Nutritional Needs of Patients

Question 1

What effect does systemic inflammation have on protein, carbohydrate, and lipid metabolism?

Answer 1

Protein: changes in synthesis and degradation, loss of muscle mass, increased production on CRP

Carbohydrate: increased insulin resistance, impaired glucose tolerance

Lipid: maintained or increased lipid oxidation

Question 2

Which cancers tend to make patients hypermetabolic?

Answer 2

Pancreatic, gastric, bile duct, kidney, adrenal, NSCLC, and head and neck cancers

Question 3

What is the DRI for protein for healthy adults?

Answer 3

0.8 g/kg/d

Question 4

How much protein is recommended for adults with cancer?

Answer 4

1-1.5 g/kg/d

Question 5

How much protein is recommended for adults with cancer cachexia?

Answer 5

1.5-2.5 g/kd/d

Question 6

How much protein is recommended for adults undergoing hematopoietic stem cell transplant?

Answer 6

1.5 g/kg/d

Question 7

What is the RDA (g/d) for carbohydrates for healthy adults?

Answer 7

130 g/d

Question 8

What is the DRI for fat?

Answer 8

20-35% total energy intake

Question 9

What is the DRI for carbohydrate?

Answer 9

45-65% total energy intake

Question 10

What is the DRI for protein?

Answer 10

10-35% total energy intake

Question 11

What is the Holliday-Segar method for calculating fluid needs?

Answer 11

0-10 kg: 100 mL fluid/kg
10-20 kg: 1000 mL fluid + 50 mL fluids for each kg over 10 kg
20+ kg:
(</= 50 yrs) 1500 mL fluid + 20 mL fluid for each kg over 20 kg
(>50 yrs) 1500 mL fluid + 15 mL fluid for each kg over 20 kg

Question 12

What is the BSA method for calculating fluid needs?

Answer 12

1500 mL fluid x BSA (m2)

Question 13

What is the RDA for fluids?

Answer 13

1 mL/kcal of estimated needs

Question 14

How much do fluid needs increase for patients with a fever?

Answer 14

12.5% per every 1 degree C above normal

Question 15

How much do fluid needs increase for sweating?

Answer 15

10-25%

Question 16

How much do fluid needs increase for hyperventilation?

Answer 16

10-60%

Question 17

How much do fluid needs increase for hyperthyroidism?

Answer 17

25-50%

Question 18

How do extraordinary gastric and renal losses affect fluid needs?

Answer 18

Needs vary based on output

Question 19

Which micronutrient levels decrease during the inflammatory process?

Answer 19

Selenium, Copper, Iron, Zinc

Question 20

Which micronutrients levels are usually not affected by inflammation?

Answer 20

Thiamine (B1), Riboflavin (B2), Cobalamin (B12), Folate (B9)

Question 21

How does alcoholic liver disease affect micronutrient levels?

Answer 21

Decrease in folate, thiamine, pyridoxine, and vitamin A

Question 22

How does renal failure affect micronutrient levels?

Answer 22

Decrease in folate, pyridoxine, and vitamin C

Question 23

How do GI fistulas and diarrhea affect micronutrient levels?

Answer 23

Decrease in all vitamins and multiple trace minerals, especially zinc and selenium

Question 24

How does loss of bile affect micronutrient levels?

Answer 24

Decrease in fat-soluble vitamins

Question 25

How does pancreatitis affect micronutrient levels?

Answer 25

Decreased absorption of vitamin B12

Question 26

How does gastrectomy and terminal ileum resection affect micronutrient levels?

Answer 26

Decrease in iron and vitamin B12

Question 27

How does bariatric surgery affect micronutrient levels?

Answer 27

Decrease in all vitamins and minerals, such as iron and zinc

Question 28

How does critical illness affect micronutrient levels?

Answer 28

Decrease in vitamin C despite supplementation

Question 29

How does SIADH affect micronutrient levels?

Answer 29

Decrease in sodium

Question 30

What are the estimated energy needs (kcal/kg) for cancer, repletion, weight gain?

Answer 30

30-35 kcal/kg

Question 31

What are the estimated energy needs (kcal/kg) for cancer, inactive, nonstressed?

Answer 31

25-30 kcal/kg

Question 32

What are the estimated energy needs (kcal/kg) for cancer, hypermetabolic, stressed?

Answer 32

35 kcal/kg

Question 33

What are the estimated energy needs (kcal/kg) for sepsis?

Answer 33

25-30 kcal/kg

Question 34

What are the estimated energy needs (kcal/kg) for hematopoietic cell transplant?

Answer 34

30-35 kcal/kg

Question 35

What are the estimated energy needs (kcal/kg) for obese patients?

Answer 35

11-14 kcal/kg (actual body weight) or 22-25 kcal/kg (IBW)

Question 36

What electrolytes shift during refeeding syndrome?

Answer 36

Potassium, Phosphorus, Magnesium

Question 37

What micronutrient should be supplemented for patients at risk of refeeding syndrome?

Answer 37

Thiamine