Malnutrition Flashcards
what is malnutrition?
lack of uptake or intake of nutrition = altered body compositions/ body cell mass - diminished physical + mental function from disease
highest prevalence of malnutrition in what age groups?
highest in youngest (18-19) and oldest age groups (90+)
How many people malnourished on admission ?
1/3 admitted to hospital malnourished on admission (big issue in the community_
what factors exacerbate malnutrition in the hospital?
disease-related anorexia inflexibility of mealtimes quality of food stress gastro symptoms lack of exercise poly-pharmacy low mood/ depression co-morbidities - eg. dementia
what is the impact of malnutrition on surgery?
postoperative mortality 10 times greater in those who lost more than 20% body weight after op
evidence for link with malnutrition and poorer clinical outcomes
increased mortality, sepsis, post surgical outcomes, pressure sores
decreased wound healing, response to treatment
how to screen malnutrition?
screening tool - low, medium, high risk
MUST tool
how to assess malnutrition?
systematic process of collecting + interpreting info to determine nature/ cause of nutrient imbalance
What is anthropometry?
anthropometry - science that defines physical measures of a person’s size, form, and functional capacities
eg. weight, arm circumference, hand grip strength, CT
what is the biochemistry assessment?
intensive monitoring
identify the nutrient imbalances
important of histories?
full medical history - meds/ past surgeries/ gastro symptoms etc
dietary history - allergies etc
social history - SES/ disabilities/ addiction
How to measure nutrition requirements?
indirect calorimetry - resting metabolic rate
Avg. dietary intake that is needed for an individual
When should nutrition support be considered?
malnourished
at risk of malnutrition
when is a patient malnourished?
BMI less than 18.5
unintentional weight loss of more than 10% in past 3-6 months
BMI less than 20 + weight loss more than 5% in past 3-6 months
when is a patient at risk of malnutrition?
Eaten or are likely to little/ nothing for more than 5 days
Poor absorptive capacity/ high nutrient losses/ increase nutritional needs
what is artificial nutrition support?
provision of enteral/ parenteral nutrients to treat or prevent malnutrition
when is parenteral feeding considered?
GI tract is not functional or accessible
why is enteral feeding better than parenteral?
Given GI tract accessible - this is preferred as it uses the gut
when do you use enteral or parenteral feeding?
when oral nutrition is not safe or possible
what is a NGT?
naso-gastric tube - when gastric feeding is possible - enteral
what is a NDT/ NJT?
naso-duodenal/ naso-jejunal - when gastric feeding is not possible - parenteral
complications associated with enteral feeding?
mechanical: misplaced NGT - leads to death (aspirate needs to be extracted with acidic pH)
metabolic: hyperglycaemia/ deranged electrolytes
GI: aspiration/ laryngeal ulceration etc
what is parenteral nutrition?
delivery of nutrients, electrolytes + fluid directly to venous blood
when do you use parenteral nutrition?
inadequate/ unsafe oral or enteral nutritional intake
non-functioning or inaccessible GI tract
Where is parenteral nutrition administered?
central venous catheter inserted at tip of superior venous cava
complications associated with parenteral feeding?
mechanical: line inserted wrongly - leads to pneumothorax/ thrombosis/ haemothorax etc
metabolic: deranged electrolytes, hyperglycaemia etc
Catheter related infections
Does nutritional support help?
patients receiving nutritional support have lower mortality rates/ reduction in readmissions
what is albumin?
most abundant circulating protein in healthy individuals
- synthesised in liver
what does low albumin indicate?
poor prognosis
albumin is low when inflammation is high
effect of inflammation on albumin?
inflammation stimulus = release cytokines = cytokines act on liver and down-regulate production of albumin
Is albumin a valid marker of malnutrition in the acute hospital setting?
No - albumin synthesis reduces in response to inflammation (can not be used as a marker)
what is refeeding syndrome?
biochemical shifts + clinical symptoms that occur in malnourished/ starved on reintroduction of nutrition
What happens during starvation?
Glycogenolysis Protein catabolism Ketone production Electrolyte depletion Decrease in basal metabolic rate - brain uses ketones instead of glucose
What happens when nutrition is re-introduced to a starved individual?
Introduction of carbs = secretion of insulin = Na/K ATPase pump which requires magnesium as co-factor
Mass cellular uptake of electrolytes
Reduces sodium and fluid excretion = refeeding oedema
hypokalaemia
Thiamine deficiency
What constitutes high risk of Refeeding Syndrome?
High risk - 1 or more of BMI less than 16/ low K+/Mg2+/PO4 prior to feeding/ no nutrition for more than 10 days/ unintentional weight loss of 15% or more for 3-6 months
OR
2 or more of BMI less than 18.5/ past abuse of drugs or alcohol no nutrition for more than 5 days/ unintentional weight loss of 10% or more for 3-6 months
What constitutes extremely high risk of Refeeding Syndrome?
BMI less than 14
Negligible intake for more than 15 days
Management of Refeeding Syndrome?
Start with only 10-20kcal per kg
Electrolytes/ fluids monitored
