Podcast
Questions and Answers
What is the caloric need approximately for an average healthy adult male?
What is the caloric need approximately for an average healthy adult male?
- 25-30 calories/kg/day
- 30-35 calories/kg/day
- 20-25 calories/kg/day (correct)
- 15-20 calories/kg/day
How many calories are provided by 1g of fat (lipids)?
How many calories are provided by 1g of fat (lipids)?
- 9 calories/g (correct)
- 11 calories/g
- 7 calories/g
- 5 calories/g
What percentage of protein calories is required for an average healthy adult male?
What percentage of protein calories is required for an average healthy adult male?
- 25%
- 20% (correct)
- 10%
- 15%
How much does trauma, surgery, or sepsis stress increase the kcal requirement?
How much does trauma, surgery, or sepsis stress increase the kcal requirement?
By how much does pregnancy increase the kcal requirement?
By how much does pregnancy increase the kcal requirement?
What does the Harris–Benedict equation calculate based on?
What does the Harris–Benedict equation calculate based on?
Which vitamin deficiency can lead to night blindness?
Which vitamin deficiency can lead to night blindness?
What is the potential effect of a deficiency in thiamine (B1)?
What is the potential effect of a deficiency in thiamine (B1)?
Which mineral deficiency can lead to cardiomyopathy and weakness?
Which mineral deficiency can lead to cardiomyopathy and weakness?
What is the potential effect of a deficiency in cobalamin (B12)?
What is the potential effect of a deficiency in cobalamin (B12)?
Which vitamin deficiency can cause pellagra, characterized by diarrhea, dermatitis, and dementia?
Which vitamin deficiency can cause pellagra, characterized by diarrhea, dermatitis, and dementia?
What is the potential effect of a deficiency in pyridoxine (B6)?
What is the potential effect of a deficiency in pyridoxine (B6)?
Which mineral deficiency can lead to poor wound healing, alopecia, and rash?
Which mineral deficiency can lead to poor wound healing, alopecia, and rash?
Which nutrient deficiency is characterized by anorexia, weight loss, and wasting, and believed to be mediated by TNF-α?
Which nutrient deficiency is characterized by anorexia, weight loss, and wasting, and believed to be mediated by TNF-α?
Where does the majority of protein breakdown from skeletal muscle occur?
Where does the majority of protein breakdown from skeletal muscle occur?
Which nutrient cycle removes urea from the body with the help of kidneys?
Which nutrient cycle removes urea from the body with the help of kidneys?
Where does fat digestion primarily occur, involving the formation of micelles for absorption?
Where does fat digestion primarily occur, involving the formation of micelles for absorption?
Which fatty acids are essential for prostaglandin synthesis and immune cells?
Which fatty acids are essential for prostaglandin synthesis and immune cells?
In central venous TPN, what percentage of amino acid solution is typically included?
In central venous TPN, what percentage of amino acid solution is typically included?
What is the primary fuel for most neoplastic cells?
What is the primary fuel for most neoplastic cells?
In the respiratory phase, what does a high Respiratory Quotient (RQ) indicate?
In the respiratory phase, what does a high Respiratory Quotient (RQ) indicate?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
In the postoperative phases, which state has different nutritional requirements compared to diuresis and catabolic states?
In the postoperative phases, which state has different nutritional requirements compared to diuresis and catabolic states?
What is the maximum administration rate of glucose in Central line Total Parenteral Nutrition (TPN)?
What is the maximum administration rate of glucose in Central line Total Parenteral Nutrition (TPN)?
What should be considered to prevent refeeding syndrome?
What should be considered to prevent refeeding syndrome?
What is the potential effect of a deficiency in selenium?
What is the potential effect of a deficiency in selenium?
Which mineral deficiency can lead to alopecia, rash, and poor wound healing?
Which mineral deficiency can lead to alopecia, rash, and poor wound healing?
What is the potential effect of a deficiency in phosphate?
What is the potential effect of a deficiency in phosphate?
Which vitamin deficiency can lead to scurvy and poor wound healing?
Which vitamin deficiency can lead to scurvy and poor wound healing?
What is the primary effect of a deficiency in niacin?
What is the primary effect of a deficiency in niacin?
Which effect is associated with a deficiency in vitamin K?
Which effect is associated with a deficiency in vitamin K?
What is the potential effect of a deficiency in vitamin D?
What is the potential effect of a deficiency in vitamin D?
Which mineral deficiency can lead to hyperglycemia, encephalopathy, and neuropathy?
Which mineral deficiency can lead to hyperglycemia, encephalopathy, and neuropathy?
What is the potential effect of a deficiency in cobalamin (B12)?
What is the potential effect of a deficiency in cobalamin (B12)?
What does the Cori cycle involve?
What does the Cori cycle involve?
