Clinical Nutrition - Malnutrion

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Author:
jcu1
ID:
215100
Filename:
Clinical Nutrition - Malnutrion
Updated:
2013-04-22 14:28:41
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GI
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GI
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  1. what are the caloric requirements for healthy normal adults?
    20-25 kcal/kg/day
  2. caloric requirements for malnourished/mild stress adult
    30 kcal/kg/day
  3. caloric requirements for critical illness - adults
    30-35 kcal/kg/day
  4. caloric requirement for a boy 1-3 y, 7-10 y, 11-14 y
    • 102
    • 70
    • 55
    • kcal/kg/day
  5. Protein:
    total percentage of calories
    energy contribution
    • 10-35%
    • 4 kcal/g
  6. adult protein need
    • normal: 0.8 g/kg/day
    • >60 y: 1g/kg/day
    • pregnant/lactating: 1.3-1.5 g/kg/day
  7. Carbs:
    percentage of calories
    energy contribution
    • 45-65%
    • 4 kcal/g
  8. Fat:
    total percentage of calories
    energy contribution
    • 25-40%
    • 9 kcal/g
  9. how much fluid/day:
    avg adult
    critically ill
    • avg adult: 30-35 ml/kg/day
    • critically ill: 30-40 ml/kg/day
  10. how much fluid per day:
    pediatric
    • 1st 10 kg: 100 ml/kg
    • 2nd 10 kg: 50 ml/kg
    • above 21 kg: 20 ml/kg
  11. two types of malnutrition
    • marasmus
    • kwashiorkor
  12. definition of marasmus malnutrition
    protein/calorie depletion
  13. definition of kwashiorkor malnutrition
    protein depletion
  14. marasmus presentation
    • indadequate amounts of nutrition
    • decreases kin fold
    • thickness/arm circumfrence dec
    • <80% of IBW
    • somatic, gut protein stores are depleted
    • visceral proteins stable
  15. kwashiorkor presentation
    • hypoalbuminemic malnutrition
    • adequate calorie intake
    • dec albumi and other plasma proteins
  16. what do antibiotics do to nutirent status
    vitamin k deficiency
  17. what does cholestyramin do to nutrient status
    A, D, E, K, beta carotene malabsorption
  18. what do loop diuretics do to nutrient status
    • thiamine deficiency
    • K, Ca, Mg imbalance
  19. what do H2RAs and PPIs do to nutrient status?
    B12 deficiency
  20. effect of malnutrition on GI
    • dec enzyme activity
    • dec transit time
    • impaired motility
    • bacterial overgrowth
    • maldigestion and malabsorption
  21. effect of manutrition on liver
    • dec protein synthesis
    • dec microsomal activity
    • hepatic insufficiency
  22. affect of malnutrition on hematology
    • stem cell failure
    • dec erythropoeisis
  23. affect of malnutrition on cell mediated immunity
    • delayed cutaneous hypersensitivity
    • dec lymphocyte transformation
    • dec phagocytosis
    • dec bactericidal capacity
    • dec chemotaxis
  24. risk factors for malnutrition
    • underweight (<80% IBW)
    • overweight (>120-125% IBW)
    • Excessive weight loss (>10%)
    • No nutrition for extended period
    • abnormal losses, malabsorption, fistulas, wounds
    • alcoholism
    • inc demand (sepsis, surgery)
    • meds (steroids, immunosuppressants, antineoplastic agents)
  25. ways to asses malnutrion
    • serum protein - most common method
    • immune function
  26. evaluation of serum proteins - albumin
    • normal: 3.5-5 g/dl
    • T1/2: 18 days

    hypoalbuminemia isn't specific to malnutrition, but it's present in many cases
  27. evaluation of serum proteins - prealbumin
    • normal: 17-40 mg/dl
    • T1/2: 2-3 days
  28. what serum proteins can be evaluated in malnutrition?
    • albumin
    • prealbumin
    • RBC
    • transferrin
  29. evaluation of serum proteins - transferrin
    normal: >200 mg/dl
  30. what is measured with assess immune function in malnutrition evaluation
    • total lymphocyte count
    • delayed cutaneous hypersensitivity

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