Surgery I
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| Prevalence of malnutrition in hospitalized pts | 15-50%
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| Cachexia | Loss of wt, appetite, mx atrophy, & weakness; usu signifies an underlying dz
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| Kwashiorkor | acute visceral protein depletion. Usually children
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| Marasmus | Simple starvation
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| Body composition is divided into: | fat mass & lean body mass
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| Early vs late starvation | Early: proteolysis is dominant; late: body adapts to conserve protein, fat becomes major energy source
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| Fat mass: % of total body wt (TBW)? | 25-35% TBW
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| Lean mass: % of total body wt (TBW)? | 40% TBW
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| Lean body mass composition | 60% skeletal mx; 20% RBC & conn tissue; 20% organ tissue
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| peripheral neuropathy may be due to deficiencies in: | niacin, thiamine, vitamin B6, vitamin B12
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| Primary means of measuring protein (nitrogen) balance in body: | urine urea nitrogen
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| marker for significant nutritional depletion: body wt that is: | less than 90% of the usual or ideal body wt
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| Percentage of total body protein contained in skeletal muscle | 60% (this is major site of protein catabolism during starvation and/or illness)
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| Most widely used biochemical marker of muscle mass | 24 hr urine creatinine
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| Creatinine is: | degradation product of creatine, an energy storage compound located in skeletal muscle
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| Most common test to measure breakdown of protein | Urinary urea nitrogen
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| 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
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| 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
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| Creatinine- height index (CHI) level that defines skeletal muscle depletion | CHI < 80%
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| Serum albumin half life: | 18 - 20 d
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| Normal serum albumin = | > 3.5 g/dL
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| Serum prealbumin: Sensitive to: | acute changes in nutrient intake
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| Basal (resting) Energy Expenditure (BEE) is calculated by using: | Harris-Benedict equation
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| In pts who have sustained injuries, calculate resting energy expenditure by: | bedside indirect calorimetry to determine VO2 and VCO2 (Weir Formula)
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| Catabolic Index (CI): measures: | severity of stress (CI = UUN – 0.5 (dietary nitrogen intake) + 3 g)
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| Routes for delivering nutrition | Enteral. Enteral plus venous. Central venous access (eg, TPN)
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| Preferred route for delivering nutrition | Enteral
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| Primary fuel source for body | Carbohydrates. Metabolized as glucose, stored as glycogen (both depleted from liver/muscle stores in 24-36h of fasting, then fat & protein used)
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| Essential fatty acids are: | linoleic acid and linolenic acid
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| Fat metabolism yields: | fatty acids, glycerol, and ketone bodies (ketone bodies used as fuel during starvation)
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| Daily protein requirement in healthy adult | 0.8 gm/kg/day (minimum 0.54 gm/kg/day). Up to 2x that in stressed pt
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