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52 Cards in this Set

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What is the motto of surgical nutrition?

"If the gut works, use it"

What are the normal daily dietary protein requirements for adults?

1 g / kg / day

What are the normal daily dietary caloric requirements for adults?

30 kcal / kg /day

By how much is basal energy expenditure (BEE) increased or decreased in pts with severe head injury?

Increased ~1.7x

By how much is basal energy expenditure (BEE) increased or decreased in pts with severe burns?

Increased ~2-3x

What is the calorie content of fat?

9 kcal/g

What is the calorie content of protein?

4 kcal/g

What is the calorie content of carbohydrate?

4 kcal/g

What is the formula for converting nitrogen requirement / loss to protein requirements / loss?

Nitrogen x 6.25 = protein

What is RQ?

Respiratory Quotient: ratio of CO2 produced to O2 consumed

What is the normal RQ?

0.8

What can be done to decrease the RQ?

More fat, less carbohydrates



(decreased RQ = decreased CO2 produced relative to O2 consumed)

What dietary change can be made to decrease CO2 production in a patient in whom CO2 retention is a concern?

Decrease carbohydrate calories, and increase calories from fat

What lab tests are used to monitor nutritional status?

Blood levels of:


- Pre-albumin (t1/2 = 2-3 days)


- Transferrin (t1/2 = 8-9 days)


- Albumin (t1/2 = 14-20 days


- Total lymphocyte count


- Anergy


- Retinol-binding protein (t1/2 = 12 hours)

Which lab test is good for assessing acute change in nutritional status?

Pre-albumin (t1/2 = 2-3 days)

Which lab test is good for assessing chronic change in nutritional status?

Albumin (t1/2 = 14-20 days)

Where is iron absorbed?

Duodenum (proximal jejunum)

Where is vitamin B12 absorbed?

Terminal ileum

What are the surgical causes of vitamin B12 deficiency?

- Gastrectomy


- Excision of terminal ileum


- Blind loop syndrome

Where are bile salts absorbed?

Terminal ileum

Where are fat-soluble vitamins absorbed?

Terminal ileum

Which vitamines are fat soluble?

A, D, E, K

What are the signs of Vitamin A deficiency?

Poor wound healing

What are the signs of Vitamin B12 / Folate deficiency?

Megaloblastic anemia

What are the signs of Vitamin C deficiency?

Poor wound healing, bleeding gums

What are the signs of Vitamin K deficiency?

Decrease in vitamin K-dependent clotting factors (II, VII, IX, X); bleeding; elevated PT

What are the signs of Chromium deficiency?

Diabetic state

What are the signs of Zinc deficiency?

- Poor wound healing


- Alopecia


- Dermatitis


- Taste disorder

What are the signs of fatty acid deficiency?

- Dry, flaky skin


- Alopecia

What vitamin increases the PO absorption of iron?

PO vitamin C (Ascorbic Acid)

What vitamin lessens the deleterious effects of steroids on wound healing?

Vitamin A

What are the common indications for total parenteral nutrition (TPN)?

- NPO > 7 days


- Enterocutaneous fistulas


- Short bowel syndrome


- Prolonged ileus

What is TPN?

Total Parenteral Nutrition = IV nutrition

What is TPN?

- Protein


- Carbs


- Lipids


- (H2O, electrolytes, minerals/vitamins, +/- insulin, +/- H2 blocker)

How much lipid is in TPN?

20-30% of calories (lipid from soybeans, etc)

How much protein is in TPN?

1.7 g / kg / day (10-20% of calories) as amino acids

How much carbohydrate is in TPN?

50-60% of calories as dextrose

What are the possible complications of TPN?

- Line infection


- Fatty infiltration of liver


- Electrolyte / glucose problems


- Pneumothorax during placement of central line


- Loss of gut barrier


- Acalculus cholecystitis


- Refeeding syndrome


- Hyperosmolality

What are the advantages of enteral feeding?

Keeps gut barrier healthy, thought to lessen translocation of bacteria, not associated with complication of line placement, associated with fewer electrolyte / glucose problems

What is the major nutrient of the gut (small bowel)?

Glutamine

What is "refeeding syndrome"?

Decreased serum K+, Mg2+, and PO4 after refeeding (via TPN or enterally) a starving pt

What is an elemental tube feed?

Very low residue tube feed in which almost all of the tube feed is absorbed

Where is calcium absorbed?

- Duodenum (Actively)


- Jejunum (Passively)

What is the major nutrient of the colon?

Butyrate (and other short-chain fatty acids)

What must bind B12 for absorption?

Intrinsic Factor from the gastric parietal cells

What sedative med has caloric value?

Propofol delivers 1 kcal/cc in form of lipid

Why may all insulin placed in TPN bag not get to pt?

Insulin will bind to IV tubing

What is the best way to determine the caloric requirements of a pt on the ventilator?

Metabolic chart

How can serum bicarb be increased in pts on TPN?

Increase acetate (which is metabolized into bicarb)

What are trophic tube feeds?

Very low rate of tube feeds (usually 10-25 cc/hr) which are thought to keep mucosa alive and healthy

When should PO feedings be started after a laparotomy?

Classically after flatus o stool PR (usually post-op days 3-5)

What is the best parameter to check adequacy of nutritional status?

Pre-albumin