Term
| What Are the Essential Nutrients |
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Definition
| Not synthesized in the body in sufficient amounts. macronutrients and micronutrients |
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Term
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Definition
• Protein = essential amino acids
• Carbohydrate (e.g., dextrose)
• Fat = fatty acids
• Water |
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Term
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Definition
• Electrolytes
• Vitamins
• Minerals
• Trace elements |
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Term
| Dietary reference intakes (DRIs) |
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Definition
• Estimated average requirement (EAR)
• Recommended dietary allowances (RDAs)
• Adequate intake (AI)
• Tolerable upper limit (UL) |
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Term
| Estimated average requirement |
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Definition
| Adequate to meet the needs of 50% healthy individuals of specific age and sex. no clinical utility |
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Term
| Recommended dietary allowances |
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Definition
Same as EAR but
a) 97–99% of population, and b) additional physiologic conditions (e.g., pregnancy, lactation) except in infants <1 year old
clinical utility: Commonly used to determine essential nutrient requirements |
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Term
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Definition
When RDA is not determined:
– Infants <1 year old
– Certain nutrients
clinical utility: Commonly used with RDA |
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Term
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Definition
Highest level unlikely to pose a risk (data when available)
clinical utility: toxicology |
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Term
| Total energy macronutrient requirement |
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Definition
resting + activity energy
expenditure = 20–30 kcal/kg/day |
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Term
| Water macronutrient requirement |
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Definition
1 mL/kcal expenditure = 20–30
mL/kg/day |
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Term
| Protein macronutrient requirement |
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Definition
| 0.8 g/kg/day or 15% of total kcal/day |
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Term
| carbohydrate macronutrient requirement |
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Definition
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Term
| fat macronutrient requirement |
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Definition
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Term
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Definition
• Primary = marasmus
• Secondary = kwashiorkor +/- marasmus |
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Term
| Certain diseases, conditions, and sequelae of surgeries that can cause malnutrition |
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Definition
• Hepatic and/or renal failure
• Beriberi
• Chronic pancreatitis or pancreatectomy |
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Term
| medicxations that can cause malnutrition |
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Definition
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Term
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Definition
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Term
| Which is defined as adequate to meet needs of 50% healthy individuals of specific age and sex? |
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Definition
| Estimated average requirement (EAR) |
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Term
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Definition
• Metabolism: fat >>> carbohydrate and proteins
• Associated with end-stage cachexia
• Starved appearance
• Tricep skinfold (TSF) <3 mm
• Body mass index (BMI) <18.5 kg/m2 |
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Term
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Definition
• Metabolism: carbohydrate and proteins >>>> fat
• Associated with critical illness
• Well-nourished appearance:
TSF >3 mm and BMI >18.5 kg/m2
• Edema
• Hypermetabolic states: sepsis, extensive trauma, and burns |
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Term
| risk factors for malnutrition |
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Definition
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Term
| A 20-year-old male patient was just admitted to the surgical intensive care unit after extensive trauma from a multiple vehicle accident on interstate highway 95. He appears well-nourished, and his baseline BMI = 32 kg/m2. He has new-onset edema. This is |
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Definition
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Term
| Goals of nutrition support |
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Definition
• Support during systemic response to inflammation during critical illness
• Provide adequate nutrition during illness or injury recuperation |
