Nutritional Disorders Flashcards
Kwashiorkor
Protein energy malnutrition
Inadequate protein intake with reasonable energy (caloric) intake.
Edema is characteristic
Marasmus
Protein energy malnutrition
Involves inadequate intake of protein and calories. Characterized by emaciation
Kwashiorkor is likely secondary to _____
Hypermaetabolic acute illness
Such as trauma, burns, sepsis
Marasmus is likely secondary to
Chronic diseases
COPD
Cancer
Aids
How does Kwashiorkor differ from Marasmus?
K is adequate carbohydrate consumption and decreased protein intake lead to decreased synthesis of visceral proteins
The resulting hypoalbuminemia contributes to extravascular fluid accumulation
What happens to the CV system when you have protein- energy malnutrition?
Decrease in CO and contractility
What do you see in the liver when you have a pt with protein energy malnutrition?
Hepatic synthesis of serum protein and levels of circulating proteins are decreased
ABCD components of the nutritional assessment
Anthropometric measurements
Biochemical assessment
Clinical examination
Dietary assessment
Anthropometric measurements
Triceps skin fold and mid arm muscle circumference are most commonly used
What clinical signs will you see with marasmus?
Weight loss
Proceeds to cachexia
Body fat stores disappear
Muscle mass decreases, most noticeably in the temporalis and interosseous muscles
Serum albumin may be normal or slightly decreased, rarely decreasing to less than 2.8g/dL
What clinical presentation might you see with kwashiorkor?
Rapid onset
May develop in pts with normal subcutaneous fat and muscle mass
Serum protein level typically declines and the serum albumin is often less than 2.8 g/dL
Dependent edema, ascites, or anasarca may develop
What is the most important laboratory test to dx protein-calorie undernutrition?
Serum albumin
What do transferrin, transthyretin, and prealbumin tell you about the protein deficiency pt?
Reflect short term changes
What lab tests, according to WHO, will you get for a suspected protein deficiency pt?
Blood glucose Blood smears Hemoglobin Urine exam and culture Stool examination by microscopy for Ova and Parasites HIV Electrolytes
What is the treatment for protein deficiency?
Phase 1:
Correction of fluid and electrolyte abnormality
Treat any infections
Phase 2:
Repletion of protein, energy, and micronutrients
Concomitant admin of vitamins
Which vitamins are fat soluble?
A, D, E, and K
Which vitamin deficiency is most common with EtOHers?
Thaimine (B1)
How to pts with thiamine deficiency present?
Anorexia
Muscle cramps
Paresthesias
Irritability
Advanced deficiency:
- wet beriberi - CV syndrome
- dry beriberi - peripheral and CNS
What clinical manifestation will you see with wet berberi?
Peripheral vasodilation High output heart failure Dyspnea Tachycardia Cardiomegaly Pulmonary edema Peripheral edema Warm extremities mimicking cellulitis
What clinical presentation will you see with dry beriberi?
Peripheral nervous system:
-polyneruopathy - affecting leg, footdrop, wrist drop, areflexia
CNS:
- Wernicke encephalopathy
- Korsakoff syndrome amnesia
- Wernicke - Korsakoff syndrome: both neurologic and psychaitric symptoms
How do you dx thiamine deficiency?
Erythrocyte transketolase activity and urinary thiamine excretion
What is the treatment for thiamine deficiency?
Thiamin 50-100 mg IM or IV bid
When in doubt - banana bag before glucose!
Vitamin B2 deficiency
Riboflavin
Primary - inadequate intake of fortified cereals, milk, and other animal products
Secondary - interactions with a variety of medications, alcoholism, and other causes of protein - calorie undernutrition
What is the clinical manifestation of riboflavin deficiency?
Cheilosis Angular stomatitis Glossitis Seborrheic Dermatitis Weakness Corneal vascularization Anemia
