Malnutrition

Question 1

Kwashiorkor

Answer 1

disease state in which individual diet results in serious protein deprivation but still significant caloric intake (carb based diet)

Question 2

Kwashiorkor symptoms

Answer 2

acute state
stunted growth
skin lesions
loss of hair and hair pigment
immune system weak
fatty liver
DECREASED SERUM ABLUMIN
EDEMA
no sig. muscle wasting
no sig. loss of body fat
NON ADAPTIVE MALNUTRITION
HIGH MORTALITY PATHOLOGICAL STATE

Question 3

Marasmus

Answer 3

disease state in which individuals caloric deprivation is greater than individuals’ protein deprivation

Question 4

marasmus symptoms

Answer 4

chronic state
arrested growth
extreme weakness
ANEMIA
NO EDEMA
immune system okay
extreme muscle wasting (CACHEXIA)
extreme loss of body fat (CACHEXIA)
ADAPTIVE RESPONSE TO UNDERNOURISHMENT
low mortality pathological state

Question 5

loss of protein mass

Answer 5

in order to adjust to reduced energy intake
body uses AA as source of energy

Question 6

energy expenditure

Answer 6

decreased energy expenditures due to decreased energy intake, decreased body mass
lethargy

Question 7

energy reserves

Answer 7

physiological fasting triggers the oxidation of fatty acids and ketosis to provide energy

Question 8

response mediators

Answer 8

endocrine systems (thyroid)
hematological changes (hemoglobin)

Question 9

Body’s energy stores

Answer 9

glycogen -> glucose (brain and muscle)
protein -> AA -> gluconeogenesis -> glucose
fat -> fatty acids -> energy (muscle)
fat -> fatty acids -> ketones -> energy (brain and muscle)

Question 10

Physiological response to starvation
Acute (1-3 days)

Answer 10

• muscles break down to generate AA
  AA taken up by liver generate glucose for brain
  some ketogenesis in liver very little

Question 11

Physiological response to starvation
Chronic (10-15 days)

Answer 11

breaking down fat
go into ketogenesis in liver
gluconeogenesis reduced
muscle break down minimal
brain is using ketones for energy
high levels of ketones go to kidneys and muscles

Question 12

How screen and diagnose malnutrition?

Answer 12

BMI < 20.5?
lose weight in last 3 months?
food intake reduced in last week?
critically ill?
if patient > 70 yrs, screen automatically

Question 13

if they scores more than 3 points

Answer 13

patient is at nutritional risk

Question 14

if they scores less than 3 points

Answer 14

repeat screening weekly

Question 15

Clinical markers for diagnosis

Answer 15

albumin (half life 21 days)
- hepatic failure, renal failure dont use if have these
prealbumin (3 day half life)
- hepatic faulure, renal failure
tranferrin (10 day half life)
- affected by iron status
C-reactive protein (1 day half life)
used to validate tests above

Question 16

signs of malnutrition

Answer 16

ulcer on heels
hair problems
fatigue
edema

Question 17

treatment of protein energy malnutrition

Answer 17

slow increase in foot intake
give electrolytes
avoid refeeding syndrome

Question 18

refeeding syndrome

Answer 18

reintro of nutrients in malnourished person triggers synthesis of proteins, fats, and glycogen which depletes serum K, magnesium and phosphorus
can result in cardiac, pulmonary, and neurological consequences that can be fatal