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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!

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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, 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

30
Q

chromium deficiency sx

A

hyperglycemia, encephalopathy, neuropathy

31
Q

selenium def sx

A

cardiomyopathy, weakness

32
Q

copper def sx

A

pancytopenia, neuropathy, ataxia

33
Q

zinc def sx

A

wound healing

34
Q

B6 def sx

A

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

35
Q

B1 def sx

A

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

36
Q

B2 def riboflavin

A

edematous mucous membranes, angular stomatitis, glossitis, seborrheic dermatitis

37
Q

niacin def B3

A

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

38
Q

essential fatty acid def

A

dermatitis, hair loss, tpenia

39
Q

A def

A

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

40
Q

D def

A

rickets, osteomalacia, osteoporosis, craniotabes, rachitic rosary

41
Q

E def

A

neuropathy, ataxia, retinal degernation, hemolytic anemia, infertility

42
Q

b9 folate def

A

megaloblastic anemia, sensory predominant neuropathy

43
Q

b12 cobalamin def

A

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

44
Q

biotin B7 def

A

AMS, myalgia, dysesthesia, anorexia, papulosquamous dermatitis

45
Q

K def

A

coagulopathy

46
Q

C def

A

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

47
Q

cori cycle

A

glucose converted to lactate in muscle
lactate goes to liver converted to pyruvate and then to glucose via GNG

48
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
49
Q

hyperMg @ 6 mEq/L

A

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

50
Q

hyperMg @ 15 mEq/L

A

Cardiac arrest

51
Q

hyperMg overall sx

A

flushing, hypotension, hyporeflexia, and respiratory depression.

52
Q

mgmt hyperMg

A

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

53
Q

hyperK EKG changes >6

A

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

54
Q

Mg effect on K

A

magnesium helps drive the sodium-potassium ATPase pump.

55
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.

56
Q

hypoCa EKG changes

A

prolonged QT interval (proportional to the imbalance)

57
Q

hyperK EKG changes

A

Peaked narrow T waves and wide QRS are EKG changes

58
Q

hypoK EKG changes

A

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

59
Q

hypophos and administration of insulin

A

insulin/Dfluids can drive phos into cells

60
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

61
Q

burn care energy expenditure

A

indirect calorimetry

62
Q

obese energy expenditure

A

penn state equation

63
Q

hypoNa fast correction

A

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

otherwise <0.5 mEq/L/hr or slower

64
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

65
Q

after RNY what increases absorption

A

Digoxin
Lithium
Penicillin
Atorvastatin

66
Q

after RNY what decreases absorption

A

Phenytoin
erythromycin
warfarin
ampicillin
tamoxifen
cyclosporine
levonorgestrel
imatinib
tacrolimus

67
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

68
Q

causes of pseudohypoNa

A

hyperTg
multiple myelnoma
hyperglycemia 1.6 for 100
amyloidosis

69
Q

CCB toxicity treatment

A

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

70
Q

LR constituents

A

Na 130
K 4
Cl 109
Ca 2.7
Lactate 28

71
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

72
Q
A

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