Malnutrition

Question 1

Who is affected?

Answer 1

Children, those in hospital + the elderly are vulnerable.

Question 2

What is the aetiology of malnutrition?

Answer 2

· Illness, cancer and dementia.

· Mental health conditions such as anorexia.

Question 3

Suggest the possible risk factors for malnutrition.

Answer 3

· Older people over 65.
· Long-term conditions.
· Chronic progressive conditions.
· Drug or alcohol abuse.·

Question 4

What signs and symptoms might suggest a patient may have an iron deficiency?

Answer 4

· Fatigue.
· Anaemia.
· Decreased cognitive function.
· Headache.
· Glossitis.
· Nail changes.

Question 5

What signs and symptoms might suggest a patient may have an iodine deficiency?

Answer 5

· Goitre.
· Developmental delay.
· Mental retardation.

Question 6

What signs and symptoms suggest a patient may have a vitamin D deficiency?

Answer 6

· Poor growth.
· Rickets.
· Hypocalcaemia.

Question 7

What signs and symptoms might suggest a patient may have a vitamin A deficiency?

Answer 7

· Night blindness.
· Poor growth,
· Hair changes.

Question 8

What signs and symptoms might suggest a patient may have a folate deficiency?

Answer 8

· Glossitis.
· Anaemia.
· Neural tube defects.

Question 9

What signs and symptoms might suggest a patient may have a zinc deficiency?

Answer 9

· Anaemia.
· Hepatosplenomegaly.
· Hyperpigmentation.
· Diminished immune response.

Question 10

During an examination of a malnourished child, what signs may you see?

Answer 10

· In children&raquo_space;> Kwashiorkor (swollen ankles, scaly skin, swollen abdomen, depigmented), Marasmus (hair loss, wrinkled skin, severe wasting).

· Cachexia - does not always present in malnourished pts but all cachectic pts suffer from malnutrition.

Question 11

What investigations might you request to diagnose malnourishment?

Answer 11

· FBC. 
· U&Es.
· LFTs. 
· Urinalysis. 
· Blood glucose.
· Vitamin levels, TFTs and iron studies. 
· Stool specimen if history of abnormal stools or patterns. 
· Growth measurements. Including BMI.

Question 12

List some differential diagnoses.

Answer 12

· Impaired physical function - infection, malignancy, renal or heart failure.
· Depression.
· Dementia.

Question 13

What complications may occur?

Answer 13

· Refeeding syndrome:
	- Hypokalaemia.
	- Hypophosphataemia. 
· Reduced ability to fight infection. 
· Impaired wound healing. 
· Dehydration.
· Fertility problems. 
· Hypothermia.