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32 Cards in this Set
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- Back
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Side effects of Tacrolimus |
renal insufficiency, hyperglycemia (DM2), GI, osteoporosis BUT you can decrease steroids! |
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Side effects of cyclosporine A |
nephro/hepato/neurotoxicity, HTN, hyperglycemia, HLD, osteoporosis, hyperK+/Mg+ |
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Side effects of cellcept |
birth defects, GI (N/D, reflux) BUT when taken with tacro & steroids, you can decrease tacro dose |
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Examples of steroids |
'sone, solu-medrol |
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Grapefruit interacts with? |
cyclosporine, tacrolimus, neoral |
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examples of prophylactics |
'zole(s) |
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Pre-transplant nutrition requirements: kcal pro cho fat Na supplements |
kcal = 1.2-1.3xBEE or 30-35 kcal/kg pro: min=1 g/kg, up to 1.8-2.0 g/kg; restrictionNOT recommended for encephalopathy CHO = 60% from complex CHO fiber: 20-30 g fat = 25-35%, < 7-10% kcal sat fat, < 300 mg cholesterol, no trans Na: 1.5-2 g Ca supp for osteopenia |
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When is EN recommended for pre-transplant pts? |
moderate-severe PEM; TPN only when EN contraindicated |
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Acute post-transplant nutrition requirements: kcal pro cho fat fluid vit/min electrolytes |
kcal: 130% BEE (using Harris Benedict, dry wt) or 35-40 kcal/kg pro: 1.5-2.0 dry wt CHO: 50-70% (limit simple CHO for hyperglycemia) fat: 30% fluid restriction as needed Vit/min: RDA electrolytes: monitor K, Na, Mg, P |
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Post-transplant: when do you begin oral diet? |
oral diet as soon as tolerated solids by 2nd or 3rd day |
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Discharge nutrition education: |
low Na: 2-4 g low fat/low cholesterol manage blood sugar (carb count, avoid simple/refined sugars) 20-30 g fiber Ca/Mg from food 8-10 cups H2O PA for weight! food safety: cook meats to correct T, ❌ raw fish/buffets/salad bars/undercooked eggs; wash F/V, proper food storage, leftovers within 1-2 days, hand hygiene |
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Post-transplant main goal? |
prevent/treat chronic dz assoc. w/ long-term post-transplant phase: obesity, HLD, HTN, DM2, osteoporosis |
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Post-transplant (3 months) nutrition requirements: |
kcal = 1.2-1.3xBEExAF to maintain wt (or 30-35 kcal/kg pro: 0.8-1 g/kg CHO = 50-60% from complex CHO fiber: 20-30 g fat = 25-35%, < 7-10% kcal sat fat, < 300 mg cholesterol, no trans Na < 4 g monitor K, P, Mg supps as needed fluid: 30-35 mL/kg |
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DM2 + obesity increases risk of? |
rejection |
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**MNT for hepatitis: kcal cho pro fat vit/min for acute/chronic? other recs? acute/fulminant (crisis)? |
kcal: 30-35 kcal/kg CHO: 50-55% - no low carb diets pro: 1-1.2 (acute), DRI (well-nourished chronic) fat: moderate to liberal if tolerated; limit if steatorrhea Na: no restriction supplement: B vit, Vit K, C, Zn small freq meals for anorexia crisis: EN |
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**MNT for alcoholism/alcoholic liver dz: management priorities: kcal: pro: CHO: Fat: supplements? |
priorities: abstinence, also: vit/min repletion, improved nutrition kcal: 1.2-1.5 x REE (min 30 kcal/kg) pro: 1-1.5 g/kg CHO: 50-55% (complex) Fat: 30-35% Supp: B vits: folate, thiamin, B12; Vit C Vit A,D,K, Min: Zn, Se, Ca, Mg, P |
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**MNT for cirrhosis: kcal pro Na fat Vit supp Fluid What do you NOT supplement? |
