Nutrition in practice

Question 1

Define malnutrition

Answer 1

State of nutrition in which deficiency or excess of energy/ protein/ other nutrients causes measurable adverse effects on tissue

Question 2

What is the cost of malnutrition to NHS England?

Answer 2

£19.6 billion

Question 3

Name 4 generic causes of malnutrition

Answer 3

• Low intake due to inadequate availability or quality of food
• Reduced intake of food when food is available
• Increased nutritional requirments
• Lack of recognition and treatment

Question 4

What can cause reduced intake of food

Answer 4

• Dysphagia
• Prolonged periods of nil by mouth
• Side effects of treatment
• Pain
• Psychological
• Social
• Poor dentition
• Reflux

Question 5

What can cause increased nutritional requirments (3)

Answer 5

• Infections
• Involuntary movements
• Wound healing

Question 6

What happens to respiratory and cardiac function during malnutrition

Answer 6

They both decrease

Question 7

Does risk of pressure sores increase or decrease during malnutrition

Answer 7

Increase

Question 8

Does risk of infection and ability to wound heal increase or decrease during malnutrition

Answer 8

Infection= increase

Wound heal=decrease

Question 9

What are the 5 steps of MUST

Answer 9

1) BMI
2) Weight loss
3) Acute disease effect
4) Add scores from 1-3
5) Action plan

Question 10

How much can weight change due to fluid fluctuation

Answer 10

Increase by 10-20%

Question 11

What is meant by MUAC

Answer 11

Mid upper arm circumference

Question 12

BMI=

Answer 12

Weight (kg)/ Height (m2)

Question 13

Name some ways height can be measured in difficult situations (eg bedbound patients)

Answer 13

Knee height
Demi span
Ulna length

Question 14

What is BMI likely to be if MUAC <23.5<20

Answer 14

<20

Question 15

What is BMI likely to be if MUAC is >32

Answer 15

> 30

Question 16

How much weight do the following ascites add

a) Tense ascites
b) Moderate ascites
c) Minimal ascites

Answer 16

a) 14 kg
b) 6 kg
c) 2.2 KG

Question 17

How much weight do the following classifications of peripheral oedema add

a) Severe
b) Moderate
c) Mild

Answer 17

a) 10kg
b) 5 kg
c) 1 kg

Question 18

Where is fat mass (skin folds) most commonly measured? What does it estimate?

Answer 18

Use the triceps site

Estimates total adiposity

Question 19

How do you calculate fat free mass

Answer 19

Arm muscle circumference- mid upper arm circumference- (0.314 x triceps site)

Question 20

What does handgrip dyanomometry measure

Answer 20

Muscle strength and endurance

Question 21

What is the most abundant protein in the plasma

Answer 21

Albumin

Question 22

What is normal range of albumin

Answer 22

35-50g/l

Question 23

Function of albumin

Answer 23

Maintaining oncotic pressure

Question 24

Name some causes of hypoalbuminaemia

Answer 24

• Inadequate protein intake

- Inflammation and sepsis

Question 25

How does sepsis lead to hypoalbuminaemia

Answer 25

Capillary wall becomes porous and albumin drifts out

Question 26

Why isn't low albumin always detected in patients with malnutrition

Answer 26

Because in some patients who are starving, there is no inflammatory response so no reduction in vascular permeability

Question 27

Define refeeding syndrome

Answer 27

Condition characterised by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding

Question 28

How do intracellular stores of K+, PO4- and Mg2 change during starvation

Answer 28

They deplete

Question 29

During refeeding, what substrate is used for energy

Answer 29

Switches from fatty acids to carbohydrates

Question 30

Why does switch from fatty acid metabolism to carbohydrate metabolism cause refeeding syndrome

Answer 30

Raised insulin secretion Insulin stimulates potassium, phosphate and magnesium to return to cells Intracellular stores replenished at expensive of plasma concentration

Question 31

Describe what biochemistry tests would show in a refeeding syndrome patient

Answer 31

- Hypokalaemia - Hypomagesaemia - Hypophosphataemia - Thiamine deficiency - Salt and water retention

Question 32

Describe the clinical consequences hypophosphataemia

Answer 32

``` Seizures Weakness Osteomalacia Impaired resp muscle function Cardiac failure Rhabdomolysis ```

Question 33

Define rhabdomolysis

Answer 33

Results from muscle injury

Question 34

Describe the clinical consequences of hypomagnesaemia

Answer 34

Tetancy, paraesthesia, seizures, ataxia Arrhythmias Anorexia Abdo pain

Question 35

Describe the clinical consequences of hypokalaemia

Answer 35

``` Paralysis Paraesthesia Rhabdomyolysis Resp depression Arrythmias Constipation ```

Question 36

Which patients are at moderate risk of refeeding syndrome

Answer 36

Those with very little food intake for >5 days

Question 37

Which patients are at high risk for refeeding syndrome

Answer 37

BMI<16 Unintentional weight loss >15% for >10 days Low levels of K, PO, Mg OR ANY OF THE 2 Patients BMI<18.5 Unintentional weight loss >10% for last 6 weeks History of alcohol/ drug use

Question 38

What is meant by enteral route?

Answer 38

``` Oral Nasogastric Orogastric Nasojejunal Gastrostomy Jejunostomy ```

Question 39

What is meant by parenteral route

Answer 39

Peripheral or central (eg not via gastric)

Question 40

When you enteral tube nutrition be advised

Answer 40

Insufficient oral intake/ oral intake not possible | But gut is functioning

Question 41

What are the indications for parenteral nutrition

Answer 41

GIT unable to digest/ absorb or GIT cannot be assessed

Question 42

Name the disadvantages of parenteral nutrition (6)

Answer 42

- Risk associated with placement - Risk of catheter related sepsis - Disordered liver function - Gut atrophy - Physological implications - Cost