Protein energy malnutrition (PEM) and acute illness Flashcards
What is an example of a visceral protein?
Albumin (made by the liver)
True or false: Visceral protein levels can be diagnostic of disease states.
False
What is the difference between caloric restriction and starvation?
Caloric restriction includes adequate amounts of protein and micronutrients but starvation does not.
Marasmus is a primary deficit of ______.
energy
Kwashiorkor is a primary deficit of ______.
protein
Name some differences between the clinical picture of patients with marasmus vs kwashiorkor.
Marasmus - people will have muscle wasting, especially in the chest and shoulders. Visceral protein remains normal until late stage.
Kwashiorkor - people will be edematous due to low albumin levels and can also lack skin pigmentation.
How can fatty liver be a result of protein insufficiency?
No protein intake –> no apoprotein synthesis for VLDL export –> fat accumulates in liver.
What is sarcopenia?
Age-related muscle loss
What are the average BMI limits of survival (low-end)?
Males: 13
Females: 11
What can cause secondary protein energy malnutrition?
Illnesses that result in malabsorption, increased energy needs, inability to utilize foods, etc.
What are some features of the “stress response” brought about by illness?
Characterized by an increase in energy expenditure, altered protein synthesis and catabolism, insulin resistance and hyperglycemia.
Which subcategory of energy expenditure increases the most as a result of illness?
basal
True or false: Illness often results in an increase of protein catabolism as well as an increase in acute phase proteins and a decrease in albumin.
True dat.
During acute illness, does glucose suppress muscle catabolism and gluconeogenesis?
Nope.
If a patient’s GI system does not work, should you feed them by mouth (enterally)?
What would Chuck Testa say?
What is the difference between total parenteral nutrition (TPN) and peripheral parenteral nutrition?
TPN has high osmolality and requires administration in a large vein like the vena cava. It meets energy and protein needs.
Peripheral PN can be infused through a smaller vein and may not meet energy or protein needs. Lower osmolality to reduce risk of phlebitis (inflammation of a vein).
How should one be re-feeded after starvation?
Replete electrolytes (phosphate, potassium, magnesium, thiamine) prior to nutritional support, slowly wean on nutrition.
How is malnutrition defined?
BMI of less than 18.5 or has lost 10% or more of their body weight involuntarily over the last 3 to 6 months
Name five clinical indications for nutrition support.
- If the patient is significantly malnourished and will not be able to meet their nutrient needs over the next 48 hours.
- If the patient is acutely ill and will not be able to meet their nutrient needs over the next 7-10 days.
- Pre-operative patients with moderate to severe PEM.
- Inpatients with severe liver disease.
- Patients undergoing myeloablative stem cell transplantation.
