Malnutrition

Question 1

Malnutrition Presentation

Answer 1

• Insidious weight loss, can be masked by oedema
• Listlessness increasing fatigue, cold sensitivity, non-healing ulcers

Presentation in children

• Bipedal oedema, visible severe wasting
• Poor weight gain, slowed linear growth, behavioural changes
• Marasmus, kwashiorkor, nutritional dwarfism

Question 2

Malnutrition Assessment

Answer 2

• BMI, percentage unintentional weight loss
• Consider nutritional support for those with
• BMI <18.5
• Unintentional weight loss >10% over 2-3 months (5% if BMI<20)
• Those who have eaten little/nothing for 5 days who are unlikely to eat again for 5 days
• Absorption problems

Question 3

Malnutrition Differentials

Answer 3

• Elderly failure to thrive

- Severe malnutrition

Question 4

Malnutrition Ix

Answer 4

• Anthropomorphic investigations
• BMI
• Mid and upper arm diameter
• Skin folds

Question 5

Malnutrition Management (Elderly)

Answer 5

• General advice
• Use of supplements
• If inability to shop/prepare meals- refer to social services, meals at home, community dietician
• If difficulty with feeding utensils- refer to occupational therapy
• Nausea- consider antiemetics
• Treat oral pathology
• Investigate dysphagia

Question 6

Malnutrition Acute Management of Malnourished

Answer 6

• Check for co-existing dehydration, infection, anaemia, hypoglycaemia
• Correct shock
• Restore electrolyte balance alongside not before feeding

Question 7

Malnutrition Refeeding Syndrome

Answer 7

• Fluid balance abnormalities
• Abnormal glucose metabolism
• Low phosphate, magnesium, potassium, thiamine
• Those at high risk of refeeding syndrome include
• Anorexia nervosa, chronic alcoholism, cancer, post-op, elderly patients with decreased reserve

To prevent

• Start refeeding at no more than 50% of energy requirements
• Increase rate if no problems
• If very malnourished start even lower and continuous cardiac monitoring
• Potassium, phosphate, calcium and magnesium should be given unless blood levels are high beforehand

Question 8

Malnutrition Complications

Answer 8

• Impaired immune response and increased risk of infection
• Impaired wound healing
• Others