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Flashcards in Malnutrition Deck (25)
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1

Malnutrition occurs as a result of:

Inadequate dietary supply
GI failure
Unusual losses
Increased demands

2

What would increase the resting energy expenditure in a patient?

Major trauma
Major inflammatory disorders
Fever (+13% for every ºC of fever)
Burns
Sepsis

3

Loss of appetite and decreased food intake due to:

Infection
Trauma
Neoplasia
Malabsorption
Psychiatric disorder
Chronic illness
Unbalanced tissue demand
Abnormal losses
Dietary lack

4

What happens when malnutrition affects membrane function?

Decreased total body potassium
Increased total body sodium

5

What needs to monitored in malnutrition?

Electrolytes (K+ and Na+)
Anaemia
Infection (may be silent)
Hypothermia
Hypoglycaemia
Hypoalbuminaemia (infection)
Oedema

6

What can lead to decompensation in malnutrition?

Excessive energy intake
Infection
Trauma
Small bowel overgrowth
Abnormal losses

7

What causes nutritional oedema?

Hypoalbuminaemia
Salt and water retention
Impaired membrane function

8

What is refeeding syndrome?

Malnourished patients have loss of tissue and damaged machinery
If excess energy and protein is provided to gain weight there is
-overloaded circulation
-heart failure
-Abdominal distension
-Profound secretory diarrhoea
Glucose uptake by cells also drops extracellular K+, PO4-, Mg2+, thiamine

9

Management of malnutrition

1) Gain metabolic control (treat infection, underlying condition, prevent hypothermia and hypoglycaemia, correct intracellular deficiencies, low levels of feeding)
2) Replete tissue deficit (fortified supplements, protein, nutrients)
Promote digestions through elemental feeds
Feeding tubes?

10

What can hypophosphataemia do?

Altered cardiac function, arrhythmia, acute ventilatory failure, lethargy, weakness, coma, rhabdomyolysis

11

What can hypokalaemia do?

Arrhythmias, ECG changes, cardiac arrest, paralysis, weakness, rhabdomyolysis

12

What can hypomagnesaemia do?

Arrhythmia, tachycardia, respiratory dperession, tremors, tetany

13

What does thiamine deficiency lead to?

Congestive heart failure, lactic acidosis, weakness

14

When is someone at high risk of refeeding syndrome?

BMI15% or very little intake for 10days
Alcohol abuse, drugs, BMI10%

15

What are the options for enteral tube feeding?

Nasogastric
Naso jejunal
Gastrotomy
Jejunotomy

16

Why is enteral tube feeding good?

Maintains gut integrity
Relatively low cost
Low risk
Physiologically normal

17

How do you decrease the risk of misplaced NG tubes?

pH aspirate

18

When is parenteral feeding used?

In intestinal failure
(post op, ischaemia, dysmotility, IBD)

19

When can iron deficiency occur?

In dietary restriction, malabsorption and intestinal bleeding

20

When does vitamin B12 deficiency occur?

Ileal disease or resections

21

When does hypomagnesiumaemia occur?

After high volume diarrhoea

22

Why is there deceased intake in Crohn's?

Pain, bloating, nausea
Dietary restriction
Cytokines and anorexia

23

Why is there digestion and absorption failure in Crohn's?

Extensive mucosal damage
Resections
Fistulae
Specific nutrient problems

24

Why are there increased losses in Crohn's?

Diarrhoea
Blood loss
Stomas
Fistulae

25

What treatment is as good as steroids for Crohn's?

Enteral feeding with an elemental diet
Decreased inflammation, cytokines
Improves remission rates and nutritional status