Lecture Notes
RQ for fat metabolism ONLY
0.7
to maintain N-balance, adults should consume _ g of protein/kg of body weight/day
0.8
RQ for typical (mixed) energy source
0.85
RQ for carbohydrate metabolism ONLY
1
for most purposes, fluid requirement can be estimated using caloric consumption with the following equation:
1 mL/kcal/day
significant weight loss is _% in 6 months
10
for women, method of Hamwi states that they should weigh _ pounds for first 5 feet, then _ pounds per each additional inch
100, 5
for men, method of Hamwi states that they should weigh _ pounds for first 5 feet, then _ pounds per each additional inch
106, 6
N-balance is maintained when protein intake constitutes _% of total calories consumed each day
12-15
_ method of diet history is fastest but may not represent a normal day of eating for the patient
24-hour dietary recall
for most hospitalized patients, _ method of taking a dietary history usually provides a sufficient overview of patient's dietary pattern
24-hour dietary recall
normal range for serum albumin
3.5-5
moderately malnourished person is _% of their usual body weight
75-84
mildly malnourished person is _% of their usual body weight
85-95
severely malnourished person is _% of their usual body weight
<75
anthropometric measure to determine severity of malnutrition
BMI
_ may be complicated by non-nutritional factors like muscle injury, some medication, inadequate renal function/incomplete urine collection, inaccurate height measurement, dietary meat intake
CHI
decrease in _ is usually interpreted as indicator of muscle wasting due to malnutrition
CHI
biochemical function impaired by vitamin B12/folate deficiency
DNA biosynthesis and cell division
_ complications of enteral feeding may include diarrhea or constipation
GI
N-balance =
N-intake - N-losses
if patient needs long-term nutrition support, do not use _ method of enteral nutrition
NG tube
non-nutritional factors that affect serum albumin levels (4)
RBC levels, liver disease, dehydration, pregnancy
equation for indirect calorimetry
REE
_ is REE*1.25*injury factor
TEE
a decrease in _, when combined with low serum albumin, is generally associated with a poor prognosis in hospitalized patients
TLC
significant day-to-day variation in WBC and differential counts limit _'s use in monitoring changes in nutritional status over time
TLC
N-losses equation
UUN + 4
TLC equation
WBC*lymphocyte differential
1.25 in TEE equation is the _ factor for typical hospitalized patient
activity
patients at risk for developing refeeding syndrome are those with _, chronic _ or _, morbid _ with excessive weight loss, prolonged _, significant _ and _, or NPO _ days
anorexia nervosa, malnutrition, alcoholism, obesity, fasting, stress, depletion, 7-10
parenteral solution that is a mixture of glucose and crystalline amino acids; mostly a 50:50 mix of essential and non-essential
base solution
2 potential benefits of including fiber in enteral feeding formula
bulk up stool, GI flora health
_ in enteral formula serves as source of energy; makes up 40-80% of total calories
carbohydrate
refeeding syndrome electrolyte abnormalities are associated with development of _, _ or even _
cardiac arrhythmia, confusion, death
parenteral catheter can be placed either _ (into distal vena cava or R atrium) or _ (cephalic vein)
centrally, peripherally
assuming normal renal function, amount of _ in urine is directly proportional to muscle mass
creatinine
_ nutrition support ingprovides delivery of nutrient solution (formula) to GI tract through feeding tube and is used to provide nutrition to patients with partial to completely functioning intestine
enteral
_ in enteral formula provides 20-30% of total calories
fat
_ in enteral formulas helps absorb certain vitamins, is a source of essential fatty acids
fat
_ method of diet history may present patient recall issues; patient may leave things out; patient may change from typical behavior because they are aware of being monitored
food diary
_ method of diet history taking requires less patient effort but is more general and presents recall issues on behalf of patient
food-frequency questionnaire
urinary excretion of creatinine over 24 hours is normalized for _ and _ and reported as CHI
height, sex
biochemical function impaired by iron deficiency
heme biosynthesis
refeeding syndrome is characteristically associated with 3 electrolyte abnormalities:
hypophosphatemia, hypomagnesemia, hypokalemia
_ is based on the measurement of gas exchange occurring across lungs using "metabolic cart"- oxygen consumed/CO2 produced correlates with energy utilization
indirect calorimetry
generally considered the "gold standard" for assessing energy requirements in clinical setting
indirect calorimetry
_ complication of parenteral feeding is catheter-related sepsis (Staphylococcal sp.)
