Malnutrition Flashcards
What BMI should be considered for treating malnutrition?
BMI less than 18.5 or BMI less than 20 with unintentional weight loss greater than 5% in the last 3 to 6 months.
What are the types of nutritional support for reduced oral intake?
enteral tube feeding
Parenterally nutrition
Oral nutrition suppot
What is oral nutrition support?
Fortified food, additional snacks, and high-calorie drinks.
What is enteral tube feeding?
Feeding directly into the gut through a nasogastric or oro gastric tube. aThe GI tract should be accessible and functional, therefore avoid in malabsorptive diseases, diverticular disease, GI bleeding and bowel obstruction.
What are some contraindications for enteral tube feeding?
Malabsorptive diseases, diverticular disease, GI bleeding, bowel obstruction, and haemodynamic instability.
Why should enteral tube feeding be avoided in haemodynamic instability?
Haemodynamically instability will be worsened with enteric feeding due to poor end-organ perfusion and diversion of blood away from vital areas.
What risks are associated with enteral tube feeding?
Obstruction, dislodgement, bleeding, pneumothorax, and refeeding syndrome.
What is parenteral nutrition?
Nutrition delivered through a central vein for those with a non-functioning GI system.
What components are included in parenteral nutrition?
Lipid emulsions, protein, carbohydrates, sodium, magnesium, calcium, and potassium.
What are the risks with parenterally nutrition?
There is risk of pneumothorax from air embolism, central line associated infection or re feeding syndrome, Wernicke’s encephalopathy and parenteral-associated cholestasis. They should be monitored daily but there is risk of hyperglycaemia and lipid excess causing hepatic toxicity
What is the contraindication for parenterally nutrition?
Wernicke’s encephalopathy and parenteral-associated cholestasis.
What is the suggested nutritional prescription for energy?
25 to 35 kcal/kg per day. with 0.8 to 1.5g per kilogram in protein and 30 to 35 ml fluid per kilogram. The fluid should account for losses from drains and fistula and input from other sources like intravenous drugs
How should low food amounts in the last 5 days be provided with t nutritional support for reduced?
nutrition support should be 50% of requirements in first 2 days before increasing the feed rates.
What is refeeding syndrome?
A complication caused by sudden reversal of starvation, leading to loss of electrolytes. loss of potassium, phosphate, magnesium and calcium in starvation. The sudden reversal causes increased uptake of these ions and loss of sodium and water out of the cell which the kidney cannot handle.
What are key markers of refeeding syndrome?
Hypophosphatemia, which can cause rhabdomyolysis, cardiac failure, muscular weakness and sziure. This is more common with enteral feeding.
Who is at risk for refeeding syndrome?
Chronic alcoholics and patients nil-by-mouth for more than 7-10 days.
What causes malnutrition?
Deficiency in nutrient intake causing adverse effects on body composition or function.
What are some malabsorption disorders?
- Coeliac disease
- IBS/IBD
- Cystic fibrosis
- Whipple disease
- Chronic pancreatitis
- Bacterial overgrowth
- Parasitic diseases
- HIV infection
- Hyperthyroidism
- Lactose deficiency
- Zollinger-Ellison syndrome
- Liver disease.
What is bacterial overgrowth?
Presence of excess colonic bacteria in the small intestine, causing epithelial injury. This is typically E.Coli, kliebsella and aeromans, anaerobes which produce enterotoxins and cause direct epithelial injury.
What factors regulate bacteria levels in the small intestine?
- Gastric acid secretion
- Intestinal motility
- Intact ileocecal valve
- IgA levels.
What cases loss of gastric acid secretion?
h.pyrloi infection, antacids, pernicious anaemia and Sjögren’s syndrome
What reduces intestinal motility
IBS
Hypothyroidism
Type 2 diabetes
What reduces the function of the ileocecal valve?
diverticulosis
Bowel strictures
Ileocacecal resection
How does bacterial overgrowth present?
This can result in abdominal pain, bloating, watery diarrhoea and malabsorption. Fat malabsorption causes weight loss, diarrhoea and vitamin A (vision) D (bones) and K (coagulopathy) and E (muscle co-ordination) deficiencies.
There is typically Bitamin B12 deficiency and B1 and B3 deficiencies occur from utilisation from bacteria. Ataxia may be present and paraesthesia and sensory ataxia from B12 deficiency