What is the primary fuel for most neoplastic cells?
What is the primary fuel for most neoplastic cells?
What does a high Respiratory Quotient (RQ) indicate in the respiratory phase?
What does a high Respiratory Quotient (RQ) indicate in the respiratory phase?
What occurs after prolonged starvation or malnutrition characterized by a shift from fat to carbohydrate metabolism?
What occurs after prolonged starvation or malnutrition characterized by a shift from fat to carbohydrate metabolism?
What should be considered to prevent refeeding syndrome?
What should be considered to prevent refeeding syndrome?
Which nutrient is preferred postoperatively to avoid bacterial translocation and TPN complications?
Which nutrient is preferred postoperatively to avoid bacterial translocation and TPN complications?
What fatty acids are essential for prostaglandin synthesis and immune cells?
What fatty acids are essential for prostaglandin synthesis and immune cells?
In the case of conditions like CVA where regular feeding is not possible, what can be considered for tube feeds?
In the case of conditions like CVA where regular feeding is not possible, what can be considered for tube feeds?
What can treat high gastric residuals?
What can treat high gastric residuals?
What does starvation initially deplete before switching to fat metabolism?
What does starvation initially deplete before switching to fat metabolism?
What mineral deficiency can lead to poor wound healing, alopecia, and rash?
What mineral deficiency can lead to poor wound healing, alopecia, and rash?
What is the major site of protein production and breakdown?
What is the major site of protein production and breakdown?
Which nutrient cycle removes urea from the body with the help of kidneys?
Which nutrient cycle removes urea from the body with the help of kidneys?
Where does fat digestion primarily occur, involving the formation of micelles for absorption?
Where does fat digestion primarily occur, involving the formation of micelles for absorption?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What is the primary fuel for most neoplastic cells?
What is the primary fuel for most neoplastic cells?
Which organ is the major stressor in increasing catecholamines, cortisol, and cytokines?
Which organ is the major stressor in increasing catecholamines, cortisol, and cytokines?
What should be considered to prevent refeeding syndrome?
What should be considered to prevent refeeding syndrome?
Which mineral deficiency can lead to poor wound healing, alopecia, and rash?
Which mineral deficiency can lead to poor wound healing, alopecia, and rash?
In central venous TPN, what percentage of dextrose solution is typically included?
In central venous TPN, what percentage of dextrose solution is typically included?
How many calories are provided by 1 gram of fat (lipids)?
How many calories are provided by 1 gram of fat (lipids)?
What is the primary fuel for most neoplastic cells?
What is the primary fuel for most neoplastic cells?
What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?
What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?
Which nutrient cycle removes urea from the body with the help of kidneys?
Which nutrient cycle removes urea from the body with the help of kidneys?
What is the potential effect of a deficiency in cobalamin (B12)?
What is the potential effect of a deficiency in cobalamin (B12)?
Which mineral deficiency can lead to poor wound healing, alopecia, and rash?
Which mineral deficiency can lead to poor wound healing, alopecia, and rash?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What is the potential effect of a deficiency in thiamine (B1)?
What is the potential effect of a deficiency in thiamine (B1)?
Which nutrient is the primary fuel for most neoplastic cells?
Which nutrient is the primary fuel for most neoplastic cells?
What is the approximate half-life of albumin?
What is the approximate half-life of albumin?
What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?
What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
In the postoperative phase, which state is characterized by diuresis (days 2-5)?
In the postoperative phase, which state is characterized by diuresis (days 2-5)?
What is the preferred nutrition method postoperatively to avoid bacterial translocation and TPN complications?
What is the preferred nutrition method postoperatively to avoid bacterial translocation and TPN complications?
What can be considered for tube feeds in conditions where regular feeding is not possible, such as CVA?
What can be considered for tube feeds in conditions where regular feeding is not possible, such as CVA?
Which mineral can lead to poor wound healing, alopecia, and rash if deficient?
Which mineral can lead to poor wound healing, alopecia, and rash if deficient?
Which vitamin deficiency can cause pellagra, characterized by diarrhea, dermatitis, and dementia?
Which vitamin deficiency can cause pellagra, characterized by diarrhea, dermatitis, and dementia?
Which effect is associated with a deficiency in vitamin K?
Which effect is associated with a deficiency in vitamin K?
What is the maximum recommended daily caloric intake for an average healthy adult male?
What is the maximum recommended daily caloric intake for an average healthy adult male?
How much can trauma, surgery, or sepsis stress increase the kcal requirement in percentage?
How much can trauma, surgery, or sepsis stress increase the kcal requirement in percentage?
By what percentage does pregnancy increase the kcal requirement?
By what percentage does pregnancy increase the kcal requirement?
Which equation calculates basal energy expenditure based on weight, height, age, and gender?
Which equation calculates basal energy expenditure based on weight, height, age, and gender?
