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Advanced Medical Nutrition Therapy II > Parenteral Nutrition (part 1) > Flashcards

Parenteral Nutrition (part 1) Flashcards

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USMLE® Step 1 flashcards
1
Q

____ ____ is the delivery of nutrients directly into the bloodstream intravenously

A

Parenteral nutrition

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2
Q

Parenteral nutrition is a means of providing adequate nutrition for those who not have sufficient ____ function to restore or maintain optimal nutrition status

A

GI

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3
Q

Indications for the use of parenteral nutrition:

A

-A non-functioning GI tract
-Bowel rest
-Bowel obstruction
-Bowel perforation
-High output small bowel fistula
-Enteral access is not feasible or failed trials of enteral nutrition (post-pyloric)

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4
Q

What could lead to a non-functioning GI tract?

A

-Prolonged small bowel ileus
-Severe malabsorption
-Intractable vomiting or diarrhea
-Severe short bowel syndrome
-Small bowel ischemia
-Severe IBD

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5
Q

What would be indications of bowel rest?

A

-Severe exacerbation of IBD
-Radiation enteritis

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6
Q

What are some contraindications to parenteral nutrition?

A

-Functioning GIT
-Treatment < 7 days
-Inability to obtain venous access
-Prognosis that does not warrant aggressive nutrition support

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7
Q

Parenteral nutrition may be used if the GIT cannot be used for over ____ days

A

7

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8
Q

Carbohydrates are in the form of ___ ___ in parenteral nutrition

A

Dextrose Monohydrate

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9
Q

Dextrose monohydrate provides ____ kcal/g

A

3.4

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10
Q

Commercially available parenteral nutrition formulas can range from ___-___% carbohydrate

A

5-70%

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11
Q

The minimum dextrose dose should be ____ mg/kg/min

A

1

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12
Q

Inadequate carbohydrate administration causes ____ to be utilized as an energy source

A

Protein

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13
Q

In stable patients, the dose of dextrose should be ___-____ mg/kg/min

A

4-5

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14
Q

We should use the low end of the dextrose range (4 mg/kg/min) for patients with…

A

-Diabetes mellitus
-Hyperglycemia

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15
Q

Critically I’ll patients should get under ____ mg/kg/min of dextrose

A

4

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16
Q

Excessive carbohydrate administration can lead to…

A

-Hyperglycemia
-Increased CO2 production
-Fatty liver

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17
Q

How to calculate the maximum carbohydrate dose:

A

-Decide which standard to use (4 or 5 mg/kg/min)
-(4 or 5 mg) x (weight in kg) x (1440)
-Divide value by 1000 (to convert mg to g)

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18
Q

What is the protein source that is added to parenteral nutrition?

A

Crystalline amino acids

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19
Q

Parenteral nutrition contains all ___ ___ ___ and some NEAA

A

Essential amino acids

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20
Q

The concentration of protein in parenteral nutrition ranges from ____-___%

A

3-20

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21
Q

The protein in parenteral nutrition provides ____ kcal/g

A

4

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22
Q

Currently, ____ is not included in crystalline amino acids solutions because it is unstable

A

Glutamine

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23
Q

Lipids in parenteral nutrition are in the form of ____ ____ ___

A

Lipid injectable emulsions

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24
Q

The source of fat is…

A

Long-chain fatty acid emulsion

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25
Q

The long-chain fatty acid emulsions in parenteral nutrition come from…

A

-Soybean oil
-Also contain egg yolk phospholipid and glycerol

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26
Q

Lipid injectable emulsions are ____-dense and ____

A

Calorie; isotonic

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27
Q

There is also a mixed oil lipid injectable emulsion called ____

A

Smoflipid

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28
Q

Smoflipid is made up of…

A

-30% soybean oil
-30% MCT
-25% olive oil
-15% fish oil

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29
Q

Another alternative lipid injectable emulsion is Omegaven, which is rich in ___-___ fatty acids

A

Omega 3

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30
Q

Omegaven is believed to have ____-____ effects

A

Anti-inflammatory

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31
Q

Omegavan is FDA-approved for use in pediatric patients with parenteral nutrition-associated _____

A

Cholestasis

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32
Q

A 10% lipid emulsion provides ____ kcal/mL or ____ kcal/g

A

1.1; 11

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33
Q

A 20% lipid emulsion provides ____ kcal/mL or ____ kcal/g

A

2.0; 10

34
Q

A 30% lipid emulsion is only available for ____ ____ _____

A

Total nutrient admixture

35
Q

A 30% lipid emulsion provides ____ kcal/mL or ____ kcal/g

A

3.0; 10

36
Q

What are the minimum requirements for lipids in a parenteral nutrition formula?

A

-2-4% of total kcal needs from linoleic acid
-10% of total kcal needs provided as lipid in parenteral nutrition should prevent essential fatty acid deficiency

37
Q

What is the optimal fat intake for someone on parenteral nutrition?

