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xCase 15 SBA > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

what is malnutrtion?

A

defieicnies, excesses or imbalances in a person intake of energy or nutrients- WHO

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2
Q

what are the different types of undernutrition and define

stunting, wasting, underweight

A

stunting- low height for age

wasting- low weight for height

underweight- low weight for age

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3
Q

what are the types of overnutriton?

A

overweight

obesity

diet-relared non-communicabel diseases (Heart disease, stroke, diabetes, cancer)

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4
Q

how can we define types of malnutrtion

A

specific (nutrient missing)

long stadning ( after period of inadequate eating)

sudden ( sudden marked change in food intake- bereavemet)

recurrent (cycles of inadeuqate nutritona —> malnutiriton)

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5
Q

what are the causes of severe undeniutrtion globally?

A

lack of dietary education (inapproproate weaning)

limited or unstabel food supply (war/famine/poverty)

presence of infection (poor hygiene- reduced appeitie/aborpsiton/ increased nutrition loss)

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6
Q

what is Kwashiorkor?

A

pure protein deficiency without energy deficiency (lack of protein but normal calorie intake?

  • stunting
  • suceptibilioty to infections
  • hair colour changes (melanin not made)
  • flaking skin
  • impaired nutrietn absorption
  • bloated abdomin (fat accumualitng in liver and fluid in abdomen)
  • lethargic
  • poor appetite
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7
Q

what is this?

A

Marasmsus- Protein-energy malnutrtion

emaciated (body fat stores used for energy)

ketosis

lack of energy AND protein itnake

  • ribs very prominent
  • alert and irritable
  • severe muscle wasting
  • Voracious feeder
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8
Q

why might individuals become malnourished?

A

inadeuqate nutrient intake

increased metabolic requirmeents

excessive nutrient losses

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9
Q

what are the consequences to the indivdual of malnutriton

A
  • infertility
  • skin and chest infections
  • would complications
  • DVT and embolisms
  • hypothermia
  • pressure ulver
  • repsiatory failure

loss of earning/ employment

psychological

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10
Q

what Tool can we use to asses Malnutriton?

MUST

A

MUST- malnutriton universals creening

  1. BMI (below 18.5kgm2 2 points, 18.520kg/m2- 1 point)
  2. unplanned weight loss over 3-6 months ( 5-10% bodyweight 1 point) (> 10% 2)
  3. acute disease effect- ill and no nutritonal itnake for >5 days - 2 points
  4. overall risk fo malnutrtion
    1. 2 or more hgih risk, 1 medium risk
  5. action
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11
Q

what is a nutrtional assesment - ABCDE?

A
  • Antropology
    • wight, BMI, % weight change, Mid upper arm cirucmference
  • bloods
    • Hb- albumin, C reactive protien, WCC< HB1ac, soidum, urea, calcium and phosphate (baseline used when assessing risk of refeeding sydnrome), magneisum (GI losses), micronutrients
  • CLinical
    • disease state may increase risk of malnutriton, symptoms caused by disease . altered bowel movements, Upper gastrointrsintal upset, early satiety, dyshgaia , letharyg
  • dietary
    • dietary assment, and nutritonal requirments of patient
  • Envuronment
    • social- ability to cook, shop, eocnomic afford food, storage
    • physical- appetie, dntures, dexterity, use of cutlery, diarrhoea, pain, dyshagia
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12
Q

how is nutrtional requirmenets different to dietary assesment?

A

nutrtional screening- simple rapdi genrrla procedure- enegry, protien fluid, macor balcne, micronutirents

nutritonal asssment- more detialed, specif, indepth evaluation- wauntiy, uwiuality of food, poriton sizesm cooking methofs

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13
Q

what are the risk factros for refeeding syndrome?

A

one or more of- high risk

BMI- less than 16kg/2

unintentional weight loss greater than 15%

little to no nutritonal itnake for 10 dyas

low levels of pottaisdum, poshopsahte or magenisum priot to feeding

conditom hisotyr or drugs

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14
Q

what is the treatment for undernutriton

A

FOOD

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15
Q

what is oral nutritoanl support?

A

additiona snakc, fotritified food, oral nutritonal supplemnts, sip food

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16
Q

how can food be foritfied clinically?

A

fat- cream, butter, cheese, creme fraiche- fat is best 1g= 9Kcal comapred to 4g carbs and protiens

carbs- suagr, jam

Protien- skimmed milk pwoder, peantu butter

17
Q

what are 3 differen types of fortification of food in scoiety?

