Nutrition

Question 1

Reasons for malnutrition in hospitalised patients

Answer 1

Increased nutritional requirements e.g. burns, surgery
Increased nutritional losses e.g. malabsorption, output from stoma
Decreased intake e.g. dysphagia, nausea, sedation, coma
Effect of treatment e.g. nausea, diarrhoea
Enforced starvation e.g. prolonged periods NBM
Missing meals e.g. due to investigations - minimise meal time disruption
Difficulty with feeding e.g. lost dentures, no one available to assist
Unappetising food

Question 2

Identifying patients at risk of malnutrition

Answer 2

History:
Recent decrease in weight (>20%, accounting for fluid balance)
Recent reduced intake
Diet change (e.g. recent change in consistency of food)
Nausea & vomiting
Pain, diarrhoea which may have led to reduced intake

Question 3

Examination evidence of malnutrition

Answer 3

Skin hanging off muscles
No fat between fold of skin 
Hair rough and wiry
Pressure sores
Sores at corner of mouth 
Calculate BMI (<18.5 suggest malnourishment)

Question 4

Malnutrition Universal Screening Tool (MUST)

Answer 4

Step 1
Measure height and weight to get a BMI score

Step 2
Note percentage unplanned weight loss and score using tables provided

Step 3
Establish acute disease effect and score.

Step 4
Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.

Step 5
Use management guidelines and/or local policy to develop care plan

Question 5

Define refeeding syndrome

Answer 5

Life-threatening metabolic complication of refeeding via any route after a prolonged period of starvation

Question 6

Patients at risk of refeeding syndrome

Answer 6

Those initiating artificial (enteral/parenteral) feeding after prolonged starvation
Malignancy
Anorexia nervosa
Alcoholism

Question 7

Prevention of refeeding syndrome

Answer 7

High-dose Pabrinex during refeeding window
Identify at-risk patients
Assess and monitor closely during refeeding (glucose, lipids, sodium, potassium, phosphate, calcium, magnesium and zinc)
Close involvement of a nutritionist is required

Question 8

Features of refeeding syndrome

Answer 8

Rhabdomyosis
Red and white cell dysfunction 
Respiratory insufficiency 
Arrhythmias 
Cardiogenic shock
Seizures
Sudden death