18 Questions
Which of the following is a hallmark sign of refeeding syndrome?
Hypophosphatemia
What is a predisposing condition for refeeding syndrome?
Chronic alcohol consumption
For at-risk patients, what is the recommended approach before initiating nutrition to prevent refeeding syndrome?
Correct baseline electrolyte abnormalities
What is a risk associated with excessive dextrose infusion in total parenteral nutrition (TPN)?
Hypertriglyceridemia
In liver complications associated with TPN, what can excessive fat accumulation in liver cells due to overfeeding lead to?
Hepatic steatosis
What should be the composition of Lipids, Dextrose, and Protein in a balanced PN nutrition to help prevent hepatic steatosis?
20% Lipids, 50% Dextrose, 30% Protein
What is the main factor determining the risk of hyperglycemia in parenteral nutrition?
Rate of infusion
In the context of parenteral nutrition, how can the risk of hyperglycemia be minimized?
Adding regular insulin to the regimen
Which patient is at higher risk of hyperglycemia during parenteral nutrition?
A diabetic patient receiving steroids
What is the recommended maximum dextrose infusion rate to minimize the risk of hyperglycemia?
Between 4-6 mg/kg/min
In a patient who has been unable to eat and has lost weight, what complication should be monitored for when initiating parenteral nutrition?
Referral syndrome
Which laboratory parameter is crucial to evaluate when assessing a patient’s nutritional status?
Prealbumin levels
Which of the following complications is associated with hypertriglyceridemia?
Hypoglycemia
What is the normal range for prealbumin levels in the body?
15 to 45 mg/dL
In non-stressed individuals, lower values of which protein are associated with malnutrition?
Albumin
When evaluating the patient's body mass index (BMI), what does a lower weight indicate?
Severe malnutrition
Which of the following is a potential complication of parenteral nutrition related to liver function?
Hyperbilirubinemia
What should be monitored weekly to evaluate the progress of nutrition therapy?
Prealbumin levels
Study Notes
Refeeding Syndrome
- Reintroduction of nutrition after prolonged fasting or starvation can cause refeeding syndrome
- Hypophosphatemia is a hallmark sign of refeeding syndrome
- Symptoms include electrolyte abnormalities (K, Mg, P), glucose intolerance, severe fluid shifts, sodium/fluid retention, and vitamin deficiencies
- Can cause acute respiratory failure and cardiac failure
Predisposing Conditions
- Chronic starvation
- Prolonged fasting (> 10 days)
- Significant unintentional weight loss (> 15% weight loss within 3-6 months)
- BMI < 16 kg/m2
- Chronic alcoholism
- Anorexia
- Morbid obesity with massive weight loss
- Not fed for 7 to 10 days
- Malabsorption syndrome
Prevention and Treatment
- Correct baseline electrolyte abnormalities before initiating nutrition
- Advance nutritional regimen slowly (over 3-5 days)
- Include vitamin replacement in the supplementation (thiamine 100 mg; folic acid 1 mg)
Liver Complications
- Hepatic steatosis (excessive fat accumulation in liver cells)
- Cholestasis
- Cholelithiasis
Managing Hyperglycemia
- Limit dextrose infusion rate to less than 4 mg/kg/min
- Monitor blood glucose levels
- May add regular insulin (goal < 180 mg/dL)
- Start dextrose below the goal and advance as tolerated
- Allow endogenous insulin to regulate the glucose level of the body
Nutritional Assessment
- Calculate the patient's body mass index (BMI) and compare it to the average
- Evaluate the patient's albumin or prealbumin levels
- Evaluate the patient's ability to eat
- Evaluate the patient's stress factor (severity of diagnosis)
- Evaluate the patient's diet history
- Calculate ideal body weight (IBW) using the formula: IBW (female) = 45.5 + 2.3*(height over 60 inches)
Complications of Parenteral Nutrition
- Hyperglycemia
- Hypertriglyceridemia
- Refeeding syndrome
- Liver complications
- Fluid and electrolyte imbalances
- Infection and infusion-related reactions
Learn about refeeding syndrome, a potentially life-threatening condition that can occur when nutrition is reintroduced after prolonged fasting. Understand the hallmark signs, symptoms, and predisposing conditions of refeeding syndrome.
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