

OK above 120 mEq/L otherwise c/f central pontine myelinolysis

otherwise <0.5 mEq/L/hr or slower

65
Q

lithium toxicity

A

Hyperca, HyperMg, HypoCalciuria. KIDNEYS INCREASE REABSORPTION in LOOP. Nephrogenic DI
and increase PTH for some reason

worsens in RNY bc more Li absorbed

66
Q

after RNY what increases absorption

A

Digoxin
Lithium
Penicillin
Atorvastatin

67
Q

after RNY what decreases absorption

A

Phenytoin
erythromycin
warfarin
ampicillin
tamoxifen
cyclosporine
levonorgestrel
imatinib
tacrolimus

68
Q

highest risk of malnutrition

A

weight loss > 5% in 1 mo or >10% in 6 mos, BMI < 20, critial illness, advanced age, decreased oral intake

69
Q

causes of pseudohypoNa

A

hyperTg
multiple myelnoma
hyperglycemia 1.6 for 100
amyloidosis

70
Q

CCB toxicity treatment

A

IV Cagluc
HIGH DOSE insulin
atropine if bradycardic
LEVO if shock
DOBUT or EPI if suspected cardiogenic shock

71
Q

LR constituents

A

Na 130
K 4
Cl 109
Ca 2.7
Lactate 28

72
Q

best maintenance fluids for adult, kids, neonate

A

adult: D51/2NS + 20 mEq K
peds: D5NS + 20 mEq K
neonate D51/4NS + 20 mEq K

73
Q

SIADH

A

high ADH. hyperNa. low UOP

tx: fluid restrict, slow diuresis,&raquo_space;» severe: conivaptan, tolvaptan (compettiive antagonist to V2)

74
Q

DI (neurogenic)

A

low ADH. hypoNa. lots UOP.

tx: free water, &raquo_space;» severe: DDAVP

75
Q

MC cause of malignant vs benign hyperCa

A

malignant: breast ca
benign: hyperPTH

76
Q

symptomatic level of iCa and Ca

A

<1 and <8 respectively

77
Q

trousseaus sign

A

carpopedal spasm with BP cuff up (hypoCa)

78
Q

tx hyperCa

A

NS 200-300 cc/hr + lasix after euvolemic

if malignant disease: calcitonin, bisphosphonates, steroids, dialysis

79
Q

how to fix severe acidosis

A

bicarb pushes over 7.20
bc acidosis can decrease contractility

80
Q

what to look out for as you quickly correct acidosis

A

hypoKALEMIA (H in, K out)

81
Q

how does myoglobin affect kidney

A

converted to ferrihemate in ACIDIC environemnt… which is toxic

need to alkanize the urine and hydrate

82
Q

how much renal mass must be affected to increase Cr and BUN

83
Q

tx tumor lysis

A

hydration. > rasburicase (urate to inactive allantoin), allopurinol (decrease urate production), alkalinize urine, diurese

84
Q

Vit D creation

A

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
Q

transferrin vs ferritin

A

ferritin is acute phase reactant
transferrin is not

86
Q

what does fever do to basal metabolic rate

A

add 10% for each degree about 38C

87
Q

best marker for acute nutritional status

A

PREALBUMIN&raquo_space;»> retinal binding protine, transferrin

88
Q

half life albumin

89
Q

transferrin half life

90
Q

prealbumin half life

91
Q

IBW male

A

106+ 6lb for every inch above 5 ft

92
Q

IBW female

A

100lb + 5 lb for every inch above 5 ft

93
Q

severe malnutrition 4 signs

A
  1. anergy
  2. transferrin < 200
  3. albumin < 3
  4. weight loss >20% in 3 mo
94
Q

what to do if preop seevere* malnutrion

A

needs preop malnutrition if undergoing major thoracic or abdominal surgery

95
Q

when does enteral feeding have SURVIVAL beneifts (3)

A

pancreatitis
burns
sepsis

96
Q

postop catabolic stage vs anabolic

A

0-3 days catabolic
3-5 days anabolic

97
Q

which amino acids increase in stress?

A

alanine (good because GNG substrate) and phenylalanine

98
Q

where does GNG occur in late stress

99
Q

PEG week indication

100
Q

refeeding syndrome sx day

101
Q

ppx refeeeding syndrome

A

10-15 Cal/kg/day

102
Q

majority of skeletal muscle breakdown

A

glutamine > alanine

103
Q

90% of nitrogen loss

A

through urea (kidney - end location)

104
Q

lipid digestion

A

triacylglycerides, cholesterol and lipids

to

micelles and fatty acidse

105
Q

enzymes involved in lipid digestion

A

pancreatic lipase
cholesterol esterase
hospholipase

106
Q

micelle composition

A

aggregate of bile salts, LCFA, and monoacylglycerides

107
Q

MCFA and SCFA aborption

A

simple diffusion into enterocyte

108
Q

chylomicron absorption

A

(made of 90% TAG, 10% phospholipid/cholesterol)… enters directly into LYMPHATICS

109
Q

LCFA absorption

A

into LYMPHATICS too instead of enteroctyes

110
Q

lipoprotein lipase where

A

ENDOTHELIUM of liver and adipose tissue

111
Q

lipoprotein lipase function

A

clears chylomicrons and TAGs, breaking them down into fatty acids and glycerol

112
Q

free fatty acid binding protein location

A

endothelium in the liver and adipose tissue

113
Q

what does free fatty acid binding protein bind

A

SCFA and MCFA

114
Q

what does hormone sensitive lipase HSL do

A

breaks down TAG to fatty acids and glycerol

stimulated by catecholamines, growth hormone, steroids

115
Q

how does glucose and galactose get absorbed

A

through SECONDARY ACTIVE TRANSPORT (Na gradient made by ATPase) to then release into portal vein via enterocytes

116
Q

how does fructose get absorbed?

A

fACILITATEDDIFFUSION into enterocyte and into portal vein

117
Q

protein absorption?

A

proteases break down
and then SECONDARY ACTIVE TRANSPORT as free amino acids into portal vein

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