Case 5 - Malnutrition patient

Question 1

MUST tool and how it is calculated

Answer 1

• BMI (score 0,1,2)
• Unplanned weight loss (0,1,2)
• Acute disease affecting swallow (0,2)
• Determines if people are low, medium or high risk
• Determines management eg dietician, nutrition care plan, monitor food/encourgae

Question 2

Causes of malnutrition

Answer 2

• Anorexia nervosa
• Alcohol/drug dependency
• Low income/poverty
• Social isolation
• T1DM
• Hyperthyroidism
• HIV/AIDs
• Depression
• Crohns, Coeliac disease

Question 3

How is malnutrition managed?

Answer 3

• MUST score
• Dietician if high risk
• Food first approach - eg add full fat cream to mashed potato rather than oral supplements such as Ensure
• If these are presribed they should be between meals not instead of
• Can have NG tube/PEG if necesary

Question 4

What is re-feeding syndrome?

Answer 4

• Metabolic abnormalities that occur on feeding someone after prolonged starvation
• Hypophosphataemia
• Hypokalaemia
• Hypomagnesaemia
• Abnormal fluid balance

Question 5

What puts you at increased risk of re-feeding syndrome?

Answer 5

• More than 5 days of little intake
• BMI less than 18.5
• History of unintentional weight loss of more than 10% in 3-6 months
• History of alcohol abuse, drug therapy inc insulin, chemotherapy, diuretics and antacids
• Low K+, Mg, PO4 prior to refeeding

Question 6

How to prevent re-feeding syndrome?

Answer 6

• Identify those at high risk
• If not eaten in more than 5 days, re-feed no more than 50% of requirements for first 2 days