Nutrition and Malnutrition Flashcards
Malnutrition
State of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes adverse effects on body etc and clinical outcome
Disease-related malnutrition
Under nutrition caused by disease or illness
Psychosocial causes
Inappropriate food provision Self neglect Bereavement Inability to access food Deprivation Loneliness ...
Effects of malnutrition
Impaired immune response Impaired wound healing Reduced muscle strength Reduced resp muscles inactivity Impaired thermoreg Depression, apathy
What tool is used for screening of malabsorption?
MUST (Malnu. Universal Screening Tool)
5 steps
- BMI
- Unplanned weight loss?
- Acute disease effect?
- Add up scores
- Management guidelines
If weight and height cannot be measured, what is an alternative method to measure BMI?
Mid Upper Arm Circumference
bent at the elbow at a 90 degree angle, with the upper arm held parallel to the side of the body
What can be used for height?
Ulna length
MUST score
0 = low risk 1 = medium risk 2+ = high risk
What strength test can also be used?
Hand grip test
“ABCDE” of malnutrition?
Anthropometry, biochemistry, clinical condition, dietary intake, economic/psychosocial issues
Enteral tube feeding
delivery of nutritionally complete feed directly into gut via a tube
Stomach
Duodenum
Jejunum
NG
NJ
Percutaneous endoscopic gastrostomy
Surgical jejunostomy
Parenteral nutrition
Intravenous nutrition
Central or peripheral vein
People who need it//
- inadequate/unsafe oral intake
- non functional, inaccessible GI tract
> PICC - Peripherally Inserted Central Catheter
Tunnelled catheter (Hickman line)
US guided
Who needs nutritional support?
BMI < 18.5
>10% unintentional weight loss
BMI < 20 and 5% unintentional weight loss >5%
Likely to eat little or nothing for more than 5 days or longer
Oral nutritional supplements
Ready made drinks Powders (milkshake) Puddings Carb supplements Fat supplements Fat and protein supplements
Enteral Tube Feeding - contraindications
> Lower GI obstruction
Severe diarrhoea or vom
High enter-cutaneous Fistula
Intestinal ischaemia
Estimating energy requirements
Calculate BMR
Add factor to account for increased requirements caused by disease
Add/subtract energy to allow weight gain/loss
Refeeding syndrome
Potentially fatal shifts in fluids and electrolytes
Insulin release
Up take of electrolytes and glucose
Blood concs go down –> big problems
esp. by parenteral or enteral
Preventing referring syndrome
Introduce nutrition support at a max of 50% for first 48 hours
Provide supplements
Monitor
Increase nutrition support to meet full requirements and monitor
Intestinal Failure (IF)
Types
Type 1 - self limiting, short term post op/paralytic ileus
Type2 - prolonged. Sepsis. Abdo surgery w/complications*** , weeks/months of care
Type 1 and 2 are ACUTE
Type 3 - long term but stable. Home parenteral nutrition CHRONIC IF
Type 1
> Replace fluid, correct electrolytes
> Parenteral nutrition if unable to tolerate oral food/fluids
> PPIs
Devices for venous access for parenteral nutrition
Portocath
PICC
Central venous catheter
Parenteral Nutrition - complications
Sepsis SVC thrombosis Line fracture Line leakage Line migration Liver disease Endocarditis
Type 3 IF (Chronic)
Home parenteral nutrition
Bowel lengthening for short bowel syndrome
Short bowel syndrome
< 200cm = short bowel
Insufficient length of small bowel to meet nutritional needs without artificial nutritional support
(normal = 250-850cm)
Most common indication home parenteral nutrition
Small bowel transplantation
> Surgery well described
Immune-suppression
Last resort
Nutritional support team
Best care
Multidisciplinary teams
DRs Specialist Dietician Pharmacist Biochemist
