Serum albumin lab levels
3.5 to 5.4 G/dL
Prealbumin lab levels
15to 35 g/ dL
The most sensitive indicator of protein malnutrition.
Prealbumin
Transferrin lab level
Greater than 200mg/ dL is normal
Serum protein that binds and transfers iron
Transferrin
Predictor of protein depletion when less than 200mg/dL
Transferrin
Nutrition lab levels Total lymphocytes count
1 to 3 x10(9)/L
Lab hydration marker bun/creatinine normal levels
Less than 20
Normal serum osmolality lab levels
275-295 mmol/ kg
Obese 400lb man lost 40 lbs in the last 6months due to starvation, before beginning refeeding what would be considered
Watch for refeeding syndrome the body can start using glycogen from the over during times of starvation. If food is reintroduced to fast the body will have insulin spike causing k/mg/p to be taken up into cells, depleting the system leading to adverse effects. Possibly death.
If patient is unable to take food by mouth when would you use enterstomal tube
needs supplement greater than 6 weeks
If patient is unable to take food by mouth what would you use if there is a risk for aspiration
Duodenal tube
In elderly when could you use mirtazipine for nutrition
patient is malnurished and depressed
When is it practical to use TPN
When GI tract is not usable parenteral nutrition is needed
why is megestrol not suggested for nutrition in elderaly
Beers list and risk of thrombotic event maybe death
Gastromy feedings PEGS CAN BE USE FOR how many weeks
great than 4 weeks
hallmark refeeding syndrome can cause what kind of shift in labs
hypophosphatemia, hypomagnesemia,
hypokalemia, and thiamine deficiency
Patient was on enteral feedings for several weeks what is the syndrome to watch for when started to refeeding
re-feeding syndrome
When some one has hadno or limited nutritional intake fr more than 5 days how should someone be feed to prevent refeeding dsyndrome
10kcal/kg perday slowly increase over days
Before correcting feeding for someone malnurished you should correct what
Fluid and electrolyte
Diagnosis of cachexia & malnutrition
BMI < 18.5 with unintentional weight loss >10% within
3-6 months
Limited or no nutritional intake for more than 5 days
Complications
of Parenteral
Nutrition
Occurs in approximately 50% of patients Pneumothorax Arterial laceration Air emboli Catheter thrombosis Catheter sepsis Hyperglycemia HHNK
Palliative
Care and
Enteral
Feeding considerations
Consider family and patient’s wishes
Obtain swallow test
Feed for pleasure
Essential diagnosis of Anorexia nervosa
female with 3 consecutive missed menses
body image disturbance
weight loss leaving body wt 15% less than expected
Female patient with bradycardia, hypotension, with complaints of being cold and constipated and amenorrhea. patient looks emaciated you suspect and labs look like
anorexia nervosa cbc> anemia an d leukopeia chemistry> electrolyte abnormals BUN> elevated creatinine> elevated Serum cholesterol> incresed FSH > low Luteinizing Hormone> low
Treatment goal of anorexia nervosa
restore normal weight and body image (2/3 success)
essentials of bulimia nervosa diagnosis
binge eatting twice weekly for 3 months
self induced vomiting, laxitives, diuretics, fasting, over exercise
overconcern with weight and shape
female patient healthy looking with complaint of sorethroat; states normal menses, on exam you see inflammation of throat and poor dentation; what would you ask and suspect
have you had any diet changes, fluctuations in weight. Labs may show abnormalities
suspect bulimia
Plan of care for some one with bulimia
educate on nutrition
start on ssri
refer to psych
What is wet beriberi
seen in thiamine (B1) deficiency
due to high physical exertion and increased carbs
effects cardiovascular system
causes peripheral vasodilation, edema, warm extremities mimic cellulitis
also
tachycardia with High output heart failure =>pulmonary edema => dyspnea,
Dry beriberi
seen in thiamine B1 deficiency
affects central and peripheral systems
leading to neuropathy lower > upper
and wernicke-korsakoff
Treatment of thiamine deficiency
3 days 50 to 100mg/day thiamine IV, then 5 to 10mg qd
Treatment of thiamine toxicity
thiamine does not cause toxicity
Riboflavin deficiency treatment
meat fish dairy
Niacin deficiency presents as? can diagnose by
Pellgra: dementia, diarrhea, dermatitis
Urine screen for Niacin metabolites show low niacin
Vitamin B deficiencies can present with symptoms of
irritability, weakness, mouth sorness, glossitis, and cheilosis (red corner of mouth)
Treatment of pyridoxine (B6) deficiency? isoniazid?