infectious
_ complications of enteral feeding include S.aureus infiltration
infectious
factors other than vitamin K status that will influence PT test result (3)
lack of protein, bleeding disorder, anti-coagulation medication
parenteral solution supplied as an oil-in-water emulsion of either soybean and/or safflower oils
lipid emulsion
characteristic of anemia caused by vitamin B12/folate deficiency
macrocytic (increased MCV)
_ complication of parenteral feeding is misplacement of the feeding catheter
mechanical
_ complications of enteral feeding include size and misplacement of feeding tube
mechanical
_ complications of parenteral feeding are things like volume overload, hyperglycemia, refeeding syndrome, organ dysfunction (CO2 retention)
metabolic
common _ complications involved in enteral feeding are dehydration, electrolyte imbalance, hyperglycemia, weight loss/gain, visceral protein loss
metabolic
characteristics of iron-deficient anemia
microcytic, hypochromic (decreased MCV and MCH)
anthropometric measure to estimate muscle mass
mid-upper arm circumference (MAC)
_ nutrition support involves provision of nutrients to patient by route that by-passes GI tract- categorized as drugs by FDA
parenteral
_ in enteral formula is essential to maintain lean body mass (muscle)
protein
easily pluckable hair is indicative of _ deficiency
protein
edema and poor wound healing is a result of _ deficiency
protein
equation for N-intake
protein intake (g/day)/6.25
conditions that may cause N-balance to become negative (2)
protein malnutrition, over-active kidney
_ is a test of blood clotting routinely used to monitor extrinsic pathway (dependent on vitamin K)
prothrombin time
top 3 determinants of malnutrition according to SGA method
recent weight loss, muscle wasting, loss of subcutaneous fat
_ in mouth indicates general malnutrition
red, beefy tongue
biochemical basis for _ is that cells are using up all the P, Mg, and K from blood to make ATP
refeeding syndrome
potentially life-threatening complication that can occur in susceptible patients receiving enteral or parenteral nutritional support
refeeding syndrome
the metabolic and physiologic consequences of depletion, repletion, compartment shifts, and interrelationships of phosphorous, magnesium, potassium, glucose metabolism, vitamin deficiency, and fluid resuscitation
refeeding syndrome
conditions that may cause N-balance to become positive (5)
renal disease, growing children, excessive protein intake, pregnancy, recovery from starvation state
measurement that is an indicator of net metabolic fuel utilization
respiratory quotient (RQ)
_ is not a marker of day-to-day nutritional status due to its long half-life- more of a long-term indicator
serum albumin
since its synthesis in liver is dependent upon adequate amino acid supply, _ is commonly used as a general marker of nutritional status
serum albumin
if patient is at risk for pulmonary aspiration of enteral feeding, bypass _
stomach
_ integrates information elicited from patient's history and physical exam to facilitate immediate (bedside) assessment of nutritional status
subjective global assessment (SGA)
TEE stands for _
total energy expenditure
TLC stands for _
total lymphocyte count
parenteral solution that refers to combination of bas solution with lipid emulsion in single bag (sometimes called a 3-in-1 admixture)
total nutrient admixture
3 serum proteins other than albumin used as markers of nutritional status
transferrin, prealbumin, retinol-binding protein
anthropometric measure to determine an estimate of body fat reserves
triceps skin-fold thickness
UUN in N-loss equation stands for _
urea urinary N
deficiencies of what 5 nutrients may cause anemia?
vitamin B12, iron, protein, copper, folate
purpura is indicative of _ deficinecy
vitamins C, K
2 examples of anthropometric measures of nutrition
weight, height