Malnutrition Flashcards
Manifests as
3 categories
_____ rlated malnutrition
____ related Malnutrition
_____ related malnutrition
wasting, stunted growth, w or micronutrient def
Starvation- chronic calorie def wout inflammation (marasmus)
Chronic dz- chronic mild to mod inflammation (Cachexia)
Acute dz- acute severe inflamm, w inadequate protein intake to meet needs (Kwashiorkor)
Persistent calorie insuffic results in
marasmus
Indiv are
mobilization of fat/muscle as energy source
exhausted body fat stores and wasting of muscle
Hypometabolic, lacking substrate for anabolism w some catabolism
Cachexia
Represents
Assc w
Distincted by
Best described in
chronic inflamm of underlying med illness
imbalance of metabolism w catabolism over anabolism
inc metabolic rate and proinflamm cytokines
prominent anorexia/loss of muscle mass (catabolism)
cancer
Kwashiorkor
Results from
stress of illness inc
pts are
stressed state
results in, affecting
sudden/profound mal
acute illness w poor oral intake
protein/carloric req
hypermetabolic w inc catabolism/proteolysis
consumes available protein
hypoproteinemia, wide variety of cell fxn, immunity
Mal also results in
adult pt w severe illness def in
Children w severe malnutrition more likely to have
def of V/M
VC, folic acid, zinc
micronutritent def, VA/VD, folate/Fe
In US, marasmus is seen in
Kwashiorkor
In elderly, malnutrition is
pt w anorexia nervosa
more freq, children w severe illness (trauma/sepsis) reducing oral intake (only on dextrose)
cachexia/chronic caloric insufficiency
CM
regularity and availability of meals
Use of special diets/supplements
Nutritional history w malnutrition risks
depend on cause
Social isolation/need assistance- prepare/shop food, eating/other aspects of care
Therapeutic diet px
Major food intolerances
Excessive supplement use
Use of alcohol, drugs, meds
Presence of illnesses or dz
Nutritional history and risk
Alcohol abuse (Nut def) chronic steroids, immunosuppresants, antimetabs
CKD, AIDS, CP dz, cirrhosis, malignancy, malabsorption
Marasmus characteristics
D\_\_\_\_\_ E\_\_\_\_\_ T\_\_\_\_\_ R\_\_\_\_\_\_ T\_\_\_\_\_\_ N\_\_\_\_\_\_ T\_\_\_\_\_\_
Dim weight to height ratio Emaciated appearance Thin, shrunken arms/legs/butt Redundant skin folds Thin, sparse hair, pluckable Normal ab exam Thin, dry skin
Kwashiorkor characteristics
N\_\_\_\_\_ A\_\_\_\_\_\_ N\_\_\_\_\_\_ N\_\_\_\_\_ D\_\_\_\_\_ H\_\_\_\_\_ P\_\_\_\_\_
normal weight for age Anasarca Normal muscle mass Normal Subq fat dry, hypopigmented hair, easily plucked Hepatomegaly, distended ab Pitting edema
Cachexia
noted in
other
loss of muscle mass
temporal area or interosseus areas
mean upper arm circum
Eval
Infant w kwashiorkor
Management
mild to mod mal
pay attention
guided by hx/PE
low serum albumin (<2.8), lymphopenia (dec cell immune fxn)
dep on severity/chronicity
nutritious diet w appropriate calories/protein
to underlying do, indicate need for supplementation
Severe mal at risk for
Refeeding syndrome
rapid delivery of nutrients
characterized by
wout management, results in
refeeding syndrome
Delivery of carbs inc blood glucose, releases insulin, activates ATP formation, retaining Na and H2O
shifts body processes from fat/prot catabolism to glyc/prot synthesis (moving electrolytes)
hypoPhos/K/Mg, thiamine def (used in glycolysis and CAC)
edema and cardiac failure
Phased approach to severe mal
1
2
3
fluids/elecs= rehydrate w isotonic solution, correct elec/A-B abnromalities
V/M= thiamine first/simultaneous
Nutrition= admin sufficient calories to meet 50% total calroic req, focus on recommended prot intake
Pts must be monitored to dtect
if pt is doing well,
fluid shifts, elec abnormalities, other sx
calories inc gradually, meet goals over next week
