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Surg Lec Nutrition

Surgery I

Prevalence of malnutrition in hospitalized pts 15-50%
Cachexia Loss of wt, appetite, mx atrophy, & weakness; usu signifies an underlying dz
Kwashiorkor acute visceral protein depletion; usu children
Marasmus Simple starvation
Body composition is divided into: fat mass & lean body mass
Early vs late starvation Early: proteolysis is dominant; late: body adapts to conserve protein, fat becomes major energy source
Fat mass: % of total body wt? 25-35% TBWt;
Lean mass: % of total body wt? 40% TBWt;
Lean body mass composition 60% skeletal mx; 20% RBC & conn tissue; 20% organ tissue
peripheral neuropathy may be due to deficiencies in: niacin, thiamine, vitamin B6, vitamin B12
Primary means of measuring protein (nitrogen) balance in body: urine urea nitrogen
marker for significant nutritional depletion: body wt that is: less than 90% of the usual or ideal body wt
percentage of total body protein contained in skeletal muscle 60% (this is major site of protein catabolism during starvation and/or illness)
Most widely used biochemical marker of muscle mass 24 hr urine creatinine
Creatinine is: degradation product of creatine, an energy storage compound located in skeletal muscle
Most common test to measure breakdown of protein Urinary urea nitrogen
Lean body mass represents: the critical cellular mass necessary for cellular structure & function; 40% of total body weight; Depletion is severe insult & defines pt morbidity & mortality
Skin fold thickness is a reasonable estimate of adipose caloric reserves because: 50% total body fat is subQ; fat is lost proportionally from central stores and subcutaneous tissue
Creatinine- height index (CHI) level that defines skeletal muscle depletion CHI < 80%
Serum albumin half life: 18 - 20 d
Normal serum albumin = > 3.5 g/dL
Serum prealbumin: Sensitive to: acute changes in nutrient intake
Resting energy expenditure is calculated by using: Harris-Benedict equation
In pts who have sustained injuries, calculate resting energy expenditure by: bedside indirect calorimetry to determine VO2 and VCO2 (Weir Formula)
Catabolic Index (CI): measures: severity of stress (CI = UUN – 0.5 (dietary nitrogen intake) + 3 g)
Routes for delivering nutrition Enteral; enteral plus vein; central venous
Preferred route for delivering nutrition enteral
Created by: Adam Barnard Adam Barnard