Response to Injury, Fluids and Nutrition

Question 1

Daily Requirement of Fluid

Answer 1

1500mL - 2500mL or 25-30 mL/kg

Question 2

most common cause of volume deficit in surgical patients

Answer 2

loss of GI fluids

Question 3

Formula for Anion Gap:
What is the normal value?

Answer 3

AG = Sodium - (Chloride + HCO3)
Normal value = <12 mmol/L

Question 4

Causes of High Anion Gap Metabolic Acidosis

Answer 4

MUDPILES
methanol
uremia
DKA
propylene glycole, paraldehyde
isoniaizid, infection, iron
lactic acidosis
ethylene glycol
salicylates

Question 5

Causes of Normal Anion Gap Metabolic Acidosis

Answer 5

HARD UP
hyperalimentation
acetazolamide
renal tubular acidosis
ureteroenteric fistula
pancreaticoduodenal fistula

Question 6

In hypocalcemia, neuromuscular and cardiac symptoms do not occur until at what level of calcium?

Answer 6

Ionized fraction falls below 2.5 mg/dL

Question 7

Symptomatic hyponatremia does not occur until sodium is at?

Answer 7

120 mg/dL

Question 8

Treatment for symptomatic and asymptomatic hyponatremia.

Answer 8

Symptomatic: 3% normal saline running no more than 1 mEq/L until it reaches 130mEq/L or symptoms are improved

Asymptomatic: correction should be no more than 0.5 mEq/L to a maximum increase of 12 mEq/L/d

Question 9

ECG changes in hyperkalemia

Answer 9

high peaked T waves
widened QRS complex
flattened P waves
prolonged PR interval

Question 10

Treatment for hyperkalemia

Answer 10

when ECG changes are present: calcium chloride or calcium gluconate

kayexalate - cation exchanges resin

Question 11

Treatment for hypokalemia

Answer 11

mild asymptomatic: oral repletion
KCL 40mEq per enteral access x 1 dose

asymptomatic hypokalemia: not tolerating enteral nutrition: KCl 20mEq IV q2h x 2 doses (slow infusion)

IV repletion: usually no more than 10 mEq/h

Question 12

What is the formula for Modified Broca?

Answer 12

Men: 110 lbs (50kg) for the first 5ft (152 cm) then add 5 lbs (2.3 kg) for each additional inch (2.54cm)

Women: 100 lbs (45 kg) for the first 5 ft then add 5 lbs (2.3 kg) for each additional inch (2.54cm)

Question 13

Formula for BMI

Answer 13

weight in kg / (ht in m) squared

Question 14

Harris Benedict equation

Answer 14

Female BEE:
665.10 + (9.56 x W) + (1.85 x H) - (4.68 x A)

Male:
66.47 + (13.75 x W) + (5 x H) - (6.76 x A)

where
W = actual weight in kg
H = height in cm
A = age in years

Question 15

estimated protein maintenance requirement for non stressed patients

Answer 15

0.8 - 1 g/kg/day

Question 16

Formula for Protein Requirement

Answer 16

Protein(g) = total kcal x (g Nitrogen/ 150 kcal) x (6.25g Protein/ g Nitrogen)

Question 17

Basal caloric requirement of a normal healthy adult

Answer 17

20-30 kcal/kg per day

Question 18

Phases of Surgical Metabolism:
characterized by reconstruction of body’s normal tissue perfusion and efforts to protect homeostasis

Answer 18

Ebb Phase

Question 19

Phases of Surgical Metabolism:
Decrease in total body energy and urinary nitrogen excretion

Answer 19

Ebb Phase

Question 20

Phases of Surgical Metabolism
provides compensating response to the initial volume replacement

Answer 20

Catabolic Phase

Question 21

Phases of Surgical Metabolism
Replacement of lost tissue

Answer 21

Anabolic Phase

Question 22

Identify the phases of surgical metabolism:
1. 24-48 hours
2. 1-2 weeks
3. months

Answer 22

1. Ebb Phase
2. Catabolic Phase
3. Anabolic Phase

Question 23

Identify the energy source for the following
1. short term fasting <5 days
2. prolonged fasting
3. after injury

Answer 23

1. muscles < lipids
2. ketone bodies
3. lipids

Question 24

Indications for Parenteral IV Nutrition (4)

Answer 24

1. Inability to absorb adequate nutrients via GI tract like massive short bowel resection, radiation enteritis, severe diarrhea, untreatable steatorrhea/malabsorption
2. complete bowel obstruction or intestinal pseudo-obstruction
3. severe catabolism with or without malnutrition when GI tract not usable within 5-7 days
4. inability to obtain enteral access

Question 25

potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial nutrients

Answer 25

refeeding syndrome

Question 26

electrolytes involved in refeeding syndrome

Answer 26

magnesium
potassium
calcium
phosphate

Question 27

provision of macronutrients in excess of metabolic demand

Answer 27

overfeeding