Disease - Nutrition

From CambridgeNotes

Requirements

  • Energy: 1800 – 2500 kCal/d (20-40 kCal/kg/d); carbohydates (4 kcal/g) : fat (9 kcal/g) from 2:1 to 1:1
  • Protein: 1 g/kg/d → divide by 6 for Nitrogen (14g/d)
  • Vitamins: require more water soluble vitamins as fat–soluble (Vitamins A, D, E, and K) are stored; Minerals and elements

Disturbance

  • Malnutrition: appearance and weight (BMI = weight/height2 is 18.5 – 25) are best; blood tests include albumin (long-term), transferrin (short-term) or prealbumin
  • Causes
    • Increased nutritional requirement: sepsis, burns, surgery
    • Reduced intake or raised losses: nil by mouth, malabsorption
  • Complications: infection, poor healing, weakness

Treatment

  • Nutritional support
    • Supplement eg. vitamins, iron, protein
    • Complete replacement
  • Methods of support: if there is a gut, use it!
    • Oral
    • Enteral (nasogastric tube) e.g. dysphagia; if long-term feeding required consider PEG (percutaneous endoscopically-guided gastrostomy)
    • Parenteral (CVP/Hickman – a small cannulae into a large vein with a high rate of blood volume) e.g. with ileus or short gut syndrome; watch for complications with daily bloods until stable, then 3 times per week; if line becomes infected it must be changed; long–term risks include villous atrophy
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