Term
| What lab measures can indication nutritional status? |
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Definition
1) Albumin (3.5-5.2 g/dl)
- Lagging indicator with 21d half life
2) Prealbumin (transthyretin) (10-43 mg/dl)
- monitors improvements in nutritional status
3) BUN (7-20 mg/dl)
- reflects protein breakdown
- elevated in high catabolic state or with high intake
- decreased in low metabolic state or with low intake.
4) Creatinine (0.5-1.1 mg/dl)
- In stead state and normal renal function, it can reflect lean body mass
5) H/H: Anemia and mean corpuscular volume (MCV) can indicate iron (low MCV), or B12/folate deficiency (high MCV) |
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Term
What micronutrient deficiencies are associated with each of the following.
1) Glossitis
2) Chielosis/Angular stomatitis
3) Pallegra (Dematitis):
4) Koilonychia (spoon nails): |
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Definition
Highest risk in Gastric bypass, ETOH/drug abuse and Celiac disease.
1) Glossitis: Thiamine, Niacin or B12
2) Chielosis/Angular stomatitis: Riboflavin and/or Folic acid
3) Pallegra (Dematitis): Niacin
4) Koilonychia (spoon nails): Iron deficiency |
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Term
| Why is Enteral Nutrition usually preferred to total parenteral nutrition (TNP)? |
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Definition
TNP requires venous access, is constantly and is associated with complications like infections, hepatic steatosis, cholestasis and bone metabolic complications.
Enteral nutrition has added benefits of trophic effects on gut barrier integrity. |
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Term
| Differentiate between the two majors forms of primary, severe malnutrition. |
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Definition
Both forms of primary protein-energy malnutrition
1) Marasmus (unstressed starvation)
- total calorie deficiency and loss of body fat/protein
2) Kwashiorkor
- primary protein deficiency and metabolic stress
**Can be combination, with stressed starvation. |
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Term
| What are the sources of energy in the body? |
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Definition
1) Stored fat (15-25%)
2) Intracellular glycogen and protein (along with intracellular water constitute body cell mass (BCM) |
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Term
How does stress affect body energy stores differently than starvation?
How can this help you differentiate with kwashiorker and marasmus? |
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Definition
1) Starvation decreases all body compartments (fat, glycogen and protein)
2) Stress (excessive expenditure of energy and body protein) only reduces BCM, increasing extracellular water.
**Ascites seen in kwashiorker, but not marasmus** |
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Term
| What are the events that occur in early, medium and late starvation? |
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Definition
1) Early (<24h)
- Glycogen stores used to provide glucose
- Insulin decreases as glycogen is depleted and Glucagon increases.
- AA moved from muscle and fat from adipose for additional energy.
2) Medium (<3 weeks)
- Glycogen depletion/glucose comes from gluconeogenesis from protein breakdown
- Lopolysis proves primary energy (ketone bodies from FA metabolism)
3) Late (>3 weeks)
- Ketone body production accelerate and blood levels rise to supply brain (reduced rate of protein breakdown)
- Hormonal adaptations (growth hormone, TSH, cortisol, renin, aldosterone and ADH all increase). Glucagon and insulin decrease. |
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Term
Which of the following is NOT a cause of starvation (without stress)?
1. Diabetic gastroparesis
2. Celiac disease
3. Dementia
4. Acute sepsis |
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Definition
4. Acute sepsis is starvation with stress (increased basal metabolic rate, protein breakdown, insulin resistance and hyperglycemia)
1. Impaired transit
2. Impaired absorption
3. Neurodegenerative |
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Term
| How do the clinical presentations of Marasmus and Kwashiorkor differ? |
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Definition
1) Marasmus is "skin and bones" of infants, with sunken cheeks, protuberant bellies, NORMAL serum albumin, no edema and "crie du chat" cry.
2) Kwashiorkor has EDEMA in slightly older kids (9 mos- 2 yrs) |
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Term
| What are the 5 common signs of malnutrition in adults? |
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Definition
1) Muscle wasting
2) Short stature
3) Decreased physical activity
4) Decreased work productivity
5) Poor weight gain in pregnancy |
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Term
| What are the 5 common causes of malnutrition NOT relating to undernourishment? |
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Definition
1) Digestion (pancreas, CF)
2) Absorption (enteritis, short bowel syndrome, tropical sprue, Whipple's disease)
3) Metabolism
4) Increased excretion
5) Increased nutritional requirement |
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Term
| Describe the 3 basic components of nutritional status assessment |
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Definition
1) Subjective clinical and dietary history data
2) PE (muscle wasting, height/weight, ascites, gum disease, skin, micronutrient)
3) Labs
- Albumin
- Prealbumin
- Retinol Binding Protein (research)
- Transferrin |
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Term
Under what conditions might each of the following be decreased?
1) Albumin
2) Pre-albumin
3) Retinol binding protein
4) Transferrin |
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Definition
All in malnutrition.
1) Nephrotic syndrome, liver disease, malignancy, fluid overload, pregnancy
2) Inflammation, fluid overload, hyperthyroid, liver, pregnancy
3) Hyperthyroidism, malnutrition, liver disorder, vitamin A
4) Inflammation, nephrotic, liver disease. |
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Term
Under what conditions might each of the following be elevated?
1) Albumin
2) Pre-albumin
3) Retinol binding protein
4) Transferrin |
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Definition
1) Dehydration (>5.2 g/dl)
2) Renal failure or dehydration (>43 mg/dl)
3) Reduced GFR and Alcoholism (>6.4 mg/dl)
4) Iron deficiency, estrogens/oral contraceptives, hepatitis, pregnancy (>400 mg/dl) |
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Term
| Why not give nutrients back to a malnourished patient very quickly? |
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Definition
| Re-feeding syndrome, where bolus of food causes rapid shift of minerals from extracellular to intracellular compartments, causing organ failure. |
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Term
| What differentiates Peripheral parenteral nutrition from total? |
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Definition
PPN involves lower osmotic solution of AA, dextrose and lipids + vitamins and mineral salts that can be given by peripheral IV
TPN involves high osmotic solution and can only be given by central venous access |
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Term
A patient who was in a traumatic car accident presents with Increased resting energy expenditure and appears to be retaining fluid.
What kind of nutritional issue is this?
What will his blood glucose levels be like? |
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Definition
Stress (Kwashiorkor-like) protein malnutrition from trauma.
Increased resting expenditure from catecholamine release and water/salt retention from RAAS
1) Metabolic response to injury / inflammation
Gluconeogenesis
Insulin resistance
Hyperglycemia |
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Term
Patient with esophageal cancer presents with weight loss, depleted fat and muscle, but relatively maintained plasma proteins.
What kind of malnutrition is this? |
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Definition
Unstressed, marasmic-predominant
Body relies on fat metabolism, and later on muscle catabolism, for energy during insufficient calorie intake |
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Term
| What are the major functional changes that occur in starvation? |
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Definition
General: decreased REE, physical activity and body Temp
Body Composition:
- Na+, H20 retention
- EC H20 (edema), decreased IC H20
- K+, Mg ++
- Fatty liver
Immune:
- predisposition to infection |
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