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nutrition > malnutrition and cachexia > Flashcards

malnutrition and cachexia Flashcards

1
Q

general state of inadequate nutrient and/or energy intake and absorption to meet metabolic demands

A

Malnutrition

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2
Q

3 causes of malnutrition

A
  1. Poor intake - imbalanced diet, anorexia, sensory issues, poor dentition, diminished thirst/hunger
  2. Poor absorption - intestinal bacterial overgrowth, inflammatory disease, GI tract resection or scarring
  3. Increased metabolic needs - cancer, burns, AIDS
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3
Q

how to calculate % usual weight

A

(actual weight ➗ usual weight) x 100

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4
Q

how to screen children for malnutrition

A

body length and head circumference

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5
Q

skin, hair, nails, mucosal membranes is what type of system

A

Integumentary

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6
Q

immunosuppression, anemia, bleeding or bruising
is what type of system

A

Hematopoiesis

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7
Q

paresthesias, weakness, cognitive delay or impairment is what type of system

A

Neurologic

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8
Q

which malnutrition screen uses calipers

A

skinfold thickness

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9
Q

which malnutrition screening uses tape measure

A

Midarm muscle circumference

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10
Q

the BMI for underweight is

A

<18.5

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11
Q

what is used to assess child’s growth relative to peers
Failure to thrive

A

growth charts

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12
Q

low height-for-age
Associated with chronic or recurrent undernutrition

A

stunting

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13
Q

low weight-for-age
Associated with recent/severe weight loss as well as chronic undernutrition

A

wasting

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14
Q

dual-energy x-ray absorptiometry (DXA or DEXA)
considered the gold standard and is most accessible

A

imaging

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15
Q

what labs are ordered to screen malnutrition

A
  1. Somatic proteins - 24 hour urinary creatinine excretion
    - Assesses relative state of skeletal muscle mass
  2. Visceral proteins - albumin, transferrin, prealbumin, retinol-binding protein
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16
Q

what protein is most commonly used; t ½ 20 days
Can be decreased in acute septic states, even without malnutrition

A

Albumin

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17
Q

what protein has t ½ of 2 days
More useful in very acute malnourishment
Also depressed in acute stress states

A

Prealbumin

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18
Q

what protein has t ½ of 8-10 days
Elevated in iron deficiency states

A

transferrin

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19
Q

what is Dietary Reference Intake (DRI)

A

nutrient reference values developed by the Institute of Medicine to quantify recommended levels of a given nutrient necessary for optimal health based on a patient’s individual characteristics (e.g. height, gender, activity level)

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20
Q

the DRI includes ?

A

RDA, AI, EAR, EER, UL

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21
Q

what is Recommended Dietary Allowance (RDA)

A

average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all (97-98%) healthy individuals in a particular life stage and gender group

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22
Q

what is Adequate Intake (AI)

A

recommended average daily intake level based on approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate

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23
Q

what is used when an RDA cannot be determined

A

Adequate Intake (AI)

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24
Q

what is Estimated Average Requirement (EAR)

A

average daily nutrient intake level estimated to meet the requirement of half (50%) the healthy individuals in a particular life stage and gender group

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25
Q

what is Estimated Energy Requirement (EER)

A

specifically used for energy - average dietary intake predicted to maintain energy balance in healthy individuals of a given age, gender, weight, height, and physical activity
level consistent with good health

26
Q

____ includes extra metabolic needs during pregnancy, lactation or childhood

A

EER

27
Q

what is Tolerable Upper Intake Level (UL)

A

highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in the general population

28
Q

what is Basal Metabolic Rate (BMR)

A

energy expenditure needed to sustain the metabolic activities of cells and tissues, blood circulation, respiration, GI and renal processing, and staying awake
- Determined with subject reclining after a 12 hour fast

29
Q

what is Basal energy expenditure (BEE)

A

BMR extrapolated to 24 hours

30
Q

what is Resting Metabolic Rate (RMR)

A

Similar to BMR; accounts for energy expenditure increases caused by recent food intake or effect of recently completed physical activity
10-20% higher than BMR on average

31
Q

what is Resting energy expenditure (REE)

A

RMR extrapolated to 24 hours

32
Q

what is the Harris-Benedict Equation

A

original equation used to determine an individual’s BMR - published in early 20th century and later revised in 1984.

33
Q

BMR is used to estimate the kilocalories needed to maintain current weight (EER) based on someone’s activity level, as follows:

A
  1. Little to no exercise - kcal/d needed = BMR x 1.2
  2. Light exercise (1–3 d/wk) - kcal/d needed = BMR x 1.375
  3. Moderate exercise (3–5 d/wk) - kcal/d needed = BMR x 1.55
  4. Heavy exercise (6–7 d/wk) - kcal/d needed = BMR x 1.725
  5. Very heavy exercise (2x/d, extra heavy workouts) - kcal/d needed = BMR x 1.9
34
Q

what is the most common deficiency worldwide

A

iron deficiency

35
Q

state of protein and total energy malnutrition

A
  1. Marasmus (Starvation)
    - Severe tissue wasting and weight loss
    - Excessive loss of lean body mass and subcutaneous fat
36
Q

PE findings of marasmus (starvation)