kcal: 35-40 kcal/kg IBW (d/t ascites) Pro: 1-1.2 dry wt, 1.5 (decompensated/malnourished) Na: 2g Fat: preferred fuel, (Inman: low to moderate: 25-40% kcal), encourage omega-3s, ↓LCFA if steatorrhea (if using MCTs make sure getting enough LCFAs to prevent deficiency) Vit: supp B complex, C, K, caution A & D, maybe water-soluble ADEK; min: Zn (common deficiency, dysgeugia) Fluid: (Inman) restriction of 1-1.5 L/day + moderate Na intake if hyponatremia DO NOT supp Fe, Cu, Mn b/c liver resp for filtering these & toxic levels could build up |
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Overall, what do you avoid in MNT for cirrhosis? What are you trying to maximize? |
unnecessary diet restrictions ↑strength/nutrition |
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**MNT for cirrhosis complications: varices ascites |
Varices: EN/PN usually not indicated, encourage PO sups, (Inman: low fiber) Ascites: ↓appetite, early satiety; diuretics, paracentesis, TIPSS, Na restriction (1-2 g) - could ↓PO intake, NO fluid restriction! |
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MNT for HE: What do you NOT restrict? Overall MNT for different stages: kcal pro fat Na fluid tips? AMS? |
MNT: ❌protein restriction even though breakdown ↑N! inadeq pro ↑catabolism and ascites! Stage 1/minimal: no specific recs, treat malnutrition Overt/stage 3-4: kcal: 35-40 kcal/kg IBW pro: 1.2-1.5, small meals fat: (Inman for Hepatic Failure & HE: 30-35% kcal from fat, with MCT if needed) Na restriction adequate fluid tips: late night snack (so body doesn’t break down muscle during sleep) EN for AMS pts |
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EN for advanced liver dz: kcal pro fat fiber omegas? |
kcal: high kcal density (1.5 kcal/ml) - you want low volume (100% RDA in 1000 ml) pro: 25% kcal (ex. promote & 2Cal) fat malabsorption - 50% kcal from fat (w/↑MCT conc.) soluble fiber lower n6:n3 ratio |
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MNT for NAFLD/NASH |
wt loss, healthy diet, exercise, low CHO/simple sugar restriction, avoidance of etoh & unnecessary meds; no specific treatments |
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What is etiology of malnutrition in liver dz? why? What are metabolic consequences? |
etiology: poor intake: d/t:N/V, taste changes (Zn def), early satiety, anorexia, etoh abuse (rec. social worker), overly restrictive diets (like Na), NPO status consequences? fat malabsorption Ca/fat sol vit malabsorption d/t cholestasis & ↓bile water sol vit malabsorption d/t etoh abuse metabolic ∆s: glucose intolerance, ↑pro/lipid catabolism |
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Treatment for Wilson's dz |
Cu binding meds, supp w/Zn, low Cu diet (❌shellfish, nuts, raisins, dried fruit/beans) |
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Treatment for Primary Sclerosing Cholangitis |
supplement ADEK |
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Treatment for Primary Biliary Cirrhosis |
VIt ADEK def & osteoporosis: monitor bone density, Ca/D supp, fat sol vit status yearly |
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A diet higher in ____ is recommended for HE? what foods have this/these? |
branch chain AAs b/c metabolized by skeletal muscle instead of liver (book says in theory, this will restore the balance b/t branched and aromatic and decrease the production of toxic neurotransmitters); foods: meat and dairy |
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**How is alcohol metabolized and how does it affect the liver? |
converted to acetaldehyde + H+ H+ replaces fat as fuel in Kreb's cycle --> fat accumulates in liver & in blood (as TGs) |
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**What do labs look like in alcoholic liver dz? |
2x greater AST:ALT elevated GGT |
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**in alcoholic liver dz, what nutrients are most responsible for malabsorption? Which nutrient deficiency responsible for Wernicke-Korsakoff syndrome? |
folate & protein thiamin |
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**for hepatic failure/ESLD, what could you try if pt not tolerating standard protein? |
altered neurotransmitter theory: BCAAs have decreased b/c muscle has used them up & AAAs (aromatic AAs) have increased b/c damaged liver is unable to clear them *use when standard therapy isn't working |
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**What is the standard treatment for HE? |
lactulose, or neomycin, or rifaximin |
