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82 Cards in this Set

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Define marasmus
Overtly malnourished
Define Kwashikor's.
'chubby cheekers'
malnourished, but do not necessarily look malnourished

Assess by looking at anthropometrics
Central line feeding: what are the options?
Subclavian artery: might not be far enough, greater chance of phlebitis

Superior vena cava: can give more irritating solutions

3000-5000 mOsm solution
How long can you leave the peripheral TPN in befor irritation/phlebitis develops?
Can take 2 days but can extend to 4 days (if you use subtherapeutic intervention with HC succinate which is water soluble)

Could even last 7 days in patient with a strong bundle where vein is huge
Inflammation leads to _____
infection
What is the size difference in Dobhoff tube verse NG tube?
Dobhoff is smaller tube, NG tube is larger and can cause irritation and inflammation quickly
Define graft versus host disease.
Cells grow really fast here:
1. Liver
2. Diarrhea
3. Dermatitis
Name the 8 important things in nutrition support.
Fluid status,
Macronutrients: AA, CHO, fat
Micronutrients: electrolytes, trace elements and vitamins
Pharmacy: meds
Daily urine output.
1.5-2L
Normal/Average BSA = ?
1.5-2 m2
Normal bowel movement = ? g
200 g/day
What is BUN?
urea
High or Low BUN is not really concerning

Can indicated pre-renal problems
What is fractional Sodium excretion? What are poor values?
=[(urea sodium/plasma sodium)/(urea creat/plasma creat)]

<1 then prerenal
>1 then nephrosis
What are the main pathophysiologic features of re-feeding syndroms?
Abnormalities in fluid balance
Abnormaliities in glucose metabolism
Vitamin deficiency (eg thiamine)
Hypophosphatemia
Hypomagnesemia
Hypokalemia
What is roux-en-y?
A small stomach pouch is created with a stapler device. After the stomach pouch, the small intestines are divided and one end brought up and connected o the small stomach pouch using the stapler. The intestines are reconnected.1 The pouch is too small to hold large amounts of food, but fat absorption is substantially reduced as food bypasses the duodenum.2
Several studies have shown that people who experience significant weight loss can develop gallstones, often do not suffer any consequences or even know they have them
T/F Low BUN is pathognomic.
False
If a patient were to aspirate, what lung is it likely to go to?
Right
You need ____ and _____ to push amino acids into the cell.
Carbohydrates and fat
What happens when phosphate level is less than 2?
pulmonary compromise
2,3-diglycerophosphate is low, so there is a shift to the Left on the oxygen-hemoglobin curve
What happens when phosphate level is less than 1?
thrombocytopenia and leukopenia
What causes a LEFT shift in oxygen-hemoglobin dissociation curve?
alkalosis and hypothermia
decreasing pCO2, low PO4, sepsis
Adjust phosphate by _____ and magnesium by _____.
phosphate by 3 and magnesium by 4
What is a new medication for gout?
Etoricoxib: a COX-2 elective inhibitor

Febuxostat: 2nd line xanthine oxidase inhibitor
T/F TPN and fat are filtered
False, TPN is filtered, fat is not
What can cause hypertriglyceridemia?
DM, pancreatitis, sepsis, renal failure
What is AEIOU?
Reasons why we use dialysis:
A: Acid/Base
E: Electrolytes
I: Intoxication
O: Overload
U: Uremia
What is the amount of aa for a patient undergoing CVVHD?
1.7-2.5 g aa/kg
What is the time for recovery for stomach and small intestine after abdominal procedures (where surgeon may have handled/touched GI tract)?
Stomach: 1-3 days
Large intestine: 3-5 days
What is the green field filter used for?
Trap clots in the vena cava
What is a new treatment for paroxysmal hemoglobulinuria
Eclulizumab: IV infusion that works as a monoclonal antibody that binds to the human C5 complement protein to reduce hemolysis
______ or midline catheter can lead to vena cava syndrome (unilateral swelling on one side of the body).
subclavian
STAMP out hypoglycemia....stands for?
S: Salicylates
T: Theophylline
A: Anabolic, Alcohol
M: MAO inhibitors
P: Papaveridine
What are the effects of steroids?
Cataracts
Catabolic in tissue
Stimulate thyroid and albumin synthesis
Hyperglycemia
Buffalo hump (redistrib TG)
Losses of K+, Ca++, Zn, Vit C
What happens if hyperglycemia >180? >220 for 16 hrs?
1) >180: Polyuria
2) >220 for 16 hrs: complement fixation; glycation
What is glycation?
non-enzymatic glycosylation

the result of a sugar molecule, such as fructose or glucose, bonding to a protein or lipid molecule without the controlling action of an enzyme
What is the minimum level of cholesterol necessary?
25 mg/dL for LDL to bind to LDL receptor
A neutrophil:lymphocyte ratio >2.2 indicates what?
inflammation
What could indicate viral or fungus infection?
elevated monocyte level
An elevated neutrophil level could indicate?
bacterial infection
CPAP and PEEP ventilators require that you multiply BEE by?
15%
What is ECMO ?
extracorporeal mechanical oxygen

ie Iron lung if pt is in repiratory failure
Name 2 problems with ranitidine?
1) Tachyphylaxis
2) Immune-mediated thrombocytopenia
What can occur with patients that are on TPN for extended periods of time?
Gallbladder stasis (Cholestasis)

