malnutrition

Question 1

what is malnutrition

Answer 1

lack of intake/uptake of nutrition resulting in altered body composition leading to diminished mental function and clinical outcome

Question 2

which demographics is it most common in?

Answer 2

women
gi issues 
65+
hosptial, long term conditions 
drug/alcohol issues

Question 3

reasons for eating less in hosptial

Answer 3

disease
drugs 
expected
inactivity 
poor food quality
depression 
inflexibility of mealtimes 
dementia

Question 4

what screening tool is used?

Answer 4

MUST

incorporated bmi, unplanned weight loss, presene of disease

Question 5

when is screening required

Answer 5

upon admission and weekly after

Question 6

what is anthropometry

Answer 6

measurement of physical properties of the body

Question 7

what is measured in anthropometry?

Answer 7

scales (bmi)
mid upper arm circumference, skin fold tricep measurement
ct scans (if already there)
hand grip strength
multifrequency bioelectric impedence analysis (renal and haem pts)

Question 8

why is biochem not used unless CRP is around 10?

Answer 8

often skewed due to inflammation

Question 9

what does indirect caloromitry calculate?

Answer 9

nutrition requirement

Question 10

what is considered malnourished?

Answer 10

BMI <18.5 OR

BMI <20 and unintentional weightloss of more than 5% in past 3-12 months

Question 11

what is considered at risk of malnutrition

Answer 11

eaten little-nothing for more than 5 days (or likely to) OR

poor absorbative capacity/increased nutritianal needs/losses

Question 12

how is enteral nutrition given?

Answer 12

NG tube via nose - stomach/duo

Question 13

how is enteral nutrition given in the long term?

Answer 13

gastrostomy/jejunstomy

Question 14

when an ngt is placed, what does an aspirate of pH 5.5 or greater require?

Answer 14

CXR. look for misplaced

Question 15

what is parenteral nutrition?

Answer 15

delivery of fluids, nutrients and electrolytes directly into venous blood

Question 16

3 things that stimulate albumin synthesis?

Answer 16

insulin
GH
cortisol

Question 17

3 things that inhibit albumin? what are these called?

Answer 17

IL6 TNF

acute phase protein

Question 18

why is albumin not a valid marker of malnutrition in acute hosptial settings?

Answer 18

decreased due to inflammation

Question 19

what is refeeding syndrome

Answer 19

biochemical shifts and clinical symptoms that occur in the malnourished patient on the reintroduction of nutrition

Question 20

how does refeeding syndrome occur?

Answer 20

1. malnutrition: insulin down, glucagon up
2. increased glycogenolysis, gluconeogenesis, catabolism - ketone production
3. refeeding - carb as main energy source
4. insulin secretion up
5. protein synthesis up, glucose uptake up, na retention, thiamine use up, intracellular shift of phosphate, potassium and magnesium (insulin increases na/k atpase)
6. results in hypophospataemia, low magnesiim, low potassium thiamine deficiency, salt retention - refeeding syndrome

Question 21

what basically happens in RFS

Answer 21

shift in metabolites leads to an uptake of electrolytes into the cell. tjis leads to low extracellular concs which have clinical manifestations

Question 22

what can happen in the fluid retiation

Answer 22

fluid overload

Question 23

3 cardiac consequences of rfs

Answer 23

arrhythmia, tachycardia, cardiac failure

Question 24

5 othe consequences of rfs

Answer 24

resp depression
encephalopathy
coma
siezures
rhabdomyelitis

Question 25

what is considered at risk for rfs

Answer 25

no food intake for more than 5 days

Question 26

high risk of rfs? (one needed to qualify)

Answer 26

bmi under 16
unintentional weight loss over 15% last yeat
no nutrition 10 days
low electrolytes prior to feeding

Question 27

high risk of rfs? 2 needed to qualify

Answer 27

bmi under 18.5
10% unintentional weight loss
no nutrition 5 days
alcohol abusr or drugs (insulin, chemo, antacids, diuretics)