Malnutrition

Question 1

What causes malnutrition

Answer 1

• Increased requirement - sepsis, burns, surgery
• ^ loss - malabsorption, output from stoma
• Decrease intake - dysphagia, nausea, sedation, coma

Enforced starvation - NBM

Difficulty feeding/ unappetizing food

Question 2

What is the presentation

Answer 2

• Recent weight loss (>20% - accounting for water loss)
• recent reduced intake
• diet change
• nausea, vomiting, pain, diarrhoea

Question 3

What are the signs

Answer 3

Skin hanging off muscle (esp. biceps)
No fat between fold of skin
Hair rough and wiry
Pressure sores
Sores at corner of mouth

Question 4

What investigations

Answer 4

BMI

Question 5

What management

Answer 5

Prevention
Assess nutrition state + weight on admission.
Identify those at risk and ensure meals not interrupted.

Enteral nutrition i.e. directly into GI tract

• If possible give via mouth.
• An all-fluid diet can meet req. consider dietician advice.
• In danger of choking or aspiration consider demi-solid diet before abandoning oral.

Early post-op enteral nutrition

Tube feeding
Liquid nutrition via tube inserted endoscopically, radiologically or surgically.

Disease-specific feeds e.g. liver cirrhosis w/ hepatic encephalopathy