14121592
Description
Flashcards by Jennifer Huber, updated more than 1 year ago
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Created by Jennifer Huber
almost 6 years ago
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| Question | Answer |
| Caloric Need | ~20-25cal/kg/day |
| Fat Calories | 9cal/g |
| Protein Calories | 4cal/g |
| Carbohydrate Calories | 4cal/g |
| Dextrose Calories | 3.4cal/g |
| Nutritional Requirement of Protein | 20% protein 1g protein/kg/day (20% of these should be amino acids) |
| Nutritional Requirement of Fat | 30% Fat important for essential fatty acids |
| Nutritional Requirement of carbohydrate | 50% carbohydrate |
| Trauma, Surgery and sepsis increase the kcal requirement by how much? | 20-40% |
| Pregnancy increases kcal requirement by how much? | 300kcal/day |
| Lactation increases kcal requirement by how much? | 500kcal/day |
| Calorie requirements for burn victims | 25kcal/kg/day + (30kcal/day x %burn) |
| Protein requirements for burn victims | 1-1.5g/kg/day + (3g/d x %burn) |
| Fever increases basal metabolic rate by how much? | 10% for each degree above 38C |
| Equation to calculate caloric need if overweight | weight = [(actual wt - ideal body wt) x 0.25] + Ideal Body Wt |
| Harris Benedict Equation for Men | BMR = (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) + 5 |
| Harris Benedict Equation for Women | BMR = (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) - 161 |
| Central Line TPN | glucose based; max glucose administration 3g/kg/h |
| Peripheral Line Parenteral Nutrition | Fat based |
| Fuel for Colonocytes | Short chain fatty acids ex butyric acid |
| Fuel for small bowel enterocytes | glutamine |
| Primary Fuel for neoplastic cells | Glutamine |
| MC amino acid in blood stream and tissue | Glutamine |
| Approximate half life of albumin | 18 days |
| Approximate half life of Transferrin | 8 days |
| Approximate half life of Prealbumin | 2 days |
| Normal Protein Level | 6.0-8.5 |
| Normal Albumin level | 3.5-5.5 |
| Normal Pre-albumin Level | 15-35 |
| Acute indicators of nutritional status | #1 pre-albumin retinal binding protein transferrin |
| Equation for Ideal Body Weight for Men | 106lbs + 6lb for each inch over 5feet |
| Equation for Ideal Body Weight for Women | 100lb + 5 lb for each inch over 5 ft |
| Preoperative signs of severe malnutrition | Acute Weight Loss >15% in 6months Albumin <3.0 |
| Indication for pre-op nutrition | Patients with severe malnutrition undergoing major abdominal or thoracic procedures |
| Respiratory Quotient (RQ) > 1 | Lipogenesis (overfeeding) |
| Respiratory Quotient (RQ) <0.7 | Ketosis and Fat Oxidation (starving) |
| Treatment if RQ > 1 | decrease carbohydrates and caloric intake |
| Treatment RQ < 0.7 | increase carbohydrates and caloric intake |
| RQ = 0.7 | Pure Fat Utilization |
| RQ = 0.8 | Pure Protein Utilization |
| RQ = 1.0 | Pure Carbohydrate Utilization |
| RQ = 0.825 | Balanced Nutrition |
| What are the 3 Postoperative Phase? | 1) Diuersis 2) Catabolic 3) Anabolic |
| Diuresis Phase | Post-op days 2-5 |
| Catabolic Phase | Post-op days 0-3 negative nitrogen balance |
| Anabolic Phase | Post-op days 3-6 positive nitrogen balance |
| How long does it take for glycogen stores to be depleted? | 24-36hrs of starvation (2/3 skeletal and 1/3 in liver) |
| Gluconeogenesis precursors | Amino acids (esp alanine) lactate, pyruvate, glycerol |
| What is the primary substrate for gluconeogensis? | Alanine |
| Amino Acids that increase during times of stress | alanine and phenylalanine |
| In late starvation, where does gluconeogenesis occur? | kidneys |
| What is the main source of energy in starvation and in trauma? | Fat (Ketones) |
| How long can people tolerate without eating? | 7days, after that place a Dobbhoff tube or start TPN |
| When to place a PEG tube | when regular feeding isn't possible or predicted to not occur for >4weeks |
| Feeding through gut as opposed to TPN helps prevent what? | bacterial translocation (bacterial overgrowth, increased permeability d/t starved enterocytes, bacteremia) |
| What do you do when patient develops diarrhea while on tube feeds? | Slow the rate, add fiber, less concentrated feeds |
| What do you do for patient with high gastric residuals while on tube feeds? | Reglan, Erythromycin |
| Name 4 Obligate Glucose Users | peripheral nerves adrenal medulla RBCs, WBCs |
| What is refeeding syndrome? what day do you usually see symptoms? | occurs when feeding after prolonged starvation/malnutrition shift from fat to carbohydrate metabolism symptoms usually on day 4 |
| Effects of Refeeding Syndrome on electrolytes | Decreased K, Mg, PO4 |
