Malnutrition; Pseudodementia; Multi-organ dysfunction syndrome (MODS) Flashcards
Describe what is meant by pseudodementia [1]
What is pseudodementia typically caused by? [1]
Pseudodementia is a condition primarily associated with cognitive deficits in older patients suffering from depression.
It is an important differential of dementia, characterised by cognitive and memory impairments that mimic those of dementia but with an underlying psychiatric cause.
primarily associated with depression in older adults.
Describe the signs and symptoms of pseudodementia [6]
- Short duration of symptoms mimicking dementia
- Equal impact on long-term and short-term memory
- Amnesia concerning specific, often emotionally charged, events
- Detailed complaints about memory disturbances
- Highlighted failures in responses to memory-related questions
- Early loss of social skills in the disease progression
- Common responses of “don’t know” to questions, rather than attempting to guess
- Minimal effort in task performance
How do you manage pseudodementia? [1]
The management of pseudodementia primarily involves treating the underlying depressive disorder, often with a combination of antidepressant medication and cognitive-behavioural therapy.
Describe what is meant by Multi-organ dysfunction syndrome (MODS) [1]
Multi-organ dysfunction syndrome (MODS):
- two or more organ systems fail concurrently due to dysregulated inflammatory response
- often emerges as a complication of sepsis, trauma, or major surgeries.
- Commonly affected systems include respiratory, cardiovascular, renal, hepatic, neurological and haematological.
What are the underlying causes of MODS [4]
Sepsis:
- Sepsis is one of the most common precipitating factors for MODS.
- The systemic inflammatory response triggered by infection can lead to widespread endothelial injury and microvascular thrombi formation resulting in multi-organ failure.
Trauma/Burns:
- Severe trauma or extensive burns cause massive tissue damage leading to systemic inflammatory response syndrome (SIRS), which may progress to MODS if not managed promptly.
Hypoperfusion/Ischaemia:
- Conditions causing prolonged hypotension such as shock (cardiogenic, hypovolaemic or septic) can result in inadequate perfusion to vital organs culminating into multi-organ failure.
Immunological Dysfunction:
- Immunosuppression due to chemotherapy, chronic steroid use or underlying immunodeficiency disorders can predispose to severe infections and subsequent MODS.
Describe how each of the following systems would present if impacted by MODS:
- CV [3]
- Resp [3]
- Renal [4]
CV:
- Tachycardia
- Hypotension
- Alterered peripheral perfusion
Resp:
- ARDS: refractory hypoxemia and bilateral pulmonary infiltrates on chest imaging.
- SOB
- Tachyopenea
- Accessory muscles used
Renal:
- Acute Kidney Injury (AKI): oliguria or anuria, electrolyte imbalances and elevated serum creatinine levels.
Describe how each of the following systems would present if impacted by MODS:
- GI [3]
- Haem [3]
- Neurological [4]
GI:
- N&V
- Ileus or GI bleeding
- Pancreatic involvement (raised amylase and lipase)
Haem:
- DIC
- Anaemia
Neurological:
- confusion, agitation, and altered level of consciousness to severe manifestations such as seizures or coma
- may be a direct result of MODS or secondary to hypoxia, metabolic disturbances or sepsis.
Descibe the effects of MODS on endocrine dysfunction [3]
Endocrine dysfunction in MODS can manifest as relative adrenal insufficiency leading to refractory shock.
Hyperglycaemia due to stress response or insulin resistance is common.
Thyroid function may also be affected with low triiodothyronine (T3) syndrome being a typical finding.
Protein-energy malnutrition (PEM) is a severe form of undernutrition characterised by insufficient intake of protein and energy. PEM can lead to [], presenting as [] or []
Protein-energy malnutrition (PEM) is a severe form of undernutrition characterised by insufficient intake of protein and energy.
PEM can lead to marasmus, presenting as significant weight loss or kwashiorkor with oedema and skin changes.
There are three main reasons why someone might become malnourished.
What are they? [3]
- Inadequate amounts of nutrients (e.g. poor variety in diet)
- Difficulty absorbing nutrients (e.g. gastrointestinal dysfunction such as coeliac disease)
- Increased nutritional demands (e.g. post-surgery for healing)
Typical clinical features of malnutrition include [5]
- High susceptibility or long durations of infections
- Slow or poor wound healing
- Altered vital signs including bradycardia, hypotension, and hypothermia
- Depleted subcutaneous fat stores
- Low skeletal muscle mass
Why should serum albumin should not be relied on in isolation to assess a patient’s nutritional state? [3]
Hypoalbuminaemia can also develop in the context of inflammatory states such as infections
Hypoalbuminaemia occurs in conditions where there is an excessive amount of protein being lost (e.g. protein-losing enteropathy, chronic renal disease) or where the production of albumin is impaired (e.g. liver disease due to loss of synthetic function or malnutrition due to a paucity of protein).
When should you give parenteral nutrition? [2]
Parenteral nutrition should be reserved for patients with intestinal failure or inaccessible digestive tracts.
Describe what is meant by refeeding syndrome and
Refeeding syndrome is a condition caused by a rapid re-introduction of normal nutrition in patients who are chronically malnourished
If malnurished: a patient’s intracellular stores of key electrolytes such as potassium and phosphate become depleted
As a result, if a patient is suddenly provided with normal levels of nutrition, there is a sudden shift of K and P into cells, leaving extracellular hypokalaemia and hypophosphataemia
Describe some of key clinical features of hypophosphataemia (CV; resp; neuro; haem) [+]
Cardiac Dysfunction:
- Hypophosphatemia can impair myocardial contractility, leading to heart failure.
- It may also cause arrhythmias due to its role in maintaining normal cellular electrophysiology.
Respiratory Failure:
- Phosphate is essential for ATP production, necessary for respiratory muscle function.
- Severe hypophosphatemia can lead to muscle weakness, including the diaphragm and intercostal muscles, potentially resulting in acute respiratory failure.
Neurological Complications:
- These can range from confusion and seizures to coma, attributable to disturbed ATP metabolism in the central nervous system.
Haematological Effects:
- Reduced 2,3-diphosphoglycerate levels in erythrocytes affect oxygen release from haemoglobin, leading to tissue hypoxia. Hypophosphatemia can also result in hemolysis.
Rhabdomyolysis:
- Phosphate depletion impairs ATP production in muscles, which can lead to muscle breakdown and rhabdomyolysis.
