ECMO Nutrition and Metabolic Management in ECMO 2

Question 1

Which electrolyte disturbance is particularly problematic when using continuous renal replacement therapy (CRRT) concurrently with ECMO?

Accepted Answer

Hypomagnesemia and hypophosphatemia

Answer

Hypernatremia

Answer

Hypercalcemia

Answer

Hyperkalemia

Question 2

What is the primary concern with administering lipid emulsions (as part of parenteral nutrition) to ECMO patients?

Accepted Answer

Lipid particles can coat and degrade the oxygenator membrane, reducing gas transfer efficiency

Answer

Lipids cause hemolysis by altering red cell membrane fluidity

Answer

Lipids bind to heparin and reduce anticoagulation efficacy

Answer

Lipid emulsions cause vasospasm at the cannulation site

Question 3

Refeeding syndrome in ECMO patients is characterized by a critical drop in which electrolyte after nutrition initiation?

Accepted Answer

Phosphate

Answer

Potassium

Answer

Sodium

Answer

Calcium

Question 4

Which condition most commonly leads to enteral feeding intolerance in ECMO patients receiving VA ECMO?

Accepted Answer

Hypoxic gut ischemia due to retrograde aortic flow and reduced splanchnic perfusion

Answer

Circuit recirculation reducing mesenteric oxygen delivery

Answer

High ECMO flows causing mesenteric venous hypertension

Answer

Anticoagulation causing mucosal hemorrhage and diarrhea

Question 5

What blood glucose target range is currently recommended for ECMO patients to balance glycemic control with hypoglycemia risk?

Accepted Answer

140–180 mg/dL

Answer

60–100 mg/dL

Answer

100–140 mg/dL

Answer

180–220 mg/dL

Question 6

How does ECMO most significantly alter zinc and selenium homeostasis?

Accepted Answer

Adsorption of trace elements onto the circuit and oxygenator leads to reduced plasma levels

Answer

ECMO promotes renal retention of trace elements

Answer

ECMO increases hepatic synthesis of metallothionein, depleting free zinc

Answer

Circuit-induced hemolysis releases intracellular zinc into plasma, causing toxicity

Question 7

What nutritional intervention has been shown to be harmful and is NOT recommended in critically ill ECMO patients?

Accepted Answer

Enteral glutamine supplementation at high doses in multi-organ failure

Answer

Vitamin C supplementation to reduce oxidative stress

Answer

Early enteral feeding within 48 hours

Answer

Protein supplementation at 1.5 g/kg/day