Protein energy malnutrition (PEM) and acute illness

Question 1

What is an example of a visceral protein?

Answer 1

Albumin (made by the liver)

Question 2

True or false: Visceral protein levels can be diagnostic of disease states.

Answer 2

False

Question 3

What is the difference between caloric restriction and starvation?

Answer 3

Caloric restriction includes adequate amounts of protein and micronutrients but starvation does not.

Question 4

Marasmus is a primary deficit of ______.

Answer 4

energy

Question 5

Kwashiorkor is a primary deficit of ______.

Answer 5

protein

Question 6

Name some differences between the clinical picture of patients with marasmus vs kwashiorkor.

Answer 6

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.

Question 7

How can fatty liver be a result of protein insufficiency?

Answer 7

No protein intake –> no apoprotein synthesis for VLDL export –> fat accumulates in liver.

Question 8

What is sarcopenia?

Answer 8

Age-related muscle loss

Question 9

What are the average BMI limits of survival (low-end)?

Answer 9

Males: 13
Females: 11

Question 10

What can cause secondary protein energy malnutrition?

Answer 10

Illnesses that result in malabsorption, increased energy needs, inability to utilize foods, etc.

Question 11

What are some features of the “stress response” brought about by illness?

Answer 11

Characterized by an increase in energy expenditure, altered protein synthesis and catabolism, insulin resistance and hyperglycemia.

Question 12

Which subcategory of energy expenditure increases the most as a result of illness?

Answer 12

basal

Question 13

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.

Answer 13

True dat.

Question 14

During acute illness, does glucose suppress muscle catabolism and gluconeogenesis?

Answer 14

Nope.

Question 15

If a patient’s GI system does not work, should you feed them by mouth (enterally)?

Answer 15

What would Chuck Testa say?

Question 16

What is the difference between total parenteral nutrition (TPN) and peripheral parenteral nutrition?

Answer 16

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).

Question 17

How should one be re-feeded after starvation?

Answer 17

Replete electrolytes (phosphate, potassium, magnesium, thiamine) prior to nutritional support, slowly wean on nutrition.

Question 18

How is malnutrition defined?

Answer 18

BMI of less than 18.5 or has lost 10% or more of their body weight involuntarily over the last 3 to 6 months

Question 19

Name five clinical indications for nutrition support.

Answer 19

1. If the patient is significantly malnourished and will not be able to meet their nutrient needs over the next 48 hours.
2. If the patient is acutely ill and will not be able to meet their nutrient needs over the next 7-10 days.
3. Pre-operative patients with moderate to severe PEM.
4. Inpatients with severe liver disease.
5. Patients undergoing myeloablative stem cell transplantation.