Met 2: Acute Malnutrition

Question 1

Severe acute malnutrition is the same as ______

Answer 1

protein energy malnutrition

Question 2

What is the key feature of malnutrition?

Answer 2

Not meeting energy requirements

(not enough calories)

Question 3

If you have a negative energy balance, what will your Nitrogen balance be?

Answer 3

If you have a negative energy balance, you will definitely have a negative Nitrogen balance

Question 4

Define underweight

Answer 4

Low-weight for age

More than 2 SD below median

Question 5

Define stunting

Answer 5

Low height/length for age

More than 2 SD below median

Question 6

Define wasting

Answer 6

Decreased weight relative to height

Weighing less than 90% of your ideal body weight (a standard based on your height)

Question 7

Define sarcopenia

Answer 7

Sarcopenia: low muscle mass

Question 8

Is marasmus typically slow or fast onset?

How does that affect adaptation?

Answer 8

Marasmus is slow onset, so patients have better adaptation

Question 9

Mild wasting is often called

Answer 9

“failure to thrive”

Question 10

Kwashiorkor

• Definition
• Cause
• Onset

Answer 10

• Edematous malnutrition
• Due to protein deficiency
• Rapid onset

Question 11

4 Signs of Kwashiorkor

Answer 11

• Edema
• Hepatomegaly
• Hyperpigmented, flaky rash
• Depigmented stripe of hair

Question 12

Cachexia occurs with _______ or _______ conditions.

It ______ reversible with feeding

Answer 12

Cachexia occurs with inflammatory or cancerous conditions (chronic illness)

It is not reversible with feeding

Question 13

Describe the Kwashiorkor mnemonic

Answer 13

Kwashiorkor results from protein-deficient MEALS

• Malnutrition
• Edema
• Anemia
• Liver is fatty
• Skin lesions (hyperkeratosis, hyperpigmentation)

Question 14

Define cachexia

Answer 14

Malnutrition in the setting of chronic illness

Question 15

Define marasmus

Answer 15

Severe malnutrition due to a calorie deficiency

Causes muscle and fat wasting

Question 16

After using up all the glycogen, the body will utilize ________ as long as possible before ______________.

Answer 16

After using up all the glycogen, the body will utilize fat stores as long as possible before turning to muscle breakdown

Question 17

What happens to basal metabolic rate with fasting?

Answer 17

Basal metabolic rate decreases

Question 18

What are the signs of malnutrition in these systems?

• decreased metabolic rate (3)
• Endocrine (2)
• GI (1)
• Heart (1)

Answer 18

• Decreased metabolic rate: hypothermia, hypotension, bradycardia
• Endocrine: low insulin, increased epi and steroids
• GI: mucosal atrophy
• Heart: myocardial atrophy

Question 19

What is the calorie intake in Kwashiorkor?

Answer 19

Calorie intake may or may not be adequate

It’s protein that’s specifically deficient

Question 20

Why do kwashiorkor kids have edema?

Why do they have fatty liver?

Answer 20

Hypoalbuminemia -> edema

Hepatic fatty acid synthesis -> fatty, enlarged liver

Question 21

Do psychological changes occur more in marasmus or kwashiorkor?

Answer 21

Kwashiorkor

Question 22

When refeeding a malnourish patient,

• Food should be given ________
• Food is administered __________ b/c…

Answer 22

• Food should be given gradually
• Food is administered parenterally b/c gut function is severely compromised and will not be able to absorb nutrients

Question 23

Refeeding syndrome has derangements in which 4 nutrients? Why

Answer 23

• hypokalemia
  
  • Due to insulin release, which forces K+ into cells
• hypophosphatemia
  
  • Due to insulin release and phosphorylation pathways being activated
• hypomagnesemia
  
  • Due to increased requirement, since ATPase enzymes active again
• Thiamine deficiency
  
  • Due to activation of energy breakdown pathways

Question 24

Full feeding should only occur once ______ has resolved

Answer 24

Full feeding should only occur once edema has resolved