| Patients with refeeding syndrome can develop what? | cardiac dysfunction, profound weakness, encephalopathy, CHF, failure to wean from ventilator |
| How to prevent refeeding syndrome | re-feed at a low rate (10-15kcal/kg/day) |
| Cachexia | anorexia, weight loss, wasting thought to be mediated by TNF-alpha glycogen breakdown, lipolysis, protein catabolism |
| Kwashiorkor | Protein Deficiency edema, and an enlarged liver with fatty infiltrates. Sufficient calorie intake |
| Marasmus | severe undernourishment look emaciated |
| Effects of Major Stress on the Body | increase catecholamines, cortisol, cytokines protein breakdown - negative nitrogen balance hepatic urea formation |
| 6.25g of protein equals how much nitrogen? | 1g of nitrogen |
| Protein synthesis in a health 70kg male | 250g/day |
| Majority of protein breakdown from skeletal muscle | glutamine (#1) alanine |
| What accounts for 90% of nitrogen loss? | Urea cycle |
| What is the primary NH3 donor? | Glutamine |
| What are Micelles? | aggregates of bile salts, long-chain free fatty acids, and monoacylglycerides enters enterocytes |
| Fat Soluble Vitamins | A, D, E, K |
| Chylomicrons | 90% TAGs, 10% phospholipids/proteins/cholesterol enters lymphatics |
| Fats that enter the portal system | medium and short chain fatty acids |
| Lipoprotein Lipase | on endothelium of liver and adipose tissue clears chlyomicrons and TAGs from blood breaks them down to FAs and glycerol |
| Saturated Fatty Acids | used for fuel by cardiac and skeletal muscles |
| Unsaturated Fatty Acids | used as structural components for cells |
| Hormone Sensitive Lipase (HSL) | in fat cells breaks fown TAGs to FAs and glycerol (sensitive to GH, caetcholamines, glucocorticoids) |
| Essential Fatty Acids | Linolenic and Linoleic Acids needed for prostaglandin synthesis (LCFA) important for immune cells |
| Glucose and Galactose | Carbohydrates absorbed by secondary active transport Na gradient formed by ATPase released into portal vein |
| Fructose | carbohydrate facilitated diffusion released into portal vein |
| Sucrose | Fructose + Glucose |
| Lactose | galactose + glucose |
| Maltose | glucose + glucose |
| Protein Digestion | Begins with stomach pepsin, then trypsin, chymotrypsin and carboxypeptidase |
| Trypsinogen | released from pancreas and activated by enterokinase (released from duodenum) activates other pancreatic protein enzymes |
| Branched Chain Amino Acids | Leucine, Isoleucine, Valine Metabolized in muscle they are essential AA |
| Name the Essential Amino Acids | Leucine, Isoleucine, valine, histidine, lysine, methionine, phenylalanine, threonine, tryptophan |
| Non-essential Amino Acids | Those that start with A, G, or C plus serine, tyrosine and proline |
| Central Venous TPN General Composition | 10% amino acid solution 25% dextrose solution Na, Cl, K, Ca, Mg, PO4, acetate Minerals and Vitamins |
| Lipid supply separate from TPN | 10% lipid solution (1.1kcal/cc) 20% lipid solution (2kcal/cc) |
| Purpose of Acetate for TPN | buffer to increase pH of solution |
| Vitamin to add separately from TPN | Vitamin K |
| Vitamins to add to patient with ETOH abuse while on TPN | Thiamine Folate Multivitamin |
| Long term TPN complication | Cirrhosis |
| Short term TPN complication | line issues like ptx or infxn |
| Chromium Deficiency | hyperglycemia, encephalopathy, neuropathy |
| Selenium Deficiency | Cardiomyopathy, weakness |
| Copper Deficiency | pancytopenia |
| Zinc Deficiency | Poor Wound Healing |
| Phosphate Deficiency | Weakness, encephalopathy, decreased phagocytosis |
| Thiamine deficiency | Wernicke's Encephalopathy Cardiomyopathy Beriberi |
| Pyridoxine (B6) Deficiency | Sideroblastic Anemia Glossitis Peripheral Neuropathy |
| Cobalamin (B12) Deficiency | Megaloblastic Anemia Peripheral Neuropathy Beefy Tongue |
| Folate Deficiency | Megaloblastic Anemia Glossitis |
| Ascorbic Acid Deficiency | Scurvy, poor wound healing |
| Niacin Deficiency | Pellagra (diarrhea, dermatitis, dementia) |
| Essential FA Deficiency | Dermatitis, Hair Loss, Thrombocytopenia |
| Vitamin A Deficiency | Night Blindness Bitot Spots |
| Vitamin K Deficiency | Coagulopathy |
| Vitamin D Deficiency | Rickets, Osteomalacia, Osteoporosis |
| Vitamin E Deficiency | Neuropathy |
| What is the Cori Cycle? | lactate from anaerobic glycolysis in muscles moves to the liver and is converted to glucose, which then returns to the muscles and is metabolized back to lactate |
| Metabolic Syndrome | Need 3 Obesity, insulin resistance (glucose >100), High TAGs (>100), Low HDL (<50), HTN |
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