Nutritional disorders Flashcards
What is your basal energy expenditure
amount of energy required to maintain basic physiologic function
What are the three factors that play a role in energy expenditure?
- basal energy expenditure
- thermic effect of food
- physical activity
How is a persons BEE measured
patient resting in a warm room, not having eaten for 12 hours
What is the equation that can be used to estimate BEE
Harris Benedict equation
What is the thermic effect of food
amount of energy expended during and following the ingestion of food
Which fatty acid is required by the body? Why?
linoleic acid
lack can lead to dermatitis, hair loss, impaired wound healing
Most important lab in the evaluation of protein-calorie undernutrition
albumin
Kwashiorkor syndrome
deficiency of protein in presence of adequate energy
enough calories, not enough protein
Marasmus syndrome
combined protein and energy deficiency
When does Kwashiorkor typically develop in industrialized countries
secondary to things like trauma, sepsis, and burns
losing proteins
When does Marasmus typically occur in industrialized countries
chronic disease states
Where does protein loss begin? Where does it progress to?
starts with skeletal muscle and progresses to liver, GI tract, kidneys and heart
Low protein affect on liver. Heart. Respiratory. GI. Immune.
Liver: hepatic synthesis slows, circulating proteins decrease
Heart: decreased CO, poor contractility
Respiratory: reduced lung volumes
GI: malabsorptions
Immune: decreasing cell function–> risk for infection
Where does muscle wasting first present
thenar eminence and temple
Treatment of protein-energy malnutrition
call a nutrition consult!
What body weight can lead to a diagnosis of anorexia
15% below the expected weight
What is the other finding that should make you think about anorexia
amenorrhea
absence of 3 menstrual cycles
Clinical features of bulimia
fluctuation of body weight, family and psychological issue, impulsive or antisocial behavior
Tx of bulimia
refer to psychiatrist
-anti depressants
Most common type of anemia? What is it until proven otherwise?
iron deficiency
bleeding until proven otherwise
What are the stages of iron deficiency
- depletion of iron stores without anemia
- anemia with a normal red blood size
- anemia with a low MCV, low reticulocyte count
Signs of severe Fe deficiency
skin and mucosal changes
- smooth tongue
- brittle nails
- spooning of nails
- cheilosis
Tc of FE deficiency
identify cause
ferrous sulfate PO
When do you give parentral iron
- refractory to PO iron
- GI disease
- dialysis
Most common cause of thiamine deficiency
chronic alcoholism
What are the early sx of thiamine def
- anorexia
- muscle cramps
- paresthesias
- irritability
Late sx of thiamine def
cardiovascular dys, neurological dys
What is wet beriberi? Sx?
peripheral vasodilation caused by high output heart failure
Sx: dyspnea, tachy, cardiomegaly, edema
What is dry beriberi?
perhipheral nerve involvement causing motor and sensory neuropathy, paresthesias and loss of reflexes
What is Wernicke-Korsakoff syndrome
severe complication causing encophalopathy, amnesia, confabulation
What do you need to absorb B12
intrinsic factor
What is pernicious anemia
autoimmune disease where the autoantibodes against parietal cells that produce intrinsic factor
no intrinsic factor=no B12
Who is at risk for b12 def
pts with hx of abd surgery, alcoholic, elderly
What type of anemia does b12 def cause
macrosidic with hypersegmented neutrohils
How do you treat b12 def
IM b12 daily for first week, weekly for first month, monthly for life
Typical cause of folic acid def
lack of dietary intake
Type of anemia caused by folic acid def
macrocidic
How is vit D synthesized
synthesized in skin during exposure to UVB light and through diet
Vit D def causes
osteomalacia
Tx of Vit D def
ergocalciferol or cholecalciferol
