Malnutrition and Cachexia

Question 1

What is malnutrition?

Answer 1

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

Question 2

What are causes of malnutrition?

Answer 2

Poor intake
Poor absorption
Increased metabolic needs

Question 3

What is the gold standard for malnutrition screening?

Answer 3

Duel-energy x-ray absorptiometry (DEXA)

Question 4

What do labs screening for malnutrition look for?

Answer 4

Somatic and visceral proteins
Somatic = urinary creatinine
Visceral = albumin and transferrin

Question 5

What is the half life of albumin?

Answer 5

20 days

Question 6

What is the half life of prealbumin?

Answer 6

2 days

Question 7

What is the half life of transferrin?

Answer 7

8-10 days

Question 8

What is the DRI?

Answer 8

Dietary Reference Index
Made by institute of medicine to recommend levels of a nutrient necessary for optimal health

Question 9

What is RDA?

Answer 9

Recommended dietary allowance
Average daily dietary nutrient intake level sufficient for nearly all healthy individuals

Question 10

What is AI?

Answer 10

Adequate intake
Recommended intake based on approximations of nutrient intake by healthy people

Question 11

What is EAR?

Answer 11

Estimated average requirement
Average need that meets the requirement of half the healthy individuals

Question 12

What is the EER?

Answer 12

Estimated energy requirement
average dietary intake predicted to maintain energy balance

Question 13

What is UL?

Answer 13

Tolerable upper intake level
Highest average daily nutrient intake level

Question 14

What is BMR?

Answer 14

Energy expenditure needed to sustain the metabolic activities, reclining after a 12 hour fast

Question 15

What is BEE?

Answer 15

Basal energy expenditure
BRM extrapolated to 24 hours

Question 16

What is RMR?

Answer 16

Resting metabolic rate?
BMR but accounts for energy expenditure increases caused by recent food intake or effect of recently completed physical activity. 10-20% higher than BMR on average

Question 17

What is REE?

Answer 17

Resting energy expenditure
RMR extrapolated to 24 hours

Question 18

What is the most common worldwide deficiency?

Answer 18

iron deficiency

Question 19

What is marasmus?

Answer 19

starvation, the state of protein and total energy malnutrition due to lack of intake

Question 20

What is kwashiorkor?

Answer 20

protein deficit, protein malnutrition in the presence

Question 21

What does kwashiorkor look like on a PEx?

Answer 21

Classic edematous appearance
Skin/hair changes, dryness
bradycardia, hypotension, hypothermia
Distended abdomen with dilated bowel loops
Lethargic, apathetic, irritable

Question 22

What is cachexia?

Answer 22

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

Question 23

Is cachexia reversible?

Answer 23

Not fully reversible by conventional nutritional support

Question 24

How many cancer patients are affected by cachexia?

Answer 24

50-80%

Question 25

What is cachexia thought to be caused by?

Answer 25

Thought to be tied to mitochondrial dysfunction

Question 26

What are the risks of parenteral nutrition?

Answer 26

Bacteremia, sepsis, poor weight gain Fat overload syndrome - fever, HSM, coagulopathy Bone metabolism disease in children

Question 27

What are the general principals for low-appetite patients?

Answer 27

-frequent small meals -energy dense foods -powdered supplements -add calories and nutrition to preferred foods

Question 28

What is dumping syndrome?

Answer 28

Sx: sweating, flushing, dizziness, tachycardia Caused by large amounts of foods (esp sugar) moving rapidly from the stomach to the bowel

Question 29

What is megestrol acetate (Megace)?

Answer 29

Synthetic progestin that has been found to promote appetite Often in AIDS and cancer patients

Question 30

What are the SE of Megace?

Answer 30

GI upset, HA, insomnia, rash

Question 31

What is cyproheptadine (Periactin)

Answer 31

1st generation antihistamine that can be used as an appetite stimulant

Question 32

What are the SE of cyproheptadine (Periactin)?

Answer 32

Dizziness, drowsiness, anticholinergic

Question 33

What are the CI of cyproheptadine (Periactin)?

Answer 33

Allergy, MAOI, urine/gastric obstruction, acute angle closure glaucoma, gastric ulcer

Question 34

What is dronabinol (Marinol)?

Answer 34

Cannabinoid-derived agent (THC); can suppress N/V and promote appetite. Is schedule III

Question 35

What is the SE of dronabinol (Marinol)?

Answer 35

Euphoria, GI upset, dizziness, drowsiness, AMS

Question 36

What is the CI to dronabinol (Marinol)?

Answer 36

allergy, disulfiram or flagyl in 14 days, allergy to alcohol or sesame oil