Special diets

Question 1

Side effects of ketogenic diet

Answer 1

1. poor growth ?due to ketosis
2. constipation
3. poor bone mineralization (acidosis promotes hypercalciuria–>stones)
4. high LDL (increase MCT, and carnitine and lower ketogenic ratio )
5. kidney stones (better with citrate)
6. worse GERD
7. Water soluble vit deficiency
8. Selenium deficiency

Question 2

why CF kids have low intake?

Answer 2

Nausea, vomiting
Anorexia
GERD
Constipation
DIOS

Question 3

why CF kids have malabsorption?

Answer 3

PA insufficiency
Liver/Biliary disease
SBBO (lots of abx)
DM
Short bowel/resection

Question 4

why CF kids have increased metabolic demand?

Answer 4

1. infections
2. resp distress
3. comorbid disease

Question 5

Energy requirements in CF

Answer 5

120-150 Kcal/Kg/day

Question 6

PERT

Answer 6

enteric coated, pH resistant microsphere (this protect enzymes from degradation in the stomach)

works best of given with PPI or H2RB

Given <30min before meal time

Dosing:
Infants 1000-2500 LPU/Kg/meal
Toddler 1000-2500 LPU/Kg/meal (<10,000/day)
Older children/adults 500 LPU/kg/meal, max 2500LPU/Kg/meal (<10,000/day)

Question 7

Side effects of PERT

Answer 7

1. Oral and perianal ulcers
2. colonic narrowing and intraluminal fibrosis (more in asc colon) with high doses

Question 8

CF kids ar risk of the following mineral and vitamin deficiency

Answer 8

ADEK
Na
Zn
Iron
Ca

Question 9

Low FODMAP Diet benefits

Answer 9

1. FODMAPS are poorly absorbed and osmotically increase fluid delivery in SI and colon –> distension
2. FODMAPS rapidly fermentable –> increase gases (H2, CO2,CH4) –> distension
3. FODMAPS are osmotically active
4. FODMAPS increase distension, bloating and alter motility

Question 10

Difference between pre and probiotics

Answer 10

pre: nondigestible foods that promote the growth of limited strain of bacteria. Eg: fructooligosaccharides

Prob: live microorganisms that provide beneficial effect

Question 11

Indications of probiotics in GI

Answer 11

1. IBD (VSL#3, in adults)
2. Pouchitis (VSL#3)
3. Decrease duration of diarrhea (infectious, Cdiff, chemo, traveler’s) –>sacrharomyces/Lactobacillus/Streptococcus
4. H.Pylori (adjunct to triple therapy)–>S.boullardii, Bifidobacterium, Lactobacillus
5. NEC (dec incidence and mortality) –>Bifidobacterium
6. IBD (dec sx)–>Bifidobacterium