Nutritional Considerations In The Surgical Patient

Front 1

2. How much glycogen do we store in our body? Where?

Back 1

a. 12 hours worth
b. Liver and skeletal muscle

Front 2

3. What does decreased glucose lead to?

Back 2

a. Increase glucagon→ gluconeogenesis

Front 3

4. What are FFA broken down into?

Back 3

a. Ketone bodies

Front 4

7. What is the half-life of albumin?

Back 4

a. 18 days

Front 5

8. What is the half-life of prealbumin?

Back 5

a. 2-4 days

Front 6

9. What is albumin?

Back 6

a. Heptatically produced long-term indicator of nutritional status
b. Replacement helps oncotic pressure but NOT nutritional status
c. Negative acute-phase protein

Front 7

10. What does low albumin indicate?

Back 7

a. Increased mortality with albumin <3.5
b. Albumin <3 relative contraindication to non-emergent surgery

Front 8

11. What does low albumin due to the liver?

Back 8

a. Causes cirrhosis

Front 9

12. What does albumin do to the kidneys?

Back 9

a. Nephrotic syndrome

Front 10

13. What does low albumin do to GI?

Back 10

a. Protein losing enteropathy
b. Malabsorption

Front 11

14. What does low albumin do to burns?

Back 11

a. Plasma loss due to lack of skin barrier

Front 12

15. What is prealbumin?

Back 12

a. Hepatically produced short-term indirect indicator of nutritional status

Front 13

16. What do you use to calculate BMR?

Back 13

a. Harris-Benedict equation

Front 14

17. What is the average need of kcal/kg/d for most people?

Back 14

a. 25-35 kcal/kg/d

Front 15

18. What is the ideal body weight for males?

Back 15

a. 106 lbs for the first 5 feet
b. +6 lbs for each additional inch

Front 16

19. What is the ideal body weight for females?

Back 16

a. 100 lbs. for the first 5 feet
b. +5 lbs. for each additional inch

Front 17

20. What is BMR?

Back 17

a. Energy expenditure necessary to maintain physiologic homeostasis while at rest

Front 18

21. When should you add 25% to BMR?

Back 18

a. Mild peritonitis
b. Long bone fracture
c. Mild to moderate injury

Front 19

22. When should you add 50% to BMR?

Back 19

a. Multi-organ failure
b. Severe injury

Front 20

23. When should you add 100% to BMR?

Back 20

a. Burns>40% TBS

Front 21

24. How should you modify Harris-Benedict in obese patients?

Back 21

a. (Ideal body weight)+(actual-ideal)/2
b. OR multiply BMR by a stress factor of 1.25

Front 22

25. What is protein broken down into?

Back 22

a. Glutamine
b. Alanine

Front 23

26. How can you calculate protein intake?

Back 23

a. 6.25g of protein intake=1g nitrogen
b. N(intake)= g protein/6.25

Front 24

27. What is the trick with fluid loss?

Back 24

a. Remember to match losses!

Front 25

28. What will an NG suction tube lead to?

Back 25

a. Hypochloremia
b. Hypokalemia
c. Metabolic alkylosis

Front 26

29. What is enteral administration?

Back 26

a. Through GI tract

Front 27

30. What is parenteral administration?

Back 27

a. Peripheral→ arm, leg
b. Central→ subclavian, IJV, femoral

Front 28

31. Why is enteral administration preferred over parenteral?

Back 28

a. Less expensive
b. Preserves gut functionality
c. Safer
d. Supports mucosal immunologic function and helps maintain gut flora

Front 29

32. What are the enteral administration routes?

Back 29

a. PO
b. Oral-gastric
c. Naso-gastric
d. Gastrostomy/jejunostomy tube

Front 30

33. What are the contraindications for enteral nutrition?

Back 30

a. Intestinal obstructioin
b. Prolonged postoperative ileus/hypomotility
c. Short bowel syndrome
d. Severe GI tract bleeding
e. Severe diarrhea
f. Inability to gain GI tract access

Front 31

34. When is TPN used?

Back 31

a. Conditions when enteral nutrition is contraindicated
b. Can be adjunct

Front 32

35. What do you need to monitor in a patient on TPN?

Back 32

a. MONITOR BLOOD SUGAR
b. Consider SSI with regular accu checks

Front 33

36. What is required for TPN?

Back 33

a. Venous access with a dedicated line to avoid contamination

Front 34

37. What are the contraindications for TPN?

Back 34

a. Adequately functional GI tract
b. Hemodynamic instability

Front 35

38. What is the anticipated treatment for TPN?

Back 35

a. <7 days

Front 36

39. What is the respiratory quotient?

Back 36

a. Ratio of CO2 produced to O2 produced
b. Measurement of energy expenditure

Front 37

40. What is the respiratory quotient for fats, proteins, and carbs?

Back 37

a. Pure fat=0.7
b. Pure protein=0.8
c. Pure carb=1.0

Front 38

41. What is the ideal respiratory quotient?

Back 38

a. 0.8

Front 39

42. What does a respiratory quotient >1 mean?

Back 39

a. Lipogenesis→ overfeeding

Front 40

43. What does a respiratory quotient<0.7 mean?

Back 40

a. Ketosis and fat oxidation→ starving

Front 41

44. What is the principle energy source in starvation?

Back 41

a. Fat

Front 42

45. What is refeeding syndrome?

Back 42

a. Patients using secondary metabolism for energy
b. TPN causes shift to glucose metabolism→ hypophosphatemia
c. Can’t manufacture ATP

Front 43

46. What is the insulin spike in refeeding syndrome lead to?

Back 43

a. Hypokalemia
b. Hypomagnesemia

Front 44

47. What can refeeding syndrome lead to?

Back 44

a. Respiratory failure
b. Nasusea
c. Vomiting
d. Arrhythmias
e. Mental status changes

Front 45

48. How can you avoid refeeding syndrome?

Back 45

a. 18 kcal/kg/day and 1.5g protein/day
b. Monitor electrolytes 1-2x/day
c. Begin at approximately 60% of patient’s goal

Front 46

49. How should hypokalemia be corrected in refeeding syndrome?

Back 46

a. Hypokalemia should be corrected via a secondary source→ volume bolus

Front 47

50. When should you advance calories to avoid refeeding syndrome? How much should you advance them per day?

Back 47

a. Only if hemodynamically and cardiovascularly stable
b. Advance about 100 kcal/day if indicated