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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Let’s go back to the example patient we presented at the chapter’s opening – a malnourished 63-year-old man with lung cancer who needs parenteral nutrition. So far you have established a diagnosis of severe protein calorie malnutrition. You have eliminated the relative contraindications and discussed the risks of PN with the patient and family. Realizing that there are few viable alternatives, they agree and give consent. You are ready to proceed with treatment.
Nutrition
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
2.18. Which of the following statements is/are true of severe protein-calorie malnutrition?There will be normal subcutaneous fat stores but inadequate muscle bulk.Replacement of some of the carbohydrate with protein will make little difference to the clinical state.Total body water as percentage of body weight will be increased.The serum proteins will usually be markedly decreased.Total body potassium will be decreased.
Nutritional Disorders/Alternative Medicine
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Niacin (B3) deficiency caused by alcoholism or protein-calorie malnutrition produces a state known as pellagra with skin eruptions, dermatitis, dementia, and diarrhea. Deficiency of vitamin B12 is manifested as pernicious anemia or as an uncomplicated deficiency, such as seen in vegetarian diets. Pyridoxine (B6) deficiency is seldom caused by dietary restrictions except in association with alcoholism. Drug-induced deficiency is more common with use of hydralazine, penicillamine, isoniazid, or cycloserine. Symptoms include peripheral sensory neuropathy with ataxia, numbness, skin lesions on the face, glossitis (inflammation of the tongue), stomatitis (inflammation of the mucous membrane of the mouth), and anemia.
Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Aalam Sohal, Victoria Green, Sunny Sandhu, Marina Roytman
- Protein/calorie malnutrition is a common and underrecognized complication of cirrhosis [20]. Besides the liver, muscle tissue also plays an important role in removal of circulating ammonia [21]. Loss of skeletal mass may lead to decreased toxin clearance and as a result neuropsychiatric symptoms due to hepatic encephalopathy. The International Society for Hepatic Encephalopathy and Nitrogen Metabolism (SHEN) developed a consensus document in 2013. As per the document, dietary protein restriction should be avoided. There are studies which document that patients with hepatic encephalopathy can tolerate normoproteinemic diets and are able to benefit from them. Small frequent meals avoid undue gluconeogenesis in the liver and muscle. Amino acids are a substrate for gluconeogenesis and can lead to proteolysis of the skeletal muscle protein. This coupled with decreased protein synthesis is a frequent cause of sarcopenia in cirrhotics. As a result, small frequent meals with high protein were recommended by the society [22].
Older age is a risk factor for inadequate energy intake during acute, severe IBD and is associated with shorter time to relapse
Published in Scandinavian Journal of Gastroenterology, 2020
Katja A. Kulmala, Jan Björk, Sara Andersson, Ann-Sofie Backman, Michael Eberhardson, Francesca Bresso, Charlotte R. H. Hedin
To our knowledge, associations between inadequate nutritional intake during an active flare and durability of remission have not been previously studied. Most of the studies done so far characterising nutrition in IBD patients have focused on retrospective nutritional data in outpatients or nutritional status at admission to or at discharge from hospital. Such data can only reveal the patients’ habitual nutritional status but does not reveal the impact of dietary intake during the IBD flare. For example, Nguyen et al. [13] defined malnutrition as occurrence of Clinical Modification of the International Classification of Diseases, 9th Revision (ICD-9-CM) codes for protein-calorie malnutrition in the medical case summaries at discharge and showed that malnutrition is associated with increased in-hospital mortality, length of stay, and total charges among IBD patients [13]. However, in this study it is not possible to evaluate the contribution of the nutritional intake during the acute flare compared with the contribution of the patient’s background nutritional status prior to the acute flare. Thus, the present study highlights a unique opportunity for physicians to intervene in improving patients’ nutrition during acute flare with potential impacts on clinical outcome.
Rapid refeeding does not worsen anxiety in adolescents with anorexia nervosa: a pilot study
Published in Eating Disorders, 2022
Sinem Akgül, Andrea E Bonny, Brittny E. Manos, Kenneth Jackson, Cynthia Holland-Hall
This study has several strengths. To the best of our knowledge this is the first study to look at the daily progression of anxiety in adolescents with AN on a HRC protocol during an admission solely for medical stabilization with no structured therapeutic eating disorder care. The sample was comprised of acutely ill adolescents, all with protein calorie malnutrition started on a set refeeding protocol with little variability between patients. Furthermore, we investigated the difference between pre- and post-meal, allowing for greater clarity regarding anxiety experienced by adolescents with AN during the refeeding process.