What is the recommended protein requirement for an average healthy adult male in grams per kilogram per day?
What is the recommended protein requirement for an average healthy adult male in grams per kilogram per day?
What is the maximum recommended calorie intake for burns per day?
What is the maximum recommended calorie intake for burns per day?
How much does lactation increase the kcal requirement?
How much does lactation increase the kcal requirement?
What is the primary fuel for most neoplastic cells?
What is the primary fuel for most neoplastic cells?
What does a high Respiratory Quotient (RQ) indicate in the respiratory phase?
What does a high Respiratory Quotient (RQ) indicate in the respiratory phase?
What mineral deficiency can lead to hyperglycemia, encephalopathy, and neuropathy?
What mineral deficiency can lead to hyperglycemia, encephalopathy, and neuropathy?
What is the primary function of the urea cycle?
What is the primary function of the urea cycle?
Which nutrient is essential for prostaglandin synthesis and immune cells?
Which nutrient is essential for prostaglandin synthesis and immune cells?
Where does the majority of protein breakdown from skeletal muscle occur?
Where does the majority of protein breakdown from skeletal muscle occur?
What is the primary site of fat digestion, involving the formation of micelles for absorption?
What is the primary site of fat digestion, involving the formation of micelles for absorption?
Which nutrient is preferred postoperatively to avoid bacterial translocation and TPN complications?
Which nutrient is preferred postoperatively to avoid bacterial translocation and TPN complications?
What is the primary effect of a deficiency in niacin?
What is the primary effect of a deficiency in niacin?
What is the caloric need approximately for an average healthy adult male?
What is the caloric need approximately for an average healthy adult male?
Which mineral deficiency can lead to alopecia, poor wound healing, and rash?
Which mineral deficiency can lead to alopecia, poor wound healing, and rash?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism?
What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?
What does a high Respiratory Quotient (RQ) in the respiratory phase indicate?
Which mineral deficiency can lead to pancytopenia?
Which mineral deficiency can lead to pancytopenia?
What is the potential effect of a deficiency in pyridoxine (B6)?
What is the potential effect of a deficiency in pyridoxine (B6)?
What does a high TAGs level indicate in the context of metabolic syndrome?
What does a high TAGs level indicate in the context of metabolic syndrome?
What is the primary effect of a deficiency in niacin?
What is the primary effect of a deficiency in niacin?
Where does fat digestion primarily occur, involving the formation of micelles for absorption?
Where does fat digestion primarily occur, involving the formation of micelles for absorption?
What is the primary fuel for most neoplastic cells?
What is the primary fuel for most neoplastic cells?
What can be considered for tube feeds in the case of conditions like CVA where regular feeding is not possible?
What can be considered for tube feeds in the case of conditions like CVA where regular feeding is not possible?
By how much does pregnancy increase the kcal requirement?
By how much does pregnancy increase the kcal requirement?
What percentage of dextrose solution is typically included in central venous TPN?
What percentage of dextrose solution is typically included in central venous TPN?
What mineral deficiency can lead to osteomalacia and osteoporosis?
What mineral deficiency can lead to osteomalacia and osteoporosis?
Study Notes
-
Central line Total Parenteral Nutrition (TPN) uses glucose as the main component, with a maximum administration rate of 3 g/kg/h.
-
Peripheral line Parenteral Nutrition (PPN) is based on short-chain fats, such as butyric acid, which fuel colonocytes.
-
Glutamine is an essential amino acid, the most common one in the bloodstream and tissues, and plays a crucial role in small bowel enterocytes. It enhances immune function and is the primary fuel for most neoplastic cells.
-
Preoperative nutritional assessment involves evaluating the approximate half-lives of albumin (18 days), transferrin (8 days), and prealbumin (2 days). Normal protein and albumin levels are 6.0-8.5 and 3.5-5.5, respectively. Signs of severe malnutrition include acute weight loss (>20% in 3 months), low prealbumin levels (<15), and an energy deficit.
-
In the respiratory phase, the ratio of CO2 produced to O2 consumed (Respiratory Quotient, RQ) measures energy expenditure. A high RQ (>1) indicates lipogenesis and the need to decrease carbohydrates and caloric intake. A low RQ (<0.7) signifies ketosis and the need to increase carbohydrates and caloric intake.
-
In the postoperative phases, diuresis (days 2-5), catabolic (days 0-3), and anabolic (days 3-6) states have different nutritional requirements. Starvation or major stress (surgery, trauma, systemic illness) cause significant metabolic differences, with a shift from fat to a mixed fuel source, increased ketone body production, and gluconeogenesis.
-
With starvation, the body initially depletes glycogen stores and switches to fat metabolism. However, in trauma, protein-conserving mechanisms do not occur, and the energy source is a mixed fat and protein.