A

-20-30% of kcal from fat OR
-1 g/kg/day for stable patients and <1 g/kg/day for critically ill patients

38
Q

Optimal fat intake reduces the complications of solely dextrose-based parenteral nutrition, such as…

A

-Hyperglycemia
-Respiratory compromise

39
Q

Lipid injectable emulsions should be provided with a slow, continuous infusion rate over ____ or more hours per day

A

10

40
Q

Fat overload can lead to _____

A

Hypertriglyceridemia

41
Q

Hypertriglyceridemia can lead to…

A

-Impaired immune response
-Hepatic steatosis
-Acute pancreatitis
-Impaired vascular integrity

42
Q

Hypertriglyceridemia can impair immune response by…

A

-Causing hepatic reticuloendothelial system dysfunction
-Linoleic acid inhibits cell-mediated immune response

43
Q

Contraindications of lipids:

A

-Egg allergy
-Severe hyperlipidemia
-Use with caution in those with severe sepsis and multiple organ dysfunction syndrome

44
Q

Lipid clearance is monitored by serum _____

A

Triglycerides

45
Q

We should check baseline triglycerides prior to the initiation of ___ ____ ___, and then check again after IV lipid is initiated

A

Lipid injectable emulsions

46
Q

We should hold IV lipids if serum triglyceride level is ____ or more mg/dL

A

400

47
Q

If serum triglycerides continue to be 400 or more mg/dL, limit lipid injectable emulsions to ____ amount to prevent essential fatty acid deficiency

A

Minimal

48
Q

____ is a cofactor necessary for the transport of long-chain fatty acids for beta-oxidation

A

Carnitine

49
Q

Carnitine is not present in ___ ___

A

Parenteral nutrition

50
Q

What populations are at risk of carnitine deficiency while on parenteral nutrition?

A

-Premature infants
-Dialysis patients

51
Q

A deficiency of carnitine can lead to…

A

-Hypertriglyceridemia
-Fatty liver
-Hypoglycemia
-Muscle weakness
-Cardiomyopathy

52
Q

An IV form of L-carnitine is available to treat _____

A

Deficiency

53
Q

Vitamins are provided together in a ____ ml dose of “standard vitamins”

A

10

54
Q

Vitamin requirements differ from the ____

A

DRI’s

55
Q

Parenteral requirements for many vitamins are ____ for many of the vitamins due to decreased stability in parenteral nutrition

A

Higher

56
Q

Commercially prepared parenteral nutrition has ___ mL/day of trace elements

A

1

57
Q

Parenteral requirements for most trace elements are ____ than enteral requirements because there is 100% absorption when given IV

A

Lower

58
Q

What is the recommended dose of zinc in parenteral nutrition?

A

3-5 mg/day

59
Q

An additional ___ mg/day of zinc should be given to hypermetabolic patients

A

2

60
Q

Patients with EC fistulae, diarrhea, and intestinal drainage may require up to ___-___ mg of zinc per liter of lost fluid

A

12-17

61
Q

What is the recommended dose of copper in parenteral nutrition?

A

0.3-0.5 mg/day

62
Q

What is the recommended dose of manganese in parenteral nutrition?

A

55 mcg/day

63
Q

What is the recommended dose of chromium in parenteral nutrition?

A

10-15 mcg/day

64
Q

What is the recommended dose of selenium in parenteral nutrition?

A

60-100 mcg/day

65
Q

What minerals are not routinely included in standard trace element preparation?

A

-Iron
-Iodine
-Molybdenum

66
Q

With cholestatic liver disease, what minerals should be omitted from parenteral nutrition?

A

-Copper
-Manganese

67
Q

What are the available forms of sodium in parenteral nutrition?

A

-Phosphate
-Chloride
-Acetate

68
Q

What are the available forms of potassium in parenteral nutrition?

A

-Phosphate
-Chloride
-Acetate

69
Q

What form of calcium is given in parenteral nutrition?

A

Gluconate

70
Q

What form of magnesium is given in parenteral nutrition?

A

Sulfate

71
Q

We may need to increase electrolytes if someone has…

A

-Abnormal losses (urinary, GI, or dermal)
-Refeeding syndrome

72
Q

We may need to decrease electrolytes if someone has…

A

-Renal failure
-Congestive heart failure

73
Q

Individual electrolytes can be adjusted to correct ____

A

Abnormalities

74
Q

Acid-base balance is usually maintained by using equal amounts of ____ and ____ (1:1 ratio)

A

Chloride and acetate

75
Q

If someone is having metabolic acidosis, provide more ____

A

Acetate

76
Q

If someone is having metabolic alkalosis, provide more _____

A

Chloride

77
Q

Parenteral nutrition product ____ are a major problem in the United States

A

Shortages

78
Q

Shortages are due to…

A

-Manufacturing issues
-Company closures
-Drug recalls
-Companies can’t keep up with demand

79
Q

Shortages affect both ____ and ____

A

Macronutrients and micronutrients

80
Q

The result of product shortages is serious adverse patient outcomes, leading to…

A

-Use of suboptimal alternatives
-Errors
-Inadequate nutrition
-Deficiencies

81
Q

Strategies to manage parenteral nutrition shortages:

A

-Assess each patient for need for parenteral nutrition
-Use oral or enteral nutrition when possible
-Assess at an individual level the need for specific nutrients
-Prioritize patients
-Rationing: providing 50% dose of MVI or MVI 3x/week; ILE 1x/week

Advanced Medical Nutrition Therapy II (19 decks)

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