Nutrition for Hepatic Disease By Alaina Darby Nutrition for Hepatic Disease

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following would most likely be observed in this patient? Hypoglycemia with failure of gluconeogenesis Hyperglycemia with failure of gluconeogenesis Hypoglycemia with increased insulin levels Hyperglycemia with increased insulin levels d

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. What is one of the mechanisms of hyperglycemia in JO? Increased glucagon Failure of gluconeogenesis Depletion of glycogen Increased insulin a

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following would likely be depleted in this patient? Branched chain amino acids Sulfur containing amino acids Aromatic amino acids All amino acids a

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. High levels of which of the following would be most likely to lead to encephalopathy? Branched chain amino acids Sulfur containing amino acids Aromatic amino acids All amino acids c

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following is not a mechanism of ammonia accumulation leading to encephalopathy? Bacterial production in the GI Insufficient protein intake Decreased renal elimination High levels of branched chain AA’s d

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following should be added for this patient should he need TPN? Branched chain amino acids Sulfur containing amino acids Aromatic amino acids All of the above d… but potentially in different ratios

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. How would you start IV lipids if he is to need TPN and is 100 kg? Check triglycerides before starting lipids (max 500 g) Check triglycerides before starting lipids (max 700 g) Max of 500 g to prevent overload Max of 700 g to prevent overload b

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following would most likely need to be supplemented in this patient? Calcium Phosphorus Magnesium Potassium c

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following should be given before starting his TPN? Folate Vitamin D Magnesium Thiamine d

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which medication should not be given before thiamine? Propofol IV emulsion Dexmedetomidine IV in NS Penicillin IV in D5W Insulin IV in NS c

JO is a 45 yo WM with a history of alcoholism and cirrhosis JO is a 45 yo WM with a history of alcoholism and cirrhosis. Which of the following would most likely need to be supplemented in this patient? Potassium Iron Copper Manganese b

JO is a 45 yo WM (100 kg and BEE 2000 kcal/day) with a history of alcoholism and cirrhosis. What is the optimum calorie intake for this patient according to his weight? 2000 kcal 2500 kcal 3000 kcal 3500 kcal c

JO is a 45 yo WM (100 kg and BEE 2000 kcal/day) with a history of alcoholism and cirrhosis. What is the optimum calorie intake for this patient according to his BEE? 2000 kcal 2500 kcal 3000 kcal 3500 kcal c

What measurement does ESPEN recommend for calculating energy requirements? Resting energy expenditure Basal energy expenditure Weight-based calculation Total daily energy expenditure a

JO is a 45 yo WM (100 kg) with a history of alcoholism and cirrhosis JO is a 45 yo WM (100 kg) with a history of alcoholism and cirrhosis. What protein should he receive if he has encephalopathy? Mostly BCAAs + lactulose Mostly as AAAs + lactulose BCAAs and AAAs + lactulose No protein/amino acids + lactulose c

JO is a 45 yo WM (100 kg) with a history of alcoholism and cirrhosis JO is a 45 yo WM (100 kg) with a history of alcoholism and cirrhosis. How much protein should he receive if he has encephalopathy? 25 g/day initially 50 g/day initially 100 g/day initially 150 g/day initially 200 g/day initially b

JO is a 45 yo WM (100 kg) with a history of alcoholism and cirrhosis JO is a 45 yo WM (100 kg) with a history of alcoholism and cirrhosis. What is his goal protein intake? 25 g/day 50 g/day 100 g/day 150 g/day 200 g/day d

RD is a 24 yo WF who has arrived at the hospital with RUQ pain RD is a 24 yo WF who has arrived at the hospital with RUQ pain. She has no history of alcoholism or liver disease. She is diagnosed with HAV. What would be of greatest concern in this patient? Hypoglycemia with failure of gluconeogenesis Hyperglycemia with failure of gluconeogenesis Hypoglycemia with increased insulin levels Hyperglycemia with increased insulin levels a

RD is a 24 yo WF who has arrived at the hospital with RUQ pain RD is a 24 yo WF who has arrived at the hospital with RUQ pain. She has no history of alcoholism or liver disease. She is diagnosed with HAV. Which of the following would you not expect to be elevated in this patient? Branched chain amino acids Sulfur containing amino acids Aromatic amino acids All amino acids would be elevated d

RD is a 24 yo WF (50 kg) who has arrived at the hospital with RUQ pain RD is a 24 yo WF (50 kg) who has arrived at the hospital with RUQ pain. She has no history of alcoholism or liver disease. She is diagnosed with HAV. What is her goal protein intake? 25 g/day 50 g/day 100 g/day 150 g/day b

RD is a 24 yo WF (50 kg) who has arrived at the hospital with RUQ pain RD is a 24 yo WF (50 kg) who has arrived at the hospital with RUQ pain. She has no history of alcoholism or liver disease. Which of the following labs would indicate a need for vitamin K supplementation? High SAAG score Increased INR High sodium Increased NH3 b

RD is a 24 yo WF (50 kg) who has arrived at the hospital with RUQ pain RD is a 24 yo WF (50 kg) who has arrived at the hospital with RUQ pain. She has no history of alcoholism or liver disease. Which of the following would worsen encephalopathy? Hypoglycemia Acidosis Hypoalbuminemia Hypokalemia d

TR is 59 yo WM admitted for SBP and confusion TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 What is an appropriate caloric goal? 1750 2250 2750 3250 b

50 g/day 75 g/day 100 g/day 125 g/day TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 How much protein should he receive? 50 g/day 75 g/day 100 g/day 125 g/day c

Kidney dysfunction Low calcium Alcohol abuse Furosemide TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 What is the likely mechanism for his low magnesium? Kidney dysfunction Low calcium Alcohol abuse Furosemide c

Kidney dysfunction Low magnesium Alcohol abuse Furosemide TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 What is the likely mechanism for his low potassium? Kidney dysfunction Low magnesium Alcohol abuse Furosemide d

Kidney dysfunction Low magnesium Alcohol abuse Furosemide TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 What is the likely mechanism for his low calcium? Kidney dysfunction Low magnesium Alcohol abuse Furosemide b

Ciprofloxacin and magnesium Ciprofloxacin and potassium TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 What is a drug interaction that may occur with EN but not TPN if both potassium and magnesium are being supplemented in the feeds? Ciprofloxacin and magnesium Ciprofloxacin and potassium Furosemide and magnesium Furosemide and potassium a

Pneumonia prophylaxis Encephalopathy prophylaxis SBP prophylaxis TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 Why is he likely getting propranolol? Pneumonia prophylaxis Encephalopathy prophylaxis SBP prophylaxis Variceal hemorrhage prophylaxis d

Pneumonia prophylaxis Encephalopathy prophylaxis SBP prophylaxis TR is 59 yo WM admitted for SBP and confusion. SHx: 15-20 beers per week, occasional smoker PE: 3+ pitting edema Vitals: BP 152/89, HR 68, weight 80 kg (BEE 1650 kcal/day) Medications: furosemide 40 mg Qday, propranolol 20 mg BID, ciprofloxacin 750 mg Qweek Labs: albumin 2, Mg 1.4, Phos 2, K 3.2, Na 130, cCa 7.5, fBG 156 BONUS!! Why is he likely getting ciprofloxacin? Pneumonia prophylaxis Encephalopathy prophylaxis SBP prophylaxis Variceal hemorrhage prophylaxis c