>30 days: 75% of patients have
>45 days: 100% of patients have
What can cause contraction of the gallbladder?
CCK: cholecystokinin
Cauruelin
Erythropoietin
Cisapride
Bethanechol
Prostigmine
Cholestyramine
What are the risk factors for lactobacillemia?
immunocompromised
persistent, prolonge neutropenia
Broad-spectrum ABx use
DM
Corticosteroids
Organ transplants
cancer (more common with AML)
Roux-en-y can distrub flora
How can you tell if patient is contracted?
Na,, BUN, insulin
If you leave ___ out of solution, then you can increase phosphate.
Calcium
Triglyceride level > 400 could indicate ....?
pancreatitis
How much nitrogen is there in blood?
31-34 g N per L of blood
What is the volume of one unit of blood?
500 mL
How much amino acids is there in blood?
100 g amino acids per unit of blood
At what age is there a decline in cellular immunity?
> 60 years old
What could cause different bp readings in different arms?
coarction of aorta
What antibiotics cause spuriously high creatinine?
Cephalosporins, if you pull SCr 30 min to 2 hrs around administration of ABX, will have spuriously high creatinine.
When would you not increase carbohydrates?
hypophosphatemia
steatosis (fatty liver)
Hypercapnea risk (eg COPD)
>60 units insulin/day
Insulin can cause _____ and _____
microalbuminuria and hypernatriuresis
What is an ilealconduit?
Ilial conduit is diversion of the urine due to diseased or injured bladder. The procedure consists of using a short part of the small intestine to which the ureters are attached and the other end is placed at the surface of skin (forming stoma).
With morbid obestiy, how would you calculate kcal to start TPN?
15-20 kcal/kg
When should you be concerned about BUN?
When it is 2x admitting BUN +20 (Really contracted when admitted) or when it is 80-90 as there is the possibility of encephalopathy
Iron: what is the side effect you are concerned with? where is it absorbed?
nausea (although IV iron anaphylaxis is possible) and duodenum, but can still absorb in short-gut patients.
What is the % absorption of iron?
10% normally
20% if anemia
What is the RDA for iron?
10 mg
What would be an indication of low copper?
Neutropenia
How quickly can a duodenal ulcer heal?
6 weeks
What is the enteral progression?
clear liquids (>1000 kcal to D/C TPN???)
full liquids
Soft foods
Mechanical
What are the vitamins that you are concerned with in alcoholism?
Vitamin B12: 1-2 yr stores, but depleted by cirrhosis
Folate: 2-3 month stores, but depleted by cirrhosis
Thiamine: 3 wks in WBC, 1 wk RBC???
Can quickly get Wernicke's encephalophathy, and can have brain death in 21 days without thiamine
What is the smallest measure that can be seen with the eye?
50 microns
What are Peyer's patches?
immune surveillance in intestine
What are Kupfer cells?
Macrophages in the liver
What happens if patient does not receive fat?
34% loss of phase 1
Tell me about GVHD.
Graft versus Host disease
Look at: dermatits, diarrhea, and liver
What are the three vitamins that can cause allergies?
B1, K1 and B12 (parabens)
What is pre-albumin?
transthyretin
What are Shistocytes?
degraded RBC
are at the site of insertion
If Ca-PO4 range is less than 30, that could indicate...?
hypoparathyroidism
If Ca-PO4 range is greater than 70, that could indicate...?
precipitate of CaPO4 in soft tissues, starting with kidney

Kidney shuts down first
What are the hallmarks of renal failure in dialysis patients?
High vitamin A and high aluminum
Define morbid obsesity and obesity.
Morbid obesity is 2xIBW and obesity is 30% over IBW
What are the kcal goals for patients in the hospital?
On floor: BEE*1.5
In ICU but not on vent or on A/C: BEE*1.15
In ICU on vent: BEE*1.3
What albumin levels would indicate a 'boggy gut'?
<2.2
How can you tell if patient is anabolic?
prealbumin should increase by 4 mg% per week
What is the gold standard for hypermetabolism?
VO2/m2