Neuro

Question 1

when energy estimation equation is most accurate for TBI when IC is not available?

Answer 1

Penn state equation

Question 2

acute phase post TBI - hypo or hypermetabolism?

Answer 2

hypermetabolism

Question 3

TBI protein needs

Answer 3

1.5-2.5 g/kg

Question 4

what form of nutrition support is recommended for TBI? how soon should this be initiated?

Answer 4

EN within 24-48 hours (same for all ICU pts who are at nutrition risk)

Question 5

which sodium disorder is common in TBI?

Answer 5

euvolemic hypotonic hyponatremia (due to SIADH)

Question 6

TBI patient with hyponatremia should not be corrected faster than ___ - ____ mEq/L/d to avoid osmotic demyelination

Answer 6

10-12

Question 7

how may the use of barbiturates in acute TBI treatment impact nutrition?

Answer 7

may reduce energy requirements

Question 8

how may the use of benzodiazepines in acute TBI treatment impact nutrition?

Answer 8

may reduce energy requirements

Question 9

how can mannitol administration impact electrolytes?

Answer 9

hypokalemia, hypomagnesemia, hyponatremia

Question 10

protein recommendations acute SCI

Answer 10

1.5-2 g/kg/d

Question 11

protein recommendations in acute/rehab phases of SCI

Answer 11

0.8-1 g/kg/day for maintenance (up to 1.5 g/kg/day with pressure injuries/infection)

Question 12

which type of stroke (ischemic or hemorrhagic) typically has higher energy needs?

Answer 12

hemorrhagic

ischemic stroke is likely closer to estimated BMR (HBE or Penn State equations)

Question 13

protein recommendations in stroke

Answer 13

1-1.5 g/kg

Question 14

are patients with ALS typically hypo or hypermetabolic?

Answer 14

hypermetabolic for unknown reason (30-35 kcal/kg)

Question 15

what are the common nutrition-related side effects of medications used in neuro patients for cognitive stimulation such as amantadine, bromocriptine, levodopa, carbidopa, modafinil, and methylphenidate?

Answer 15

1. altered GI motility
2. appetite reduction
3. herbal supp interactions

Question 16

which of the following neurological diseases/injuries is NOT associated with hypermetabolism?

ischemic stroke, TBI, ALS, Parkinson’s disease

Answer 16

ischemic stroke

Question 17

what is the evidence for use of arginine-containing immune modulating formulas or EPA/DHA supplementation in TBI patients?

Answer 17

2016 ASPEN guidelines recommend their use based on one small study that showed decreased infections in patients who received immune enhancing formula containing glutamine and probiotics