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