A
  1. Relatively large head with large, staring eyes
  2. Emaciated, weak appearance
  3. Thin, dry skin with thin, sparse hair that is easily plucked
  4. Shrunken arms, thighs, and buttocks with redundant skin folds
  5. Bradycardia, hypotension, hypothermia
  6. Irritable, fretful demeanor
37
Q
  • protein malnutrition in the presence of caloric intake
  • Classically seen in babies weaned from the breast in low-income countries
A

Kwashiorkor (Protein Deficit)

38
Q

PE findings of kwashiorkor (protein deficit)

A
  1. Growth retardation
  2. Changes in skin and hair pigmentation, and thin, dry, peeling skin
  3. Low serum albumin
  4. Bradycardia, hypotension, and hypothermia
  5. Distended abdomen with dilated intestinal loops
    - May see hepatomegaly from fatty liver infiltrates
  6. Lethargic, apathetic, irritable
  7. edematous appearance
    - Begins in dependent areas, proceeds cranially
    - May involve presacral area, genitalia, periorbital area
    - Muscle atrophy with normal or even increased body fat
39
Q

multifactorial wasting syndrome defined by continuous loss of skeletal muscle mass, with or without loss of fat mass

A

Cachexia

40
Q

what cannot be fully reversed by conventional nutritional support

A

cachexia

41
Q

what affects 50-80% of cancer patients
May account for up to 20% of cancer mortality

A

cachexia

42
Q
  1. what is thought to be tied to mitochondrial dysfunction
    - Decreased ATP and protein synthesis
    - Increased oxidative stress in the body
    - Elevated inflammatory markers
A

cachexia

43
Q

what are the types of nutrition replacement

A
  1. Enteral - via the GI tract
    - Includes oral and feeding tubes
    - NG tubes - Nasogastric tubes - short-term feeding
    - PEG tubes - percutaneous endoscopic gastrostomy tubes - long-term feeding
  2. Parenteral - via the bloodstream
    - Typically delivered via a central line
    - TPN - total parenteral nutrition
    - PPN - peripheral parenteral nutrition
44
Q

where would a tube be placed with pts with higher aspiration risk

A

jejunum

45
Q

parental is only indicated if ?

A

the gut is not working for some reason!
- Major bowel resection, lack of GI motility, severe IBD, obstruction

46
Q

Where possible, nutrition should always be delivered ____
why?

A
  1. enterally
    - Parenteral carries higher risk of bacteremia and sepsis, poorer weight gain
    - Fat overload syndrome - fever, HSM, and coagulopathy due to fat sludging
    - Associated with bone metabolism disease in children with long-term use
47
Q

General Principles for Low-Appetite (Anorexia) Patients

A
  1. Frequent spacing of small meals
  2. Prioritize energy-dense foods
  3. Powdered or liquid nutritional supplementation
    - Pediasure, Ensure, protein powders
  4. Adding calories and nutrition to preferred foods
48
Q

what is included for patients on Tube Feedings

A
  1. Formulas specially designed to contain oligosaccharides, protein, and triglycerides, +/- fiber supplementation
  2. Can get specially made formulas focusing on a few key nutrients to add to tube feedings or to feed alone if full supplementation is not needed
49
Q

what is Dumping Syndrome

A
  1. sweating, flushing, dizziness, and tachycardia caused by large amounts of foods (especially high intake of simple sugars) moving rapidly from the stomach into the bowel
  2. Seen in post-gastric surgery, tube feedings
  3. Slow infusion rate and amount of feeding given at one time
50
Q

Megestrol acetate (Megace)

A

Appetite Stimulants

51
Q

Cyproheptadine (Periactin)

A

Appetite Stimulants

52
Q

Dronabinol (Marinol)

A

Appetite Stimulants

53
Q

Synthetic progestin which has been found to promote appetite
Anorexia or cachexia associated with AIDS

A

Megestrol acetate (Megace)

54
Q

SE of Megestrol acetate (Megace)

A

GI upset, headache, insomnia, rash

55
Q

what is the off-label use for Megestrol acetate (Megace)

A

Cancer-related cachexia

56
Q

1st generation Antihistamine
Can be used as an appetite stimulant

A

Cyproheptadine (Periactin)

57
Q

SE of Cyproheptadine (Periactin)

A

dizziness, drowsiness, anticholinergic

58
Q

CI of Cyproheptadine (Periactin)

A
  1. Allergy to medication
  2. MAOI therapy
  3. urinary or gastric obstruction (BPH, stenosis, etc.)
  4. acute angle-closure glaucoma
  5. gastric ulcer
59
Q

Cyproheptadine (Periactin) should not be given to ?

A
  1. premature infants
  2. neonates
  3. pregnant/breastfeeding women
  4. elderly
  5. debilitated patients
60
Q

Cannabinoid-derived agent (THC); can suppress N/V and promote appetite
Used mostly in patients AIDS and patients on chemotherapy
Controlled - Schedule III

A

Dronabinol (Marinol)

61
Q

SE of Dronabinol (Marinol)

A

euphoria, GI upset, dizziness, drowsiness, AMS

62
Q

CI of Dronabinol (Marinol)

A
  1. Allergy to medication
  2. use of disulfiram or metronidazole in last 14 d
  3. allergy to alcohol or sesame oil

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