1. Tutoring 5/3/17 Melanie Jaeger mjaeger3@uthsc.edu
Nutrition support
Tutoring 5/3/17
Melanie Jaeger

2. Metabolic Concepts

3. Patient DM (5’11” 150 lbs) is getting the following TPN regimen: D300, C60, IL50. How many kcal/kg/day is he receiving?
D=dextrose
C=Clinisol (amino acids)
IL=Intralipid (fat)
1760 kcal total
25.8 kcal/kg/day

4. What is the ASPEN recommendation for BG control for most patients?
80-100
<180
<140 D

5. What is the most accurate method of nutritional assessment?
Bioelectrical impedance analysis
BMI CT
Skinfold measurements C.

6. Which of the following surrogate markers is the best representation of acute nutritional status?
Albumin
Pre-albumin
Transferrin
Serum protein B

7. Match the following conditions with their nutritional assessment categories.
Burn
Anorexia nervosa
COPD
Starvation-related malnutrition
Chronic-disease related malnutrition
Acute disease related malnutrition
A-3
B-1
C-2

8. Patient PH’s nitrogen balance is +7
Patient PH’s nitrogen balance is +7. Which of the following statements is true about PH?
PH is in nitrogen equilibrium.
PH is in an anabolic state.
PH is in a catabolic state.
PH is losing muscle mass. B

9. Nutritional requirements

10. Generally, how many kcal/kg/day should be provided to a patient in which weight maintenance would be appropriate?
35 kcal/kg/day
20 kcal/kg/day
25 kcal/kg/day
30 kcal/kg/day C

11. MK is a 24 yo, 80 kg M s/p MVC with TBI
MK is a 24 yo, 80 kg M s/p MVC with TBI. Which of the following would be an appropriate amount of protein for him to receive per day?
65 g
100 g
120 g
180 g D

12. Parenteral Nutrition

13. Note: if the gut works, use it!

14. Which of the following statements is true?
The osmolality limit of PN administered peripherally is 1200 mOsm/kg.
Volume-restricted patients should get PN through a central line.
A 0.22 micron filter is used for TPNs containing lipids.
Clinimix is appropriate for patients who will be on PN for an extended period of time. B

15. Which of these CAN be added to TPN?
Calcium chloride
Iron dextran
Sodium phosphate
Sodium bicarbonate C

16. Around what TG level should lipids and propofol be stopped?
100
200
300
400
500 D

17. Which trace element(s) should be held in patients with liver failure?
Zinc
Copper
Chromium
Manganese
Selenium
B&D

18. You are on the nutrition support team for KD
You are on the nutrition support team for KD. Her ABG’s lead you to believe KD is in metabolic acidosis. Her K is 3.1. What form of potassium should be added to her TPN?
Potassium chloride
Potassium acetate
Potassium cannot be added to TPN. Bolus KD with 40 mEq KCl.
KD’s K level is normal. Do not give any additional K. B

19. Enteral nutrition

20. Match the disease state with the appropriate EN formulation.
Chemically-defined, nutritionally-complete (Vivonex RTF)
Polymeric, nutritionally-complete, concentrated (Nutren 2)
Concentrated, low protein, low or no electrolyte (Suplena)
Supplemented with arginine, glutamine, omega-3 FA (Impact)
AKI without dialysis
Short bowel syndrome
Multiple trauma
Fluid restricted
A-2
B-4
C-1
D-3

21. Which of these statements is true?
Soluble fiber adds bulk to the stool.
Bismuth subsalicylate is the preferred agent for treatment of diarrhea with EN.
Gastric residuals >100 are an indication to stop EN.
Erythromycin 1g IV q6h is an appropriate treatment for elevated gastric residuals. B

22. Other lectures

23. Nutrition in Liver Failure
cirrhosis
Risk of hyperglycemia
Elevated aromatics, decreased BCAA
Acute hepatitis
Risk of hypoglycemia
Both aromatics and BCAA are elevated but aromatics more elevated than BCAA
-pts are at risk of hypoMg, hypophos, hypoCa (if hypoMg)
-at risk of Wernicke’s: give thiamine before any carbs are given in TPN or EN!
-NO copper or manganese!

24. Nutrition in Obesity
Obese patients will burn their own fat if you give them a hypocaloric diet
Give more protein to obese patients
Need more protein to get the same anabolic effect (~2.5 g/kg/day)
Do not give a hypocaloric, high protein diet to obese patients with renal failure or hepatic disease

25. Which of these is not true about geriatric patients?
Have a decreased total body water
More concentrated urine
Impaired thirst
Susceptible to hyperkalemia B

26. PK is a patient with AKI who will be starting dialysis in two days and will be receiving intradialytic protein. How much protein should PK receive per day for now?
0.8 g/kg/day
1.2 g/kg/day
2 g/kg/day
2.5 g/kg/day B

27. PK is now on CRRT. How much protein does he need now per day?
0.8 g/kg/day
1.2 g/kg/day
2 g/kg/day
2.5 g/kg/day D

28. Which trace element needs to be held in patients with renal failure?
Copper
Manganese
Selenium
chromium
C (MTE-4)

29. Drug-Nutrient Interactions
Isoniazid-vitamin B6 deficiency (give pyridoxine!)
MetforminVit B12 malabsorption
What drugs do you hold EN for?
Phenytoin capsules: 2 hours before and after
Warfarin: 1 hour before and after

30. D 30%, AA 85 mL/hr
How many grams of each macronutrient is the patient getting?
How many g/kg of protein?
How many kcals?

31. D20%, AA5%, 75 mL/hr 70 kg
How many g/kg/day of protein? How many kcal/day from dextrose? How many kcal/day from protein? What percent of total daily calories are from dextrose?
1.2 g/kg/day of protein
360 kcal/day from fat
1224 kcal/day from dextrose
360 kcal/day from protein
62% of kcal from dextrose