30 - Clinical Manifestation of Malnutrition Flashcards

Question

PEM - Monokines

Answer 1

Peptide/glycoprotein mediators of the body's response to injury. Decreased IL-1 - Poor febrile response and decreased leukocyte counts in infection Increased TNF - Anorexia, muscle wasting, lipid abnormalities

Answer 2

Decrease of total body potassium Altered cellular exchange Na+ and K+ loss Potassium loss Increased intracellular Na+ Intracellular overhydration

Answer 3

Impaired absorption of: Lipids Disaccharides Glucose Decreased gastric, pancreatic & bile production Normal - low enzyme and conjugated bile Further impairment of absorption Diarrhea Irregular intestinal motility Diarrhea Bacterial overgrowth Diarrhea

Answer 4

Severe PEM at early age: Decreased brain growth Decreased nerve myelination Decreased neurotransmitter production Decreased velocity of nerve conduction

Answer 5

Gonadotropins - Decreased Hypothalamic - Pituitary Axis & Medulla Oblongata are preserved, so patients can still respond to stress. Epi and corticosteroids can still go up in response to stress.

Answer 6

Normal (90 - 110% weight for height) Mild (80 - 89% weight for height) Moderate (70 - 79% weight for height) Severe (

Answer 7

Acute Chronic Acute w/chronic background

Answer 8

Protein Energy Both

Answer 9

Weight/Height - Index of CURRENT nutritional status Height/Age - Index of PAST nutritional history Wasting - Deficit weight/height Stunting - Deficit height/age

Answer 10

Normal Wasted (acute PEM) Wasted and stunted (acute and chronic PEM) Stunted (Past PEM)

Answer 11

Calculate as percent of reference median wt/ht % Weight/Heigh = Observed Weight/Reference weight/height % Height/Age = Observed height/Reference height/age BMI = Weight/Height^2 Recommended for adolescents and adults

Answer 12

>= 18.5 - Normal 17. 0 - 18.4 - Mild 16. 0 - 16.9 - Moderate

Answer 13

Weight Loss Decreased SubQ fat Decreased adiposity (

Answer 14

``` Severely wasted Shorter Look wasted/ill Irritable Apathetic Look of anxiety Sunken cheeks (monkey) Hair dry and brittle Hair pulls out without pain Hypothermia Slow pulses Eye infections (Vitamin A deficiency) Respiratory infections Diarrhea ```

Answer 15

Edema (face, perineum, legs, feet, arms, hands) Growth not as stunted as marasmic patients Apathetic Irritable Look ill Hair turns lifeless & dull Color of hair turns to yellowish white, dull brown or red Irritation and skin lesions in areas of edema. Depigmented skin Hyperkeratotic skin Scales of dermis coming off in large patches Big bellies Hepatomegaly Fatty liver Vitamin deficiencies

Answer 16

Everything is normal or slightly reduced EXCEPT glucose Glucose is much lower than in Kwashiorkor patients Total body water high Extracellular water high Total body protein low

Answer 17

Everything is reduced or markedly reduced Total body water high Extracellular water higher Total body protein low Liver fatty infiltration severe

Answer 18

During malnutrition, hair becomes depigmented Hair is pigmented, then not pigmented, then pigmented. Not pigmented signifies malnutrition period.

Answer 19

Good Patients normalize signs of malnutrition quickly Maintain normal wt/height May take longer for height to reach normal, or they may never reach normal height. Decreased work capacity Behavioral problems Decreased capacity for social interaction and creativity. These don't persist if you "give them good stimulation when you treat them"

Answer 20

40% die without proper treatment | 10% die with proper treatment

Answer 21

``` Younger child Poor wt/height Infection (measles) Hemorrhagic tendencies Mental status changes Electrolyte disturbances Low serum protein Severe anemia ```

Answer 22

Treat in ambulatory setting GOAL - 2 times protein, 1.5 times energy requirements ``` Food supplements: Appetizing Easy to prepare Feed others in household No commercial value ``` Avoid decrease in breast feeding Vitamin and mineral supplements

Answer 23

Home vs. Hospital Care Probably hospital Resolve life threatening conditions Restore nutritional status without disrupting homeostasis Ensure nutritional rehabilitation.

