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56 Cards in this Set

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B6 (pyridoxine)
infantile seizures, peripheral neuritis, dermatitis, glossitis, microcyic anemia
B1 (thiamine)
beriberi (peripheral neuritis, loss of vibration sense, cramping legs)
CHF
Wernicke's, Korsadoff's
lactic acidosis
B5 (niacin)
pellagra (rough skin), dermatisis, diarrhea, dementia, glossitis, stomatitis, vaginitis, achlorhydria
folate
megaloblastic anemia, neutropenia, diarrhea, poor growth
vitamin E def
creatinuria, necrosis of voluntary muscle, ataxia, peripheral neuropathy, hemolytic anemia, ophthalmoplegia (), weakness, hyporeflexia
Ca
ostemalacia, osteoporosis, tremor, seizure, tetany, arrhytmia
biotin
dermatitis, alopecia, organic acidemia, seizures, ataxia
Iron
microcytic anemia, malabsorption
vitamin D
Rickets (craniotabes, rachitic rosary, thickened wrists, ankles, bowing lower extremities), infantiles tetany,
Zinc
growth failure (dwarfism), skin/nail lesions, poor wound healing, alopecia, delayed puberty, impaired immune system
vitamin A
night blindness, conjunctival drying, Bitot spots (silvery grey spots on conjunctiva), photophobia
vitamin C
tenderness in legs, pseudoparalysis, spongy blue gums
vitamin K
hypoprothrombinemia, hemorrhagic diesase of newborn
magnesium
tremor, tingling, weakness, siezure, arrhythmia
preterm infant formula, fat content
medium chain triglycerides, easier to absorb. no bile required. transported directly to liver, do not need to be esterified into chylomicrons
preterm infant Ca:Phos ratio
2:1 to 4:1
preterm formula, carbs
glucose polymers. Not lactose, relatively lactase deficient.
preterm formula, protein
whey (lactalbumin) more than casein. 60:40. similar to breast milk. term formulat might be 20:80.
nonprotein energy goal for VLBW infant
nonprotein >30kcal/kg prevents neg nitrogen balance. later >70kcal/kg
use of Na in VLBW infant
no Na for first week, then 3-6meq/kg daily
protein requirement of newborn
3.5-4g/kg/day
vit K cofactors
II, VII, IX, X both PT and PTT
vit K deficiency sx, complications
bleeding in breastfed infants, 1st week. GI and intracranial bleeds.
metronidazole in breastfeeding
discontinue BF for 24hrs after single dose therapy for trichomonas. If on 7 day therapy, no BF for that week.
TPN, fats start and max
1g/kg up to 4g/kg. Stop if hyperbili present (they can bump off protein bound bili)
high polyunsaturated fats in preterm infants
causes hemolytic anemia, reticulocytosis, throbocytosis if not mixed wtih enough vit E.
nutritional differences breastmilk vs cow
same caloric density. human milk has less protein. whey:casein humans 80:20. formula 40:60. lactose same in both. more fat in cow milk
most common complication of enteral feeds
diarrhea.
diet modification in liver failure
increase fat sol vitamens. med chain fatty acids (more easily absorbed than long chain.
folate deficiency anemia cytology
macrocytic, hypersementation of neutrophils.
vit A toxicity
HA, extremity pain, HSmeg. tibial eedema. seen in teens on isotretinoin.
percent increase in calories req for each degree of temp elevation
12% of maintenance req per degree centigrade over 37.
familial hypophosphatemia
most common non-nutitional form of rickets. xlinked. renal leak of phosphate. calcitriol does not treat. elevated alk phos. nl Ca and parathyroid hormone.
vit D deficiency
inadequate intake of vit D. or not enough sunlght. rickets associated with low phosphate, low-nl Ca, hi alk phos.decreased renal tubular reabsorption of phos and hyperparathyroidism 25-hydroxyD is low
vit D-independent rickets, type I
no 1 alpha-hydroxylase enzyme in prox tubule. 25-hydroxyvit D is nl. 1,25 dihydroxy D is 0. (type I is analogous to DM)
vit D dependent rickets, type II
end-organ resistance to vit D. high 1,25 dihydroxyvit D. (type II analgous to DM)
percent of infants with cross allergy to soy protein from milk protein
50%
most common cause of anemia in CRF on epo
Fe Deficiency
composition of colostrum vs mature milk
Colostrum: more protein (mostly whey), little fat. 50kcal/dL
Mature: lots of fat (very long chain), 70kcal/dL
lactose is same in both. Ca 30mg/dL is same, phos 14mg/dL same.
major component of whey
alpha lactalbumen
vitamin supp for BF
4-6 mo of age. Fe 1mg/kg
Vit D for dark skin or low sunlight 400IU
how long can express milk be used
48hrs refrigerated. frozen if used later
contraindications to BF
galactosemia, tyrosinemia, HIV mother, mother undergoing cancer therapy or other drug therapy contraindicated.
weight gain in 1st yr
0-3mo: 20-30g/day
3-6mo: 15-20g/day
6-12mo: 10-15g/day
VLBW energy req
100-120kcal/kg to achieve 15g/day growth
VLBW protein intake
3.5-4g/kg/day
VLBW fat intake
50% of calories, medium chain TG and vegi oils. no very long chain fats (DHA, arachadonic acid)
VLBW carb req
10-14g/kg/day 40-50% of calories
refeeding syndrome
giving too much carbs to chronicly malnourished can induce resp failure.
preterm osmole needs
immature kidneys do not retain or concentrate as well. more Na, K, and everything needed so higher osmolality to preterm formula.
decreased sense of taste.
zinc def. common in Chron's
best way to improve nutrition in CHF like hypoL
NG feeds continuous.
purpose of lactose derived oligosaccharaides in milk
inhibit bacterail adhesion to mucosal surfaces
change in AA and DHA over time with milk
same in preterm milk and term. declines with evolving lactation.
change in Zn over lactation
decreases with time
complications of increasing to 30kcal/oz with standard formula and fat in kids iwth chronic illness
diarrhea from incraeased solute load. electrolyte imbalance rare if done correctly.