Surgical Metabolism and Nutrition Flashcards by Clyde Silverio

If a patient loses 5% of his weight it one month, is it considered _____ (significant or severe) weight loss

Significant

Severe: >5% in 1 month
at 3 months: significant 7.5%; severe >7.5%

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____ is an indirect measure of protein stores

Mid-arm muscle circumference

Triceps Skinfold Thickness - indirect measure of fat stores

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What is the formula in calculating Transferrin level based on the TIBC?

Transferrin = (0.8 x TIBC) - 43

Transferrin - transport of iron, half life of 8-10 days, target level 200-300 mg/dL

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What is the formula of absolute lymphocyte count?

ALC = WBC x % lymphocyte

Target: >2000

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What is the caloric requirement and protein requirement for non-stressed patient?

25-30kcal/day

0.8 to 1g/kg/day CHON

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Feeding tube is indicated in short term access only. What is the cut-off “week”?

<6-8 weeks

Long term: if more than 6-8 weeks

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A type of enteral formula that contains 2.0 kcal/mL and has intact nutrients

fluid restricted

Standard intact nutrient = 1kcal/mL, mostly lactose free, fiber containing, or fiber free

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Cite the contraindications for Total Parenteral nutrition

Functional GIT
Hemodynamically unstable
Hypovolemic, cardiogenic, or septic shock
Severe pulmonary edema, fluid overload
Anticipated treatment <5 days
Profound metabolic or electrolyte disturbances
Unable to obtain venous access
Prognosis doesn’t warrant aggressive nutritional support

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A type or parenteral nutrition support wherein the osmolarity is around 1500-2800 mOs/L, and requires administration into large veins at 2-6L/min, complete nutritional requirements

Centra parenteral nutrition

Peripheral parenteral nutrition - <900mOsm/day, low [dextrose], low [amino acid]

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____ is a fatal condition where the fluid shifts and electrolytes (presenting as fatigue, lethargy, muscle weakness, fluid overload, cardiac arrhythmia, hemolysis) that may occur in malnourished patients receiving artificial refeeding whether enterally or parenterally

Refeeding syndrome

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[severity of weight loss: significant/severe]

1 week 1 to 2%

significant

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[severity of weight loss]

It is considered a severe weight loss in 1 month if you lost ____ %

> 5%

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[severity of weight loss]

It is considered a severe weight loss in 3 months if you lost ____ %

> 7.5%

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[severity of weight loss]

It is considered a significant weight loss in 6 month if you lost ____ %

10%

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[BMI]

what is the BMI AP cut off for overweight

23 to 24.9

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[BMI]

what is the BMI AP cut off for Obese type 1

25 to 29.9

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[BMI]

what is the BMI AP cut off for underweight

<18.5

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[BMI]

what is the BMI AP cut off for normal

18.5 to 22.9

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transferrin ___ (increases/decreases) in

IDA, anemia of chronic diseases

increases

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transferrin ___ (increases/decreases) in

hemosiderosis, thalassemia, hemochromatosis

decreases

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What is the formula in determining transferrin based on TIBC?

Transferrim = (0.8 x TIBC) - 43

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The estimated protein requirement for non-stressed patient is?

0.8 to 1g/kg/day

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burn patients need ____ grams of protein per kg per day?

2.5

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[Phase of surgical metabolism]

decreased in total body energy; urinary nitrogen excretion

“reconstruction”

(+) efforts to protect homeostasis

Shock + hypoperfusion

EBB phase

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[Phase of surgical metabolism] "after operation phase" + "recovery from operation phase"

flow phase

[Phase of surgical metabolism] decreased BMR decreased Temperature Decreased O2 consumption

Ebb phase

[Phase of surgical metabolism] "after operation phase' compensating response to initial trauma and volume replacement

catabolic phase

[Phase of surgical metabolism] Increased BMR Increased Temperature Increased O2 consumption

catabolic flow phase

[Phase of surgical metabolism] repair - conserve blood and energy reserves

ebb phase

[Phase of surgical metabolism] replacement of lost tissue positive nitrogen balance

anabolic

{Energy source] Short term fasting

lipids

[Energy source] prolonged fasting

ketone bodies

[energy source] After suregery

lipids

[Enteral formula] used in patients with normal or near normal GI function 1 kcal/mL

Standard intact nutrients

[Enteral formula] used in patients with severely impaired GI absorption predigested low-fat content OR high Medium chain TG

elemental

[Enteral formula] Intact nutrients 2 kcalmL

Fluid restricted

[Enteral formula] low PO4, low K Intact nutrients

Renal

[Enteral feeding access] short term use aspiration risks

NGT

[Enteral formula] short term use lower aspiration risk

Nasoduodenal | nasojejunal

[Enteral formula] can last 12 to 24 months

PEG

[Type of PN support] High osmolarity Provides complete nutrition needs large veins with high blood flow

CPN or TPN

What is the usual osmolarity range for Total PNN?

1500 to 2800 mOm/L

[Type of PN support] Osmolarity <900 lower [dextrose] and [amino acids]

PPN

What are the indication for parenteral nutrition?

1. Inability to absorb adequate nutrients via the GIT 2. Complete bowel obstruction or intestinal pseuroobstruction 3. Severe catabolism within 5 to 7 days 4. Inability to obtain enteral access

What are the contraindications for PN

1. Functional GIT 2. Hemodynamically unstable 3. Anticipated treatment <5 days in the absence of severe malnutrition 4. Profound metabolic or electrolyte disturbances 5. Unable to obtain previous venous access

[complications of parenteral nutrition] vitamin deficiency

Vitamin K

[complications of parenteral nutrition] dry, scaly dermatitis and loss of hair

Essential FA deficiency

[complications of parenteral nutrition] Trace mineral deficiency

Zinc Copper Chromium

[complications of parenteral nutrition] diffuse eczematoid rash at intertiginous areas

zinc

[complications of parenteral nutrition] associated with glucose intolerance

chromium

[complications of parenteral nutrition] associated with microcytic anemia

copper

What are the electrolyte disturbances in metabolic syndrome?

1. Hypokalemia 2. Hypomagnesemia 3. Hypophosphatemia

What are the vitamin deficiency in metabolic syndrome?

thiamine deficiency

The electrolyte abnormalities in refeeding syndrome is due the increased uptake of what electrolytes and vitamins?

1. Glucose 2. Thiamine 3. K, Mg, PO4

[guess the electrolyte abnormality] Nausea, vomiting, weakness, confusion, HYPOTENSION

Hypermagnesemia Again, magkakafriends ang K, Mg, Ca

[guess the electrolyte abnormality] Nausea, vomiting, weakness, confusion, HYPERTENSION + Polydipsia

Hypercalcemia Again, magkakafriends ang K, Mg, Ca

[guess the electrolyte abnormality] ileus and constipation

HYPOkalemia

[guess the electrolyte abnormality] hyperreflexia seizures tetany muscle tremors

HYPO magnesemia Again, magkakafriends ang K, Mg, Ca

[guess the electrolyte abnormality] hyporeflexia paresthesia seizures

HYPOcalcemia Again, magkakafriends ang K, Mg, Ca

how will you prepare a GI solution?

1 ampule D50 + 5 to 10 units regular insulin + Bicarbonate 1 ampule