Gastro - Malnutrition

Question 1

what is the definition of malnutrition?

Answer 1

State in which a deficiency of nutrients such as energy, protein, vitamins or minerals result in measurable adverse effects on body composition, function or clinical outcome.

• BMI <18.5 or
• unintentional weight loss >10% within last 3-6 mths or
• BMI <20 + unintentional weight loss >5% within last 3-6 mths

Question 2

which tool is used to screen for malnutrition?

Answer 2

MUST - malnutrition universal screening tool

Question 3

describe the pathophysiology of refeeding syndrome

Answer 3

Insulin secretion resumed after period of starvation… increased glycogen, fat and protein synthesis… further depletion of various electrolytes (already depleted due to starvation) leading to:
- hypomagnesaemia - risk of torsades de pointes
- hypophosphataemia
- hypokalaemia
- abnormal fluid balance
Can lead to organ failure, with abnormal heart rhythms most common cause of death

Refeeding can also result in hyperammonaemia due to downregulation of urea cycle enzymes during starvation.

Question 4

at what rate rate should feeding be resumed after starvation >5 days?

Answer 4

No more than 50% of requirements for 1st 2 days