Nutritional Medicine

Question 1

Protein-Energy Malnutrition

Answer 1

Protein-calorie starvation caused by protein and energy deficiency.

In industrialized societies, PEM is most often secondary to other diseases.

Marasmus and Kwashiorkor

Question 2

Marasmus most commonly is in association with?

Answer 2

Typically results from chronic illness

takes weeks to months to develop

COP, CHF, Cancer, AIDS

Question 3

Kwashiorkor most commonly is in association with?

Answer 3

Primarily in association with hypermetabolic acute illness

Burns, Trauma, Sepsis

20% of hospitalized patients will express kwashiorkor-like symptoms

Question 4

Marasmus etiologies

Answer 4

Develops over weeks/months

Lack of food due to lack of access

Physical disability

Chronic illness

Prolonged hospitalization

Question 5

Clinical and laboratory findings of Marasmus

Answer 5

Hx of weight loss

Muscle wasting

Absent subcutaneous fat

hypotensive, low pulse and temp

Dry, loose skin with loss of turgor

dry dull hair

mild anemia

Mildly reduced serum proteins (albumin)

Question 6

Kwashiorkor etiologies

Answer 6

Decreased intake
Increased losses (malabsorption, diarrhea, glycosuria)

Increased requirement ( fever, neoplasms, surgery)

Question 7

Kwasiorkor lab and clinical findings

Answer 7

Normal fat and muscle

Hyperpigmented, hyperkeratotic lesions of the face and extremities

often hypokalemic

Question 8

PEM overall

Answer 8

Loss of body weight
Loss of adipose stores
Loss of skeletal muscle mass

Question 9

Tests to consider when looking a liver function and malnutrition

Answer 9

ALB

D.bili

PT

Question 10

PEM has many effects

Answer 10

Muscle mass loss

Decrease in stroke volume and cardiace output

SOB due to atrophy of diaphram which leads to a decreased VC, TV, and minute volume

IMMUNE FUNCTION
decreased lymphocyte count
depressed T cells
IgA depression
neutropenia

Gastric motility and acid secretion decreased

SMall bowel mass decreases and loses villi

Bone density decreases

Menstrual cycle slows, sperm production slows

Wound healing prolongs

Question 11

PEM treatment

Answer 11

First goal is to correct fluid and electrolyte abnormalities

Then treat underlying etiology causing the malnutrition

Question 12

Three phases of Metabolic response to critical illness

Answer 12

Ebb phase

Flow phase

Anabolic phase

Question 13

Ebb phase

Answer 13

12-24 hours

fever
increased CO2 consumption
vasoconstriction

Sympathetic nervous system kicks in

rise in Epi, NE, GH, Cortisol

Question 14

Flow phase

Answer 14

Lasts the remainder of the acute illness

Hypercatabolism

Negative nitrogen balance as adipose and muscle are being used for energy

Question 15

Anabolic phase

Answer 15

Begins onset of recovery

Characterized by normalization of VS

Improved appetite and diuresis

Question 16

Calories brakedown

Answer 16

Carbs - 4 kcal/g
Proteins - 4 kcal/g
Fats - 9 kcal/g
Alcohol - 7 kcal/g