Nutrition Flashcards
How is nutritional status assessed?
- Malnutrition Universal Screening Tool (MUST) and weight
- History - weight loss, anorexia, diet change, N&V
- Exam - hydration, malnutrition, BMI <18.5, unintentional weight loss, measurements.
What is enteral feeding?
Nutrition given into the gut - best by mouth
What are the indications for NG enteral feeding?
- Unsafe swallow
- Anorexia/dementia
- Oesophageal stricture
- Pre-head and neck surgery
- Post-major upper GI/biliary surgery
- Postoperative ileus
What is the main indication for an NJ tube?
Acute pancreatitis
What is a gastrostomy and how is it inserted?
- Tube through abdomen into stomach.
2. Insert percutaneously using interventional radiology or percutaneous endoscopy (PEG)
What is a jejunostomy?
Tube through abdomen into jejunum.
When should parenteral nutrition be given, how is it given, and what are the complications?
- Last resort, GIT not functioning.
- Via dedicated central venous line or PICC
- Sepsis, thrombosis, metabolic imbalance, pneumothorax, embolism of IV line tip.
What is refeeding syndrome?
Life-threatening complication of refeeding via any route after prolonged period of starvation.
Who is at risk of refeeding syndrome?
Initiating artificial feeding after prolonged starvation, malignancy, anorexia nervosa, alcoholism.
What is the pathophysiology of refeeding syndrome?
- Insulin level rises in response to carbohydrate level.
- Increased cellular uptake of phosphate, magnesium and potassium.
- Hypophosphatemic state within 4 days which is mostly responsible for the features.
What could be causing this combination of conditions?
Rhabdomyolysis, red and white cell dysfunction, respiratory insufficiency, arrhythmias, cardiogenic shock, seizures, sudden death.
Refeeding syndrome
What is the treatment for refeeding syndrome?
IV pabrinex, monitor refeeding bloods.
