General Surgery – Nutrition & Periop Management

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Q1) All of the following are used for Nutritional Assessment except

a) Albumin

b) Prealbumin

c) Transferrin

d) PT/INR 

Ans d

Visceral protein measurement (e.g., albumin, transferrin, prealbumin) are used for nutritional assessment

Serum albumin of less than 3.5 g/dL (35 g/L) in a stable, hydrated patient; half-life is 14 to 20 days.

2. Serum prealbumin may be a more useful indicator of acute changes: 10 to 17 mg/dL corresponds to mild depletion, 5 to 10 mg/dL to moderate depletion, and less than 5 mg/dL to severe depletion; half-life is 2 to 3 days.

3. Serum transferrin of less than 200 mg/dL; half-life is 8 to 10 days.

Indirect calorimetry:, Fick equation, Harri s-Benedict equations and Estimated REE These 4 things measure the calorie and nutrition requirement. They are not indicators of previous nutritional status

Q 2) IV fluid of choice to increases calories to provide parenteral nutrition  by peripheral route is:

a) DNS

b) Lipid Emulsions

c) Arginine in DNS

d) 25% dextrose

Answer  2 (FREE)  b

Lipid Emulsions can be given by peripheral route. They are the highest source of energy and calories.  25% dextrose, although a good source of energy has high concentration of glucose which can cause thrombophelebitis.

DNS will provide just basic calories and will not cause any increase in calorie intake.

Addition of arginine, which is an amino acid will not increase the energy intake.

A BMI of less than 18.5 indicates
nutritional impairment and a BMI below 15 is associated with
significant hospital mortality. Nutritional support for a minimum of 2 weeks before surgery is required to have any impact
on subsequent morbidity bailey page 260

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