supplement 10-20mg/d
Isoniazid (lowers B6) suppliment b6 50-100mg/day
Pyridoxine toxcitiy
seen in high doses 200-2000mg/d causes neuropathy
Vitamin C toxicity
gastric irritation, diarrhea
kidney stones
high dose causes false stool and urine test
A patient with postop ileus, gastroenteritis, or paritial instestinal obstruction would need what type diet
clear liquid diet
What is a clear liquid diet
provide adequate fluids and 500 to 1000kcal
what is full liquid diet
low residue diet
clear liquid diet with added dairy, soft foods like cereal or eggs
Patient with difficulty chewing but has no GI issues should be placed on what type diet
soft diet
which is a food that represents a soft diet Raw vegetables raw fruit course bread tender foods
tender foods
what effect will low sodium diet have on diuretic therapy
use less diuretic medication, decrease potassium loss
patient with complaints of diarrhea and steatorrhea,what may be cause, suggest what type of diet
cause maybe due to fat malabsorption, suggest fat restricted diet
Patient with diagnosed hepatic encephalopathy due to chronic liver disease required what type diet
protein restricted diet 0.6g/kg/d
How to estimate water requirements for patients
1500ml for the first 20kg of body weight plus 20ml for every kg above the first 20kg
Complication from using parenteral nutrition: Hyperglycermia? How to treat
caused byparenteral infusion of dextrose too fast, also stress, or corticosteroids
Treat: decrease glucose infusion, insulin, replace dextrose with fat
Complication from using parenteral nutrition:
Hyperosmoar nonketotic dehdration, Treat?
caused by severe, undetected hyperglycemia,
Treat: insulin, hydration, postassium
Complication from using parenteral nutrition:
hyperchloremic metabolic acidosis? Treat?
caused by Due to high chloride administration
Treat: decrease chloride
Complication from using parenteral nutrition: Azotemia, Treat?
caused by high protein content, decrease protein
Complication from using parenteral nutrition: hypophosphotemia, hypokalemia, hypomagnesiemia
caused by Extracelluar to intracellular shift due to refeeding syndrome,
Treat by increasing solution concentration
Complication from using parenteral nutrition: Liver enzyme abnormalities, Treat?
caused by Lipid trapping in hepatocyctes,
Treat: Decrease dextrose
Complication from using parenteral nutrition: Acalculous cholecytitis, Treat?
caused by billiary stasis,
Treat: with oral fat
Complication from using parenteral nutrition:
Zinc defciency, Treat?
caused by diarrhea, small bowel fistulas.
Treat: increase concentration
Complication from using parenteral nutrition: Copper deficiency
caused by billiary fistula, treat with increased concentration
When parenteral nutrion is used metabolic complicatoins should be monitored how often,
Electrolytes daily until balanced, then monitor twice weekly with RBC, folate, copper, and zinc monthly
When should central vein nutritional support be considered
1) Gastrointestinal tract can not be used, and
2) support is needed for longer than 2 to 3 weeks
3) peripheral veins cant tolerate
When can peripheral vein be used for parenteral nutrition
when vein placement is adequate and fluid tolerance is good
When should enterostomy tube be placed for nutritional support
When patient GI tract can be used safely and effectively and support is needed longer than 6 weeks
When should nasoduodenal tube be used for patient
patients GI tract is safe and effective
patient not at high aspiration risk
Difference between DKA and HHNK
DKA usually seen in type 1, ketoacidosis is seen
HHNK seen in type 2 DM, no ketoacidosis
DASH diet stands for? used commonly for people with?
Dietary Approaches to Stop Hypertension
Hypertension
Female using oral contraceptive or hormone replacement therapy can effect what serum protein
transferrin
Serum osmolality normal levels
280 to 300 mmol/kg
Serum sodium normal level
< 150mEq/L
Urine specific gravity normal level
1.005 to 1.030
Urine volume normal level
> 1200mL/ day
what albumin level indicates malnutritoin
<3.5g/dL
Malnutrition with edema may have albumin level of
<2.7g/dL
Hemoglobin of <12g/dL for women by indicate
lack of iron
Parenteral nutrition needed for more months or years used what type of access
tunneled catheter or port
What are 4 complications of Parenteral nutrition
Occurs in approximately 50% of patients Pneumothorax Arterial laceration Air emboli Catheter thrombosis Catheter sepsis Hyperglycemia HHNK
What are 4 complications of Enteral nutrition
Aspiration Diarrhea Emesis GI bleeding Mechanical obstruction Hypernatremia Dehydration Re-feeding syndrome
