Flashcards in Malnutrition Deck (36):
What is the definition of malnutrition?
A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form , function and clinical outcome
What are the disease related causes of malnutrition?
Impaired digestion and/or absorption
Increased nutritional requirements
Increased nutrient losses
What is Malnutrition?
What is the malnutrition cycle?
Anorexia + Weight loss ->
What can a chronic status of malnutrition case?
Malabsorption, fistula, diarrhoea
Infection (TB, HIV etc)
What can an acute event of malnutrition cause?
caused by: Surgery, radiotherapy, chemotherapy
What physiological effects does Malnutrition have?
Increase Infection Rate
Decrease wound healing
What is the effect of starvation on the metabolic rate?
Decreased Metabolic rate
What is the effect of Injury on the Metabolic rate?
Increased metabolic rate
What type of weight loss is associated with starvation?
Slow weight loss almost all from fat stoes
What types of weight loss is associated with injury?
Rapid loss 80% from fat stores, remained from protein
What are the effects of starvation on hormones and electrolytes?
Decrease in nitrogen losses
Small increases in catecholamines, cortisol, GH, then slow fall. Insulin decreased
Initial loss of water and sodium, with late retention
What are the effects of injury on hormones and electrolytes?
Increases in catecholamines, cortisol, GH. Insulin increased but relative insulin deficiency
Retention of water and sodium due to serum albumen.
Effects of Malnutrition?
Impaired immune response
Impaired wound healing
Reduced muscle strength and fatigue
Water and electrolyte disturbances
Impaired Psyco-social function
What is weight loss a symptom of in GI disease?
Impaired GI motility
Acute liver disease
What is the MUST score?
It is a score that is used to detect malnourished adults
What biochemical assessments are used for nutritional status?
Albumen - as it is 50% of total protein plasma
Transferrin - The synthesis of this is reduced in protein restriction
Transthyetin (Prealbumin) - Reflects recent diety intake over nutritional status
Urinary creatinine - renal function
IGF1 (Growth factor) - reduced in malnutrition
What biochemical measures in the older community should be used to test for malnutrition?
Who do you offer nutritional support for?
People with a MUST score of 2
What are the components of the MUST tool and suggests a patient should have nutritional support?
BMI 10% within the last 3–6 months
BMI 5% within the last 3–6 months
Have eaten or are likely to eat little or nothing for more than 5 days or longer
Poor absorptive capacity and/or high nutrient losses and/or increased
What are the different types of nutrition support?
Food fortification and counselling
Oral nutrient support
Enteral tube feeding
When would you prescribe oral nutritional supplements?
Disease related malnutrition
Per-operative preparation of malnourished patients
Post total gastrectomy
How does enteral tube feeding work?
Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum
What are the different types of Enteral tubes?
Percutaneous endoscopic gastrostomy PEG
When would you use Enteral feeding tubes?
"If the gut works, use it"
Neuromuscular swallowing disorder
Upper GI obstruction
Increased nutritional requirements
What are the cmplications of using an enteral tube feeder?
Lower gastrointestinal obstruction
Prolonged intestinal ileus
Severe diarrhoea or vomiting
High enterocutaneous fistula
What is parenteral nutrition?
Parenteral nutrition (PN) is feeding a person intravenously, bypassing the usual process of eating and digestion
When would you consider Parenteral nutrition?
Inadequate oral or enteral nutation
Leaking in the GI track
What conditions would you use parenteral nutrition for?
IBD with severe malabsorption
Short bowel syndrome
Type 1 intestinal failure
What is referring syndrome?
Fatal shift in fluids and electrolytes which causes disturbances in organ function.
Results from a rapid invitation of re-feeding after a period of under nutrition Happens if you give a quick administration of glucose via tube feeding or parenteral feeding
What are the events that leads to referring syndrome?
1. Starvation and malnuteation
2. Leads to Glycogenolysis, gluconeogenesis and protein catabolsim
3. Leads to nutrient depletion with salt and water intolerance
4. Refeeding switches the body to anabolism
5. Insulin secretion
6. Protein and glycogen synthesis
7. Refeeding syndrome
What are the metabolic signs of refeeding syndrome?
Hypokalaemia Hypomagnesaemia Hypophosphataemia Thiamin deficiency Salt and water retention - oedema
What are the physiological symptoms of referring syndrome?
What tests do you run for high risk parents for rereeding syndrome?
How many kcal per day would you administer for a high risk patient of refeeding syndrome?