Nutrition and malnutrition

Question 1

What is malnutrition?

Answer 1

Deficiencies, excess or imbalances in intake of energy and/or nutritients

Question 2

What are some effects of malnutrition?

Answer 2

Depression
Delayed wound healing
Specific deficiencies e.g. anaemia, scurvy

Question 3

How is malnutrition assessed?

Answer 3

MUST score

BMI

Question 4

What are the indications for enteral tube feeding?

Answer 4

Impaired/unsafe swallow
No motivation to eat
Sedation

Question 5

What are the indications for TPN?

Answer 5

Non functioning gut

Inaccessible gut

Question 6

What are the complications of TPN?

Answer 6

Infection
Electrolyte imbalances
Blood clots
Liver failure

Question 7

What is refeeding syndrome?

Answer 7

Severe fluid and electrolyte shifts and related metabolic complications in malnourished patients undergoing refeeding

Question 8

What causes refeeding syndrome?

Answer 8

Primarily due to phosphate depletion, due to a shift intracellularly for ATP production with the new glucose available

Question 9

What are the red flags for refeeding syndrome?

Answer 9

Alcohol abuse
BMI <20
Little/no food in >5-10 days
Significant recent weight loss
Low K, MG or phosphate

Question 10

What is the presentation of refeeding syndrome?

Answer 10

Arrythmias
Hypotension
Cardiac failure and arrest
Respiratory failure
Rhabdomyelosis
Seizures
Coma

Question 11

How is refeeding syndrome prevented?

Answer 11

Check phosphate, K, Ca and Mg before refeeding

Prescribe Pabrinex when refeeding