Adult Nutrition

Question 1

Normal requirements for hospital pts

Answer 1

Energy: 30 kcal / kg / day
Protein: 0.8-1 g / kg / day
Fluid: 30-35 ml / kg / day

Question 2

Assessing nutritional status

Answer 2

BMI
Hx
MUST score - BMI, weight loss, acute illnesses (0= low risk, 1 = medium risk - observe, 2 = high risk - tx)
Nutritional status exam
Bloods: Hb, electrolytes, LFTs, haematinics

Question 3

Oral supplements

Answer 3

Nutritional drinks
Vitamin supplements
Electrolyte supplements

Question 4

Enteric feeds - when oral intake is like to be absent for > 5 days and gut is functioning

Answer 4

Methods - NG tube, NJ tube, percutaneous gastrostomy / jejunostomy tube

Most feeds contain 1 kcal / ml

Types - polymeric feeds (most commonly used), pre-digested feeds, disease specific and pharmaco-nutrient feeds

Administration methods - boluses, intermittent infusion, continuous infusion

Question 5

Parenteral nutrition

Answer 5

May be required in intestinal failure (acute or chronic) and is given via central venous line

PN if also feeding by other methods
TPN if only IV feeding

Question 6

Re-feeding syndrome

Answer 6

Feeding malnourished pts can cause insulin surge and activation of cellular membrane pumps - drop in serum electrolytes
RF: low BMI, weight loss > 15% over 3-6 months, poor intake for > 10 days, low electrolytes, alcohol excess

Start feeding at 10kcal / kg / day and gradually increase. Monitor K, PO4 and Mg and replace if low