-
Enteral nutrition is preferred postoperatively to avoid bacterial translocation and TPN complications. In severely ill patients, it should be started within 24-48 hours and continued for at least 5-7 days, if not able to start regular feeding.
-
In the case of conditions like CVA where regular feeding is not possible, a PEG tube can be considered for tube feeds. Renal formulations should be used for patients with renal issues, while diarrhea requires a slow rate, fiber addition, and less-concentrated feeds.
-
High gastric residuals can be treated with medications like Reglan and erythromycin. Patients can tolerate about 5-7 days without eating and should start TPN at that point if not able to begin enteral nutrition.
-
Refeeding syndrome occurs after prolonged starvation or malnutrition and is characterized by a shift from fat to carbohydrate metabolism, which can lead to symptoms like decreased potassium (K), phosphorus (PO4), and magnesium (Mg), cardiac dysfunction, profound weakness, encephalopathy, congestive heart failure, and failure to wean from the ventilator. To prevent this, it is recommended to start re-feeding at a low rate (10-15 kcal/kg/day).
-
Ethanol abuse can cause malnutrition and, when combined with re-feeding, can lead to refeeding syndrome. Symptoms include a shift from fat to carbohydrate metabolism and a decrease in K, Mg, and PO4.
-
Cachexia: condition characterized by anorexia, weight loss, and wasting, believed to be mediated by TNF-α
-
Results in glycogen breakdown, lipolysis, and protein catabolism
-
Kwashiorkor: protein deficiency, Marasmus: starvation, major stressors increase catecholamines, cortisol, and cytokines (TNF-α, IL-1), leading to significant protein breakdown and negative nitrogen balance
-
Nitrogen balance: N in = protein intake (g), N out = urine N + 4g, protein synthesis for normal 70kg male is 250g/day
-
Liver: major site of protein production and breakdown, majority of protein breakdown from skeletal muscle is glutamine and alanine
-
Urea cycle: NH3 donor is glutamine, occurs in liver, removes urea from the body with the help of kidneys, accounts for 90% of total N loss
-
Homeostatic adjustments after injury, fat digestion: involves TAGs, cholesterol, and lipids, micelles formed for fat absorption, enterocytes absorb chylomicrons, long-chain fatty acids enter lymphatics, and medium-chain fatty acids into the portal vein
-
Essential fatty acids: linolenic and linoleic acids, needed for prostaglandin synthesis and immune cells
-
Carbohydrate digestion: begins in the mouth and continues in the small intestine, glucose, galactose, and fructose are absorbed, and the rest enters the portal vein
-
Protein digestion: stomach pepsin, followed by trypsin, chymotrypsin, and carboxypeptidase, amino acids absorbed by the gut, branched-chain amino acids are important in liver failure, and non-essential amino acids start with A, G, or C
-
Central venous TPN: contains 10% amino acid and 25% dextrose solutions, along with electrolytes, minerals, and vitamins, and lipids are given separately.
-
Cachexia: condition characterized by anorexia, weight loss, and wasting, believed to be mediated by TNF-α
-
Results in glycogen breakdown, lipolysis, and protein catabolism
-
Kwashiorkor: protein deficiency, Marasmus: starvation, major stressors increase catecholamines, cortisol, and cytokines (TNF-α, IL-1), leading to significant protein breakdown and negative nitrogen balance
-
Nitrogen balance: N in = protein intake (g), N out = urine N + 4g, protein synthesis for normal 70kg male is 250g/day
-
Liver: major site of protein production and breakdown, majority of protein breakdown from skeletal muscle is glutamine and alanine
-
Urea cycle: NH3 donor is glutamine, occurs in liver, removes urea from the body with the help of kidneys, accounts for 90% of total N loss
-
Homeostatic adjustments after injury, fat digestion: involves TAGs, cholesterol, and lipids, micelles formed for fat absorption, enterocytes absorb chylomicrons, long-chain fatty acids enter lymphatics, and medium-chain fatty acids into the portal vein
-
Essential fatty acids: linolenic and linoleic acids, needed for prostaglandin synthesis and immune cells
-
Carbohydrate digestion: begins in the mouth and continues in the small intestine, glucose, galactose, and fructose are absorbed, and the rest enters the portal vein
-
Protein digestion: stomach pepsin, followed by trypsin, chymotrypsin, and carboxypeptidase, amino acids absorbed by the gut, branched-chain amino acids are important in liver failure, and non-essential amino acids start with A, G, or C
-
Central venous TPN: contains 10% amino acid and 25% dextrose solutions, along with electrolytes, minerals, and vitamins, and lipids are given separately.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge of cachexia, kwashiorkor, and marasmus, as well as the physiological mechanisms and factors contributing to these conditions such as TNF-α, protein catabolism, and nitrogen balance.
