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CNSC Exam > Pediatric Parenteral Nutrition > Flashcards

Pediatric Parenteral Nutrition Flashcards

1
Q

what is the maximum GIR of a pediatric patient

A

14 mg/kg/min

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2
Q

in PN, dextrose should provide between _______% kcals

A

40-60% kcals

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3
Q

in PN, fat should provide between _____% calories

A

20-40% kcals

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4
Q

providing over ____% of fat in pediatric patients can cause ketosis

A

60%

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5
Q

how much lipid is needed to prevent EFA deficiency

A

0.5 g/kd/day soy based lipids

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6
Q

what are symptoms of pediatric essential fatty acid disease

A

scaly rash
increased susceptibility to infection
poor wound healing
poor growth

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7
Q

are TNA’s recommended for neonates/infants

A

no

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8
Q

which amino acids are needed in greater amounts in infants less than 1 years old when TPN is given

A

tyrosine

histadine

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9
Q

which amino acids are needed in lesser amounts in infants less than 1 years old when TPN is given

A

phenylalanine
methionine
glycine
more acidic pH

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10
Q

which amino acid is conditionally essential in infants <1 years old as it is used for neural transmission and bile acid conjugation

A

taurine

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11
Q

why is taurine a conditionally essential amino acid in infants on PN <1 years old

A

it is needed for neural transmission and bile acid conjugation

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12
Q

why is a low pH desirable in infant PN

A

it increases phosphorous and calcium solubility

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13
Q

in infant PN , the amino acid profile is based on

A

human milk

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14
Q

preterm neonates, infants and children require how much sodium in PN

A

2-5 mEq/kg sodium

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15
Q

children over 50 kg require how much sodium in PN

A

1-2 mEq/kg

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16
Q

preterm neonates, infants and children require how much potassium

A

2-4 mEq/kg

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17
Q

children over 50 kg require how much potassium in PN

A

1-2 mEq/kg

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18
Q

preterm neonates require how much calcium in TPN

A

2-4 mEq/kg

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19
Q

infants and children require how much calcium in TPN

A

0.5-4 mEq/kg

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20
Q

children over 50 kg require how much calcium

A

10-20 mEq total

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21
Q

preterm neonates require how much phosphate in TPN

A

1-2 mmol/kg

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22
Q

infants and children require how much phosphate in PN

A

0.5-2 mEq/kg

23
Q

infants over 50 kg require how much phosphate

A

10-40 mol total

24
Q

preterm neonates, infants and children require how much magnesium in PN

A

0.3 to 0.5 mEq/kg

25
Q

children over 50 kg require how much magnesium in PN

A

10-30 mEq total

26
Q

which trace element needs to be increased in infant TPN if there is enter cutaneous fistulae or diarrhea

A

zinc

27
Q

which trace element needs decrease in infant TPN during cholestasis

A

manganese

28
Q

patients with cholestasis can develop _____ within the first 3 weeks of starting PN as they have difficulty excreting it from lack of bile flow

A

hypermanganesemia

29
Q

what are symptoms of hypermanganesemia in infants/neonates

A

irritability

seizures

30
Q

if an infant develops hypermanganesemia during PN infusion, what should be done

A

decrease the amount or take it out of PN

31
Q

Multitrace-4 Neonatal PN MVI and Multitrace-4 Pediatric PN MVI contains all trace elements as adults EXCEPT

A

selenium

32
Q

which trace element is NOT in multi-trace 4 PN MVI

A

selenium

33
Q

what are the important functions of selenium for infants and children

A

converts thyroid to its active form
antioxidant
needed for proper enzyme and immune function

34
Q

Selenium is not included in the Multi-trace MVI for infant PN and infants are at risk for deficiency. If an infant or neonate is on PN for over 1 month how should selenium be supplemented

A

2 mcg/kg/day

35
Q

_______ deficiency is associated with microcytic anemia & neutropenia

A

copper

36
Q

________ (along with manganese) should be eliminated or decreased in PN in children with cholestasis as it is removed by bile which is inhibited in cholestasis

A

copper

37
Q

_____ deficiency is associated with growth failure and hair loss and loss is exponential during high GI output including diarrhea

A

zinc

38
Q

when should zinc be added to infant PN

A

diarrhea, high GI output

39
Q

if a child has cholestasis, how can PN be altered to be more liver friendly

A

reduce lipids
cycle PN
decrease copper & manganese
keep the GIR within normal limits

40
Q

there is no _____ in pediatric PN MVI and there needs to be an exogenous source given for long term PN infants

A

iron (and selenium)

41
Q

______ is supplemented with long term TPN infants to assist in fat oxidation and use

A

Carnitine

42
Q

______ is a shuttle for long chain fatty acids that bring fatty acids across the mitochondrial membrane for beta oxidation

A

carnitine

43
Q

when carnitine is deficient, what are the consequences

A

increased triglycerides
increased total bilirubin
hypoglycemia
increased All Phos

44
Q

how much carnitine should be supplemented in deficiency (PN) x

A

v

45
Q

____ improves tolerance to IV fat emulsions in children/infants

A

carnitine

46
Q

what amino acid is added to preterm infant/infant PN to decrease pH and increase calcium/phosphorous solubility

A

cysteine

47
Q

how can aluminum be managed in PN

A

choose PN components with the lowest aluminum amount

48
Q

what is the max amount of aluminum per FDA guidelines

A

5mcg/kg/day

49
Q

which types of children are at an increased risk of aluminum toxicity

A

renal disease (cannot excrete well from the kidneys)

50
Q

hyperaluminemia is associated with

A

Metabolic Bone Disease

Encephalopathy

51
Q

how often should trace elements be checked on children with LT PN

A

check in 3 months after initiation, then every 3-6 months thereafter

52
Q

how often should fat soluble vitamins Be checked on children with LT PN

A

check in 6 months then annual thereafter if results are normal

53
Q

which anthropometric measures are used to evaluate if a child is malnourished

A

weight
height
mid upper arm circumference

CNSC Exam (32 decks)

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