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Chapter 7. Fluids/Electrolytes/Nutrition

A 55-year-old female underwent a Hartmann procedure for Hinchey III perforated diverticulitis. On postoperative day 8, she had failed 3 attempts at extubation and was still on mechanical ventilator support. One possible reason to explain her difficult weaning is a respiratory quotient of:

A. 0.67

B. 0.7

C. 0.8

D. 0.9

E. 1.1

Answer: E. The RQ is defined as the ratio of volume of carbon dioxide produced to the volume of oxygen used on oxidation of a nutrient. The RQ is nearly 1 for carbohydrates, 0.7 for fat, 0.8 for protein, and 0.67 for alcohol. Respiratory failure requiring mechanical ventilation and difficulty with weaning patients can occur if excess glucose is provided, hence raising the RQ to greater than 1.

Which electrolyte and acid-base abnormality is present in a neonate with intractable projectile vomiting from hypertrophic pyloric stenosis?

A. Hyperkalemic hypochloremic metabolic alkalosis

B. Hypokalemic hypochloremic metabolic acidosis

C. Hypokalemic hyperchloremic metabolic alkalosis

D. Hypokalemic hypochloremic metabolic alkalosis

E. Hypernatremic metabolic acidosis

Answer: D. Persistent emesis causes progressive loss of fluids rich in hydrochloric acid, which causes the kidneys to retain hydrogen ions in favor of potassium. Electrolyte abnormalities depend on the duration of symptoms in the affected infant. Dehydration may result in hypernatremia or hyponatremia and prerenal failure.

What is the major primary nutrient of colonocytes?

A. Acetoacetate

B. β-transferrin

C. Glutamine

D. Arginine

E. Butyrate

Answer: E. Compared with common fuels, butyrate is the principal fuel for colonocytes, followed by acetoacetate, glutamine, and glucose.

What is the major primary nutrient of neoplastic cells?

A. Glutamine

B. Short-chain fatty acids

C. Long-chain fatty acids

D. Glucose

E. Arginine

Answer: A. Glutamine is the most abundant amino acid in the human body. It is necessary for nucleotide synthesis in rapidly dividing cells, which is why it is not only the major fuel source for ...

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