Nutrition Flashcards
What is the best tool for assessing nutrition?
A, B, C
- *Wasting in:**
- Masseter and temporalis
- 1st dorsal interosseous in hands should be convex not concave
Weight loss especially in the last 3 weeks in terms of reflecting cellular function
What are the main non-nutritional causes of hypoalbuniaemia? What is albumin’s half life in serum and the body?
- Sepsis
- CLD
- Nephrotic syndrome
- Fluid retention - refeeding syndrome
Alb serum half life 12 hrs
Alb body half life 21 days
What is the underlying physiology in starvation?
What might be the clinical indication that a patient with anorexia nervosa requires ICU?
- Bradycardia
- Hypotension
- Long QT
Signs of cardiomyopathy/impending cardiac death
Summarise the complications of anorexia nervosa
Who’s at risk for refeeding syndrome? Describe the underlying insulin response and electrolyte/water changes in starvation/refeeding along with clinical consequences of refeeding
Patients at risk
- anorexia nervosa
- classic kwashiorkor
- classic marasmus
- chronic malnutrition-underfeeding
- chornic alcholism
- morbid obesity with massive weight loss
- patient unfed in 7-20 days with evdience of stress and depletion
- prolonged fasting
- prolonged intravenous hydration
Phosphate follows K to maintain electrochemical equality
What is the normal length of small bowel? What amount needs to be lost before you develop short gut syndrome?
4-5m
Loss of ~50%
- nutrient deficiency and diarrhoea as sequelae
What is the normal length of small bowel? What amount needs to be lost before you develop short gut syndrome?
4-5m
Loss of ~50%
- nutrient deficiency and diarrhoea as sequelae
What are the factors that favour intestinal absorption in short gut syndrome (factors which point toward not needing home TPN)
Chyme travels much slower in ileum which favours absorption
What are the immediate, adaptive, and chronic effects of massive small bowel resection?
- *NAGMA due to bicarbonate loss**
- Look for AGMA as that might indicate other underlying pathology
- *Bile acid**
- Watery, green diarrhoea
- Can use cholestyramine to bind bile salts and help the diarrhoea
- *Fatty acid**
- Cholestyramine will make it worse as it binds the bile salts that help dissolve the fat
- Medium chain triglycerides used as bile salts not required to absorb
- *Higher incidence of PUD** after small bowel resection
- Use PPI
- *Dry meals**
- Drinking when you eat gives diarrhoea
What is teduglutide? When might it be useful? Is it used?
~$300,000/yr so not used
What are the indications for TPN?
TPN shouldn’t used in advanced cancer for prolonged periods unless guaranteed a cure
What are the indications for PEG placement? Should PEG feeding be used in advanced dementia?
- *Don’t have to PEG early in stroke**
- Can wait 2-3 weeks, use NG in meantime
- No difference between NG feeding D1 vs D7 in unconscious stroke
PEG in Advanced Dementia
- NO evidence that it improves survival and NO evidence that improvest QoL.