A

mass fortifciaiton (breakf aste cerals -iron)- generla public

targeted fortifiication- specific populations

Market drive fortificiaiton- business oreintaeted intiaitve

18
Q

what should milkshake type oral nutritoanl supplements contain ideally ?

A

nutritioanl completet

better with fibre

19
Q

centrla route or peripheral route for parentenral nutrtion?

A

central route0 longer term acess- and for concentrated feeds which can be toxic for smaller veins

Peripheral for shorter term use,

20
Q

what is the use of enteral nutrtion if we havev Parenteral routes?

A

soem eneterla nutriton maintiend- for the health of the gut

feeds thoug nose

  • _​_Gastric
    • nasogastric- short term
    • gastrosotmy tubes- logn term
  • posy pyloric
    • nasoduodenal tube- short term
    • nasojejeunal tube- long term
    • jejeunostoym- tube long erm
21
Q

what happens in starvation? that leads to state that is suscpetibel to refeeding sydorme?

A

consequence of strvation

  • levels of gluocse fall withn 24-72 hours
  • gluocse maiantiend by glycogenoloysus
  • gluconeogeneiss
  • then meabolsim will shit to ketone
    • this sapres skeltla msucle from breakdowmn and fat free mass is prsereces
  • in effort to reduce cellular expendiutire action of cellular pumps is reduced- electorlytes leak across mmebrane
    • increas ein extracelelular water and depletion of total body pottasium, magnesium and phopshate stores
  • Loss of body fat and protein sitll occur- atrphy of guts
22
Q

Why does rapid reeding after starvation- on a electorlyte/cellular level?

A
  • in the presecne of food (oral, enteral and parenteral)
  • conversion backt o glucose as energy supply
  • rapdid celine in gluconeogeneis and anareobi metbalosim
  • insulin satrts to increase
    • ATPase pumps K+ back into cells and water and sodium further into extracellular space
  • Potasisum, phosphate, mageniusm
    • shift back into cells, strogn cocn gradidnet
  • thiamine deficiency b1 (co-enzyme in carb metabolism)
23
Q

wwhat does refeeding sydnrome reuslt in- in the body?

A

hypophosphataem

hypokal;aemai

hypomagnesaemia

reduced sodium and water excretion-nextracelelula fluid complarmetn expands- refeeding oedema

Ctimain defificney- B1 thiamine

24
Q

how do we define Refeeding sydrome?

A

refeeding syndrom is not a singlular codntion- but a grouop of biochemical shifts and clinical sympotms that occur in the lamnoruished or starved indivudal- upon reintroduction of oral, enteral or parenterl nutrtion

25
Q

how does Refeeding syndrome manifest clinically?

A

Cardiac- altered mycodracial fuction, cardiac arrest, arythmia, tachycardia

Respiratory- acute ventilatory failure, dsypnea, respriaotyr depression

renal- acute kidney injudtr, decrease urnry concentrating abiliyt, increase Potaasium loss secondayr to hypojalaemia

Gastro- anorexia, nausa, vommitingm constipation, vommiting

hametaolgical- anemai, dysfunction

MEtabolic- reduced oxygen release to tissues, glucose intolerane.

26
Q

what does thiamine deficinecy in refeeding syndrome manifest as clinically?

A

congestive heart fialure, cardiomegalty, pulmonary oedema, pleural efuffison, ataxia, coma

27
Q

How is refeeding syndrome prevented and managed?

A

restortiaon of cirulatory volume

oral thimaine 200-300mg dialy

Vitamin B co

addition balancing of multivitamin/trace supplements

Low dose- slow introduciton of nutrients

  • and potasdium, phsopahte and maneisum supplementation
  • top tsop electorylet shift
  • full requirements of fluid, elctorylets , vtimaina nd minerals form the onset
  • steady increase in nutrients- consider GI tolerance (diarrhoea if too fats, spread thoughtou day)
28
Q

describe the steady increase in nutriiton in refeeding

A

day 1- 10Kcal/kg/day

mainly carbs 50-60%, fat 30-40%, protein 15-20|%

day 2-4 increase by 5Kcal if low tolerance stop or go back lower

day 5-7 20-30 Kcal ‘kg’day

day 8-10 20Kcal/Kg/day or increase to full requirement

xCase 15 SBA (8 decks)

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