Flashcards in Malnutrition Deck (25)
Malnutrition occurs as a result of:
Inadequate dietary supply
What would increase the resting energy expenditure in a patient?
Major inflammatory disorders
Fever (+13% for every ºC of fever)
Loss of appetite and decreased food intake due to:
Unbalanced tissue demand
What happens when malnutrition affects membrane function?
Decreased total body potassium
Increased total body sodium
What needs to monitored in malnutrition?
Electrolytes (K+ and Na+)
Infection (may be silent)
What can lead to decompensation in malnutrition?
Excessive energy intake
Small bowel overgrowth
What causes nutritional oedema?
Salt and water retention
Impaired membrane function
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
-Profound secretory diarrhoea
Glucose uptake by cells also drops extracellular K+, PO4-, Mg2+, thiamine
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
What can hypophosphataemia do?
Altered cardiac function, arrhythmia, acute ventilatory failure, lethargy, weakness, coma, rhabdomyolysis
What can hypokalaemia do?
Arrhythmias, ECG changes, cardiac arrest, paralysis, weakness, rhabdomyolysis
What can hypomagnesaemia do?
Arrhythmia, tachycardia, respiratory dperession, tremors, tetany
What does thiamine deficiency lead to?
Congestive heart failure, lactic acidosis, weakness
When is someone at high risk of refeeding syndrome?
BMI15% or very little intake for 10days
Alcohol abuse, drugs, BMI10%
What are the options for enteral tube feeding?
Why is enteral tube feeding good?
Maintains gut integrity
Relatively low cost
How do you decrease the risk of misplaced NG tubes?
When is parenteral feeding used?
In intestinal failure
(post op, ischaemia, dysmotility, IBD)
When can iron deficiency occur?
In dietary restriction, malabsorption and intestinal bleeding
When does vitamin B12 deficiency occur?
Ileal disease or resections
When does hypomagnesiumaemia occur?
After high volume diarrhoea
Why is there deceased intake in Crohn's?
Pain, bloating, nausea
Cytokines and anorexia
Why is there digestion and absorption failure in Crohn's?
Extensive mucosal damage
Specific nutrient problems
Why are there increased losses in Crohn's?