Nutrition Flashcards
Weight loss
Clinically significant if more than 5% of weight in a 6-12 month period
Weight loss can result from
Decrease in body fluid
Muscle mass or far
Reduced energy intake
Increased metabolism energy output
Malignancies
Endocrine disorders
Cognitive
GI
behavioral and functional
Age related changes
Nutritional assessment
Dietary history
Physical exam
Biochemical measure
Drug nutrient interactions
Recommended daily allowances
Chronic disease present-DM, HTN, CHF, Renal or liver failure, PUD. CA
Recent illness
Drug or alcohol use
Dietary history or special diets
5-7 day diet diary including weekend
Weight gain or loss
Recent illness or trauma
Body mass and muscle wasting, loss of skin turgid, loss of hair or color, edema or enlarged liver and parotids
BMI
Skin folds
Kwashiorkor type malnutrition
Associated with depletion of visceral protein mass
Patients have no weight loss or may be overweight
Labs for nutritional status
Albumin-
Transferrin
Thyroxine binding
Insulin like growth factor 1-decreases with age naturally
Cholesterol
Drug nutrient interactions
Alcohol
Antacids
Broad spectrum antibiotics
Digoxin
Colchicine
Diuretics
Isonazid
Levodopa
Laxatives
Metformin
Mineral oil
Phenytoin
Salicylates
SSRI
Theophylline
Trimethoprim
Cachexia
Severe weight loss and diminished nutritional intake with cytokine mediated response
RA, CHF, COPD, HIV without Opportunistic infection, critical injury
Anti cytokine agents and anabolic agents offer potential but little evidence
Wasting
Severe weight loss and diminished nutritional intake without cytokine medicated response
Marasmus, cancer, AIDS, critical illness, chronic organ failure
Resting energy expenditure reduced
Visceral proteins are preserved
Treat the underlying disorder prognosis determined by underlying disease
Protein energy under nutrition
Defined as both clinical and biochemical research evidence of insufficient intake
Biochemical-hypo albuminemia or other protein insufficiency
Clinical- wasting, low BMI
Treat underlying disease or injury and provide nutritional support
Protein calorie under nutrition
Weight loss, body weight less than 90% ideal, cholesterol less than 160, albumin Less than 4, associated with increased m/m
No FDA pharmacological approved
Anabolic hormones like GH or antihistamines or TCAs, remeron, megestrol acetate for AIDS,
Malnutrition
Elderly, celiacs, CHF, COPD, major trauma or surgery, alcoholics, gastrectomy, ileal resection, CKD, cirrhosis, IBD, crohns, cancer, HIV
Physical signs of malnutrition
Emaciated, temporal muscle wasting, skin pallor, edema, generalized loss of body fat, cardiac flow murmurs
B12 deficiency
Anemia, paresthesia, glossitis, leukopenia, thrombocytopenia, difficulty with balance and propioception
Vitamin C deficiency
Bruising; petechiae, bleeding, hemarthrosis
Thiamine deficiency
Anorexia, muscle cramps, parenthesis, loss of reflexes, irritability, CHF, cardiomegaly, pulmonary edema
Zinc deficiency
Altered smell and dysguesia, perioral, pustular rash, dark skin creases, hair thinning
Copper deficiency
Microcytic anemia unresponsive to iron, pancytopenia
Chromium deficiency
Glucose intolerance with prolong use of TPN
Manganese deficiency
Weight loss, change in hair pigmentation, nausea, low plasma levels of phospholipid and triglyceride
Refeeding syndrome
Results from overzealous enteral or parental feedings following severe under nutrition characterized by severe electrolyte abnormalities and fluid retention
S/S- Electrolyte imbalance, CHF, cardiac arrhythmias, fluid overload
Other feedings
If greater than 6 weeks for enteral feeds needs PEG
If less than 6 weeks trans nasal tube good
If gut works use enteral feeds avoid parental unless necessary
