Malnutrition Flashcards
Malnutrition occurs as a result of:
Inadequate dietary supply
GI failure
Unusual losses
Increased demands
What would increase the resting energy expenditure in a patient?
Major trauma Major inflammatory disorders Fever (+13% for every ºC of fever) Burns Sepsis
Loss of appetite and decreased food intake due to:
Infection Trauma Neoplasia Malabsorption Psychiatric disorder Chronic illness Unbalanced tissue demand Abnormal losses Dietary lack
What happens when malnutrition affects membrane function?
Decreased total body potassium
Increased total body sodium
What needs to monitored in malnutrition?
Electrolytes (K+ and Na+) Anaemia Infection (may be silent) Hypothermia Hypoglycaemia Hypoalbuminaemia (infection) Oedema
What can lead to decompensation in malnutrition?
Excessive energy intake Infection Trauma Small bowel overgrowth Abnormal losses
What causes nutritional oedema?
Hypoalbuminaemia
Salt and water retention
Impaired membrane function
What is refeeding syndrome?
Malnourished patients have loss of tissue and damaged machinery
If excess energy and protein is provided to gain weight there is
-overloaded circulation
-heart failure
-Abdominal distension
-Profound secretory diarrhoea
Glucose uptake by cells also drops extracellular K+, PO4-, Mg2+, thiamine
Management of malnutrition
1) Gain metabolic control (treat infection, underlying condition, prevent hypothermia and hypoglycaemia, correct intracellular deficiencies, low levels of feeding)
2) Replete tissue deficit (fortified supplements, protein, nutrients)
Promote digestions through elemental feeds
Feeding tubes?
What can hypophosphataemia do?
Altered cardiac function, arrhythmia, acute ventilatory failure, lethargy, weakness, coma, rhabdomyolysis
What can hypokalaemia do?
Arrhythmias, ECG changes, cardiac arrest, paralysis, weakness, rhabdomyolysis
What can hypomagnesaemia do?
Arrhythmia, tachycardia, respiratory dperession, tremors, tetany
What does thiamine deficiency lead to?
Congestive heart failure, lactic acidosis, weakness
When is someone at high risk of refeeding syndrome?
BMI15% or very little intake for 10days
Alcohol abuse, drugs, BMI10%
What are the options for enteral tube feeding?
Nasogastric
Naso jejunal
Gastrotomy
Jejunotomy
Why is enteral tube feeding good?
Maintains gut integrity
Relatively low cost
Low risk
Physiologically normal
How do you decrease the risk of misplaced NG tubes?
pH aspirate
When is parenteral feeding used?
In intestinal failure
post op, ischaemia, dysmotility, IBD
When can iron deficiency occur?
In dietary restriction, malabsorption and intestinal bleeding
When does vitamin B12 deficiency occur?
Ileal disease or resections
When does hypomagnesiumaemia occur?
After high volume diarrhoea
Why is there deceased intake in Crohn’s?
Pain, bloating, nausea
Dietary restriction
Cytokines and anorexia
Why is there digestion and absorption failure in Crohn’s?
Extensive mucosal damage
Resections
Fistulae
Specific nutrient problems
Why are there increased losses in Crohn’s?
Diarrhoea
Blood loss
Stomas
Fistulae
What treatment is as good as steroids for Crohn’s?
Enteral feeding with an elemental diet
Decreased inflammation, cytokines
Improves remission rates and nutritional status