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Term
| Specialized Nutritional Support SNS indication |
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Definition
impaired ability to ingest or absorb adequate nutrients
• Intubated on mechanical ventilation
• Dysphagia
• Gastric cancer
• Hyperemesis gravidarum |
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Term
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Definition
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Term
| Parenteral nutrition (PN) |
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Definition
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Term
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Definition
| feeding through PN exclusively |
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Term
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Definition
• Preexisting nutritional status
• Severity of systemic response to inflammation
• Anticipated clinical course
• Permissible time for NPO* before SNS initiation: 0–7 days
*Note: NPO = nil per os = nothing by mouth |
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Term
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Definition
• Primary advantage of PN over EN: greater customization
• Remove any essential nutrient
• Addition of medications within bag
• Overall: EN is preferred over PN
• Less severe complications and risk for
mortality
• Benefits from GI tract stimulation |
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Term
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Definition
• Pneumothorax (rare)
• Aspiration
- Gastric feeding
Management:
- Elevate head of the bed to 30 degree, post-
pyloric insertion, continuous infusion vs. “cycled,”
and/or anti-nausea medications
• Diarrhea
- Osmolality of formula
- Other causes (e.g., infection) Management: change formula, antidiarrheal, and/or antimicrobial medications
• Catheter occlusion
Management: medication-managed and/or exchange line
• Hyperglycemia (diabetics only) Management: change formula and/or insulin
• Fluid overload
Management: limit to 20 mL/kg/day and/or continuous infusion vs. “cycled” |
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Term
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Definition
• Pneumothorax
Management: training and radiograph confirmation
• Catheter and bloodstream infections - Mortality: 12–25%
Management: dedicated line and/or antimicrobial
medications
• Catheter occlusion and thrombosis
Management: medication-managed and/or exchange
line
• Hyperglycemia (even in non-diabetics)
Management: ↓ dextrose content and/or insulin
• Fluid overload
Management: limit to 20 mL/kg/day and/or continuous infusion vs. “cycled” |
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Term
| Benefits of EN on GI Tract |
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Definition
-Supports gut function
• Release of IgA antibody
• Secretion of GI hormones
• Maintains enteric barrier against enteric bacteria |
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Term
| Which of the following complications is exclusively associated with parenteral nutrition? |
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Definition
| Hyperglycemia in nondiabetics |
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Term
| Nutrition support pharmacist determined to start patient on Osmolite 1.5 for a 70 kg (BMI = 21 kg/m2) well-nourished patient, with goal kcal of 25 kcal/kg/day, through a continuous NGT infusion |
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Definition
a) Kcal/day requirement 70 kg x 25 kcal/kg/day = 1,750 kcal/day
b) Fluidrequirements=1mLper1kcal,therefore1,750 mL/day
c) Osmolite1.5=1.5kcal/mL,therefore1,750kcal/day÷ 1.5 = 1,166 mL/day of Osmolite
d) Add 584 mL of water (1,750 – 1,166 mL) to Osmolite
e) Infusion rate of Osmolite:1,166mL/day÷24hours= 48.5 mL/hour |
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Term
| Nutrition support pharmacist determined to start patient on PN for a 70 kg (BMI = 21 kg/m2) well-nourished patient, with goal kcal of 25 kcal/kg/day, through a continuous IV NGT infusion through a total nutrient admixture (TNA) bag |
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Definition
a) Kcal/day requirement 70 kg x 25 kcal/kg/day = 1,750 kcal/day
b) Fluidrequirements=1mLper1kcal,therefore1,750 mL/day
c) AA,lipid,anddextroserequirements
AA: 1,750 kcal/day x 0.15% 262.5 kcal = ~250 kcal/day Dext: 1,750 kcal/day x 0.5% = 875.5 kcal = ~900 kcal/day Lipid: 1,750 kcal/day x 0.35% = 612 kcal = ~600 kcal/day
d) Convert requirements to grams/day:
AA: ~250 kcal/day ÷ 1 g/4kcal = 62.5 g/day Dext: ~900 kcal/day ÷ 1 g/3.4 kcal = 264.7 g/day Lipid: ~600 kcal/day ÷2 kcal/mL = 300 g/day
e) Convert g/day to %:
AA: 62.5 g/day ÷1,750 mL x 100 mL/g = 3.5% Dext: 264.7 g/day ÷1,750 mL x 100 mL/g = 15% Lipid: 300 g/day ÷1,750 mL x 100 mL/g = 17% |
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Term
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Definition
• Essential nutrient requirements • DRIs
• Determinant factors (e.g., malnutrition)
• Marasmus and/or kwashiorkar • Current illness, TSF, BMI
• Overall: EN is preferred over PN
• Less severe complications and risk for
mortality
• Benefits from GI tract |
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