Answer 24

Hypoosmolarity Moderate hyponatremia Metabolic acidosis Increased tolerance to hypocalcemia Decreased body potassium without hypokalemia Decreased body magnesium without hypomagnesemia

Answer 25

Clinical manifestations may be mild Antigen antibody reactions may be impaired False negative skin tests Altered drug metabolism & detoxification mechanisms

Answer 26

Cardiac failure secondary to anemia, fluids or improper treatment Pulmonary edema

Answer 27

``` Severe anemia Hypothermia Hypoglycemia (impaired thermoregulatory mechanisms) Severe vitamin A deficiency ```

Answer 28

Replace nutrient tissue deficits Begin to slowly avoid metabolic disruptions LIquid formula best (PO/NG) in small frequent feeds Marasmus - Larger amounts of dietary energy needed Increased mortality with TPN K+, Na+, Ca, Mg, Zn, Folic acid, Vitamin A supplementation Add iron after 1 week of diet therapy Protein source of high biologic value, and easily digested Cow, goat, ewe, buffalo, camel milk Eggs, meat, fish, soy/vegetable mixtures are good too...

Answer 29

Refeeding syndrome!!!!

Answer 30

Fluid, electrolyte & metabolic abnormalities: Chronic malnutrition - Body stores of nitrogen, phosphorous, magnesium & potassium are depleted, but serum levels are near normal Refeeding - Proteins synthesized and insulin released. Increased cellular uptake of these cations, so HUGE drops in serum concentration!!!! Common pathway ascribed to hypophosphatemia, but may include fluxes in K+, Mg+, Na+

Answer 31

``` Anorexia nervosa Classic Kwashiorkor Classic Marasmus Chronic malnutrition (underfeeding) Chronic alcoholism Morbid obesity with massive weight loss Unfed patient 7 - 10 days with evidence of stress and depletion Prolonged fasting Prolonged IV hydration Cancer cachexia ```

Answer 32

Test for electrolyte abnormalities before initiating nutrition support. Follow these values! Judiciously restore circulatory volume Increase caloric delivery slowly Administer vitamins routinely ``` Monitor: Phosphorous Potassium Magnesium Glucose Urinary electrolytes ```

Answer 33

``` Introduction of traditional foods High calories High protein Emotional and physical stimulation Seek underlying cause of persistent or recurrent diarrhea or other health problems ```

Answer 34

Weight gain Adequate wt/ht Normal CHI 0.9

Answer 35

``` Food production and distribution Preventative medicine Education Social development Economic improvement ```

Answer 36

``` Dry skin Decreased resistance to infection Night blindness Decreased hair growth 1/3 of all children on earth under 5 500,000 deaths yearly ```

Answer 37

``` Vitamin D deficiency OR Calcium deficiency OR Phosphate deficiency ``` ``` Softening/weakening of bones Bone pain or tenderness Dental deformities Impaired growth Bone fractures Skeletal deformities ```

Answer 38

``` Vitamin B1 (Thiamine) deficiency Common in alcoholics ``` ``` CHF Fluid in lungs Tachycardia Swelling of legs Memory loss Delusions Coordination problems Death ```

Answer 39

Dyspnea Tachycardia Swelling

Answer 40

``` Difficulty walking Loss of sensation Nystagmus Tingling Vomiting ```

Answer 41

Brain disorder secondary to thiamine deficiency

Answer 42

Vitamin B3 (Niacin) deficiency Diarrhea Dermatitis Dementia Death

Answer 43

``` Vitamin C deficiency Lethargy Skin spots Bleeding gums Loss of teeth Fever Death ``` Treat with horse meat and citrus fruits

Answer 44

Vitamin B2 (Riboflavin) deficiency Malnourished and alcoholics ``` Bright pink tongues Cracked lips Throat swelling Bloodshot eyes Low RBC count ```

Answer 45

Half of all newborns worldwide affected Alcoholics, bulimics, dieters, CF Bleeding

30 - Clinical Manifestation of Malnutrition Flashcards

(69 cards)