Nutrition/Pharmacology/Psychology

Question 1

What are variable components in demand of a persons energy requirements?

Answer 1

Cost of processing dietary intake
Cost of physical activity
Cost of maintaining body temperature
Cost of growth

Question 2

What are the main different types of malnutrition?

Answer 2

Marasmus - protein calorie malnutrition
Kwashiorkor - protein calorie malnutrition with inflammatory component
Obesity

Question 3

What are the different boundaries of BMI?

Answer 3

<16 - Severe consequences
<18 - physical impairment
<20 - underweight
>25 - overweight
>30 - obese

Question 4

What percentage of weight loss is considered notable?

Answer 4

5% loss can occur quickly

10% loss becomes associated with increasing morbidity

Question 5

What are the consequences of malnutrition?

Answer 5

Impaired immune response
Reduced muscle strength
Impaired wound healing
Impaired psychosocial function
Impaired recovery from illness and surgery
Poorer clinical outcomes

Question 6

What are possible causes of under-nutrition?

Answer 6

Appetite failure
Access failure
Intestinal failure

Access failure

• teeth
• stroke
• cancer of head/neck
• head injury

Question 7

What are the typical classes of drugs given for alimentary disorders?

Answer 7

Acid suppressors
Drugs affecting motility
Laxatives
IBD treatment
Drugs affecting secretions

Question 8

What are the different types of acid suppressors?

Answer 8

Antacids
- neutralise gastric acid

Alginates
- form viscous gel that floats on stomach contents, preventing reflux

H2-antagonists
- indicated in GORD/peptic ulcer disease

PPIs
- indicated in GORD/peptic ulcer disease

Question 9

What psychological problems/symptoms may be caused by GI disease/vice versa?

Answer 9

Conditioning
Nausea/vomiting
Loss of appetite (weight loss)
Diarrhoea
Sexual problems
Stress

Question 10

What psychological problems may present as GI disease?

Answer 10

Stress
Anxiety
Depression
Somatisation
Eating disorders
Mental state

Question 11

What is the process in refeeding syndrome?

Answer 11

Reduced CHO intake and therefore insulin secretion
Fat and protein become main sources of energy - reduced intracellular phosphate

On refeeding with CHO

• rapid insulin rise
• rapid ATP generation
• phosphate moves into cells
• hypophosphataemia rapidly develops

Question 12

What are the risk factors for refeeding syndrome?

Answer 12

One or more of

• BMI <16
• weight loss >15% within 3-6months
• little nutritional intake for >10 days
• low K, Phosphate, Mg levels

Two or more of

• BMI <18.5
• weight loss >10% within 3-6months
• alcohol/drug abuse

Question 13

How is refeeding syndrome treated?

Answer 13

Start low
Correct fluids
Thiamine at least 30 minutes before feeding starts
5-10Cal/kg over 24 hours

Replace Phosphate, K, Mh