W5 Case Studies: Malnutrition, Refeeding Syndrome & EDs Flashcards
Overly aggressive refeeding without adequate nutrient supplementation can be associated with serious morbidity, including:
a. cardiac dysfunction
b. arrhythmias
c. congestive heart failure
d. death
e. a, b and c
f. all of the above
f. all of the above
Therefore, significantly malnourished individuals must be repleted slowly, under close monitoring and supervision
Hark, p. 152
Which nutrient deficiencies are the hallmark of refeeding syndrome?
a. iron, zinc, copper
b. magnesium, potassium, phosphorus
c. vitamin B6, B12, folate
d. vitamin A, D, K, E
b. magnesium, potassium, phosphorus - If intracellular electrolytes are not supplied in sufficient quantity to keep up with tissue growth, low serum levels of potassium, phosphorus, and magnesium develop. Low levels of these electrolytes are the hallmark of refeeding syndrome, especially hypokalemia.
(Mahan & Raymond, p. 222)
What causes refeeding syndrome?
Refeeding syndrome (RFS) is a term used to describe the broad range of metabolic abnormalities and physiologic consequences that can occur during aggressive administration of nutrition (particularly via the intravenous route) in a severely malnourished person. These changes can lead to significant pathologic consequences - severe, potentially lethal electrolyte fluctuations involving metabolic, hemodynamic, and neuromuscular problems. Common in patients who require enteral or PN therapies - these individuals may have been eating poorly before initiating therapy because of the disease process and may be moderately to severely malnourished - but these changes can occur, to a greater or lesser degree, in every pediatric or adult patient who has been deprived of adequate nutrients.
(Mahan & Raymond, p. 222; Hark p. 183)
Refeeding syndrome occurs when energy substrates, particularly _______, are introduced into the plasma of anabolic patients
a. protein
b. carbohydrate
c. fatty acids
d. electrolytes
e. water
b. Carbohydrate - Carbohydrate metabolism by cells causes a shift of electrolytes to the intracellular space as glucose moves into cells for oxidation. Rapid infusion of carbohydrate stimulates insulin release, which reduces salt and water excretion and increases the chance of cardiac and pulmonary complications from fluid overload. Therefore, conservative amounts of carbohydrate (and adequate amounts of intracellular electrolytes - phosphorus, potassium, magnesium) should be administered.
(Mahan & Raymond, p. 222-223)
True or false: The diagnosis of failure to thrive (FTT) is solely based on anthropometric parameters.
True - FTT is considered to be due to physical or psycho- logical problems in early childhood that result in growth delay and cognitive deficiencies. However, there is no consensus on a FTT definition. Unlike undernutrition, the diagnosis of FTT is solely based on anthropometric parameters
Hark, p. 166
What changes in gastrointestinal function occur during long periods of starvation?
a. slowed motility
b. decreased gastric acid secretion
c. thinning of the mucosa
b. villous atrophy
e. decreased production of digestive enzymes
f. all of the above
f. all of the above - Gastrointestinal (GI) atrophy slows motility and gastric acid secretion and causes thinning of the mucosa, villous atrophy, and decreased production of digestive enzymes. These effects reduce GI function and can result in malabsorption and diarrhea, further exacerbating the malnutrition and increasing susceptibility to infection.
(Hark, p. 183)
True or false: Initial clinical manifestations of malnutrition includes decreased levels of serum albumin and protein.
False - Though protein status may be depleted at initial presentation, serum albumin and protein values are commonly NORMAL due to the decreased blood volume (hemoconcentration). However, as the patient is refed, the total blood volume increases, and albumin and protein concentrations may decrease (hemodilution).
Hark, p. 183
