Nutrition and Fluid Therapy.pptx nutttttt

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### Introduction
- **Importance of Nutrition and Fluid Therapy**: Introduce the concept of nutrition and fluid therapy as fundamental components in medical care, crucial for maintaining homeostasis, supporting recovery, and improving patient outcomes.
- **Overview of Topics Covered**: Briefly outline what will be discussed, including principles of nutrition, different types of fluid therapy, and their applications in various medical conditions.

### 1. **Fundamentals of Nutrition**
- **Macronutrients**:
- **Carbohydrates**: Role in energy provision, types (simple vs. complex), and dietary sources.
- **Proteins**: Importance in tissue repair and growth, amino acids, and dietary sources.
- **Fats**: Role in energy storage, types of fats (saturated, unsaturated), and their health implications.

- **Micronutrients**:
- **Vitamins**: Different types (water-soluble vs. fat-soluble), their functions, and dietary sources.
- **Minerals**: Essential minerals like calcium, potassium, magnesium, and their roles in bodily functions.

- **Water**: The role of water in the body, daily requirements, and signs of dehydration.

- **Balanced Diet**:
- **Definition and Importance**: Components of a balanced diet and its importance in preventing diseases.
- **Dietary Guidelines**: Reference to dietary guidelines, food pyramids, and portion control.

### 2. **Clinical Nutrition**
- **Nutritional Assessment**:
- **Methods**: BMI, dietary history, biochemical tests, clinical examination.
- **Importance**: Identifying malnutrition, obesity, and specific nutrient deficiencies.

- **Therapeutic Diets**:
- **Types**: Regular, soft, liquid, and specialized diets (e.g., diabetic, renal, cardiac).
- **Application**: Case studies of different therapeutic diets in managing conditions like diabetes, hypertension, and gastrointestinal disorders.

- **Enteral Nutrition**:
- **Indications**: When to use enteral nutrition, common conditions requiring tube feeding.
- **Types**: Nasogastric, nasojejunal, PEG tubes.
- **Formulations**: Types of enteral formulas (polymeric, elemental, specialized).
- **Complications**: Mechanical (e.g., tube dislodgement), metabolic (e.g., electrolyte imbalances).

- **Parenteral Nutrition**:
- **Indications**: When to use parenteral nutrition, typically in patients with non-functioning GI tract.
- **Types**: Total Parenteral Nutrition (TPN) vs. Peripheral Parenteral Nutrition (PPN).
- **Components**: Macronutrients (amino acids, dextrose, lipids) and micronutrients (electrolytes, vitamins, trace elements).
- **Complications**: Infections, metabolic derangements (e.g., hyperglycemia, refeeding syndrome).

### 3. **Fluid Therapy**
- **Physiological Basis**:

1. Nutrition and Fluid Therapy SHADA SALAM ROLL NO:140

2. FLUID AND ELECTROLYTE BALANCE DAILY FLUID BALANCE ESTIMATED FLUID BALANCE FOR A HEALTHY 70 KG ADULT IN TEMPARATE CLIMATE INTAKE (L) OUTPUT (L) WATER FROM BEVERAGES 1.2 URINE 1.5 WATER FROM FOOD 1.0 INSENSIBLE LOSSES 0.9 METABOLIC PROCESSES OF OXIDATION 0.3 FAECES 0.1 The normal volume of water required for daily maintenance in a healthy 70 kg adult is approximately 2.2 ltrs . Fluid replacement should also encompass replacement of key electrolytes. Sodium : 0.9 -1.2 mmol/kg per day Potassium : 1 mmol/kg per day Calcium : 5 mm per day Magnesium : 1 mm per day Replacement of fluid and electrolytes should be by the simplest and safest route of administration.

3. IV FLUID REPLACEMENT SOLUTIONS IV FLUID REPLACEMENT SOLUTIONS Intravenous fluid replacement may be necessary in conditions of gastrointestinal absorptive impairment or large fluid losses that cannot be quickly replaced via the enteral route. The specific type of fluid replacement therapy will be determined by the individual patient’s needs. In addition to the crystalloid fluid solutions above, fluid can also be replaced with colloid solutions eg : Gelofusine ® or Volplex ®

4. Patients who are considered to be unable to consume enough nutrition via dietary means will need to be considered for either enteral or parenteral nutrition. Provision of enteral and parenteral nutrition should take into account not only macronutrients, such as carbohydrate, fat and protein, but also vitamins, trace elements, electrolytes and water Regular biochemical monitoring is also mandatory as electrolyte and nutrient requirements can vary based on plasma levels Nutritional requirements

5. Effects of intestinal resection on fluid and nutrient absorption The main role of the intestine is the absorption of fluid, nutrients and electrolytes, and as such it has a large capacity for adaptation to the loss of intestinal length by increasing the absorptive surface area as well as molecular changes increasing nutrient transporter levels. This may be due to either surgical resection or Crohn’s disease or ulcerative colitis. Patients with reduced functional intestinal length may therefore require supplemental parenteral nutrition, intravenous fluid or both. Effects of intestinal resection on fluid and nutrient absorption The greatest consequences of loss of functioning intestinal length occur in patients with remnant small intestine of less than 200 cm. This results in significantly reduced absorptive capacity, with the associated metabolic and nutritional consequences of short bowel syndrome .

6. Patients who have less than 100 cm of total residual bowel have a particularly severe form of short bowel syndrome as they will lose more water and electrolytes from their bowel than consumed by mouth. Daily bowel losses can exceed 4  litres in a 24-hour period. Consumption of oral fluids with sodium concentrations of less than 90  mmol/L will result in a net efllux of sodium from plasma into the bowel lumen, hence hypotonic fluids should be restricted to less than 1 litre per day and patients should be encouraged to drink glucose and saline replacement solutions such as oral rehydration salts. Fluid balance needs to be carefully monitored; while some of the fluid intake will be covered by parenteral nutrition, further intravenous fluid supplementation may also be necessary in cases of particularly high bowel output.

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