malnutrition Flashcards
define malnutrition
deficiency, excess or imbalance nutrients, results in a measurable adverse effect on body function and clinical outcome
cause of malnutrition in hospital
reduced intake
-NBM
-depression
maldigestion/malabsorption
-function
-length
altered metabolism
1. injury
2.catabolism- cover metabolic need
3.anabolism- muscle recovery
impact on malnutrition
-poorer clinical outcome- increase mortality/decrease wound healing
-NHS cost
how to diagnose malnutrition
- screen: MUST (malnutrition universal screening tool)
- assess- dietitian
3.diagnose
nutritional support should be considered in people who are either:
malnourished//
at risk of malnutrition
what is considered malnourished
BMI < 18.5 kg/m2 or
Unintentional weight loss >10 % past 3-6/12 or
BMI < 20 kg/m2 + unintentional weight loss > 5 % past 3 –6/12 month.
what is considered at risk of malnutrition
Have eaten little/nothing for > 5 days +/- are likely to eat little or nothing for the next 5 days+ or
poor absorptive capacity, +/- high nutrient losses +/- increased nutritional needs ie. catabolism.
Oral Nutrition Support- examples and who is it for
-Tailored dietary counselling,
-Oral nutritional supplements (ONS)
-Fortification of meals and snacks
any patient with inadequate food and fluid intakes,
unless they cannot swallow safely, impaired GI function or if no benefit is anticipated e.g. end of life care.
Q. What is artificial nutrition support?
The provision of enteral or parenteral nutrients to treat or prevent malnutrition.
what are the 2 types of artificial nutrition support
enteral
parenteral
order of feeding preferences and to return to preferred ones as soon as clinically possible
- oral nutrition support
- enteral nutrition support
- parenteral nutrition support
enteral nutrition access: is gastric feeding possible? yes/no- what tube is used?
long term: 3 months+ access?
yes= naso-gastric tube (NGT)
no= naso-duodenal (NDT)/naso-jejunal tube(NJT)
LT= gastrostomy/ jejunostomy
what to do if there is Gastric outlet obstruction? In terms of access using enteral feeding
cannot use NGT feeding.
use NJT
What are the complications associated with enteral feeding? Mechanical, metabolic and GI
Mechanical: misplacement, blockage
Metabolic: hypergylcaemia, electrolytes imbalance
GI: Aspiration, nasopharyngeal pain, laryngeal ulceration, V+D
what to do when NGT is misplaced
-Aspirate pH ≤5.5
-pH > 5.5 → chest x-ray
Artificial Nutrition Support: Parenteral- how are the nutrients delivered
The delivery of nutrient directly into venous blood.
when to use parenteral nutrition support
inadequate/ unsafe oral +/- enteral nutritional intake
OR
impaired gastrointestinal tract
parenteral feed access:
Central venous catheter (CVC): tip at superior vena cava and right atrium.
What are the complications associated with parenteral nutrition?
-catheter related infections
-metabolic: electrolyte imbalance, hyperglycaemia
-mechanical- pneumothorax, thrombosis, catheter occlusion
Albumin- where it’s synthesised, what does hypoalbuminaemia mean?
-liver
-poor prognosis
-negative acute phase protein -> low albumin= high inflammation
albumin-what is the acute phase response
Inflammatory stimulus → activation of monocytes → release cytokines.
Cytokines act on liver -> proteins synthesis e.g. CRP, whilst downregulating production of others e.g. albumin.
Is albumin a valid marker of malnutrition in the acute hospital setting?
No. Albumin synthesis ↓es in response to inflammation ∴ poor predictor of malnutrition during acute phase.
what is refeeding syndrome
biochemical shifts & clinical symptoms occurring in malnourished/starved individual on the reintroduction of oral, enteral or parenteral nutrition
Consequences of RFS:
-Arrhythmia, tachycardia, CHF → Cardiac arrest, sudden death
-Respiratory depression
-Encephalopathy, coma, seizures
-Wernicke’s encephalopy
RFS: what are the criteria for: at risk, high risk and extremely high risk
At risk:
Very little or no food intake for > 5 days
High risk: ≥1 of the following:
-BMI < 16 kg/m2
-Unintentional weight loss > 15 % 3 – 6 /12
-Very little / no nutrition > 10 days.
-Low K+, Mg2+, PO4 prior to feeding
Or ≥2 of the following:
-BMI < 18.5 kg/m2
-Unintentional weight loss > 10% 3 – 6 / 12
-Very little / no nutrition > 5 days
-PMHx alcohol abuse or drugs (insulin, chemotherapy, antacids, diuretics)
Extremely high risk:
-BMI < 14 kg/m2
-Negligible intake > 15 days
RFS management
refer to dietitians
1. administer thiamine 30 mins before + first 10 days of feeding
2.correct and monitor electrolyte
- start 10-20kcal/kg
carb-40-50%
micronutrients from feeding - monitor fluid shifts and minimise risk of fluid and Na+ Overload
