Protein- energy malnutrition (PEM)
Human basal metabolic rate is approximately
1 kcal/ minute
Human basal metabolic rate is approximately
1kcal/ minute
1 litre of oedema weighs
1kg
1 litre of oedema weighs
1kg.
How many days of re-feeding is required for tissue repair during the recovery phase, for each day starved during the catabolic phase
3-5
Approximately how many days of re-feeding is required for tissue repair during the recovery phase, for each day starved during the catabolic phase
3-5 days
State the effects of protein energy malnutrition on muscle function
Slowly adapts to using fatty acids and ketones as fuel releasing amino acids for gluconeogenesis contributing to weakness.
Following starvation
Slight increase plasma catabolic hormones Slow weight loss Body protein is spared
State the difference between nutritional screening and nutritional assessment
A nutritional screening is a rapid process of identifying clinical characteristics known to be associated with malnutrition. A nutritional assessment is a comprehensive process of identifying and evaluating the nutritional status of individual using appropriate quantifiable methods. A nutritional assessment looks at multiple factors to gain a broader scope rather than focusing on one. A nutritional screening uses quantitative date which is less subjective and less open to personal interpretation.
Which of the following does not occur in response to injury: rapid weight loss, body protein in spared, increased metabolic rate, large increase in plasma catabolic hormones
Body protein is spared
Identify 5 situations where risk of developing protein energy malnutrition is high.
Cancer Depression and grief Elderly Obesity Acute and chronic pain
During starvation
Cardiac and respiratory function decline
Metabolic rate increases
Don't occur following starvation
The catabolic phase leads to
Increased circulating nutrients for tissue repair
Metabolic rate following injury
Increases
The catabolic phase
Leads to increased circulating nutrients for tissue repair
The body 'burns' tissue protein as fuel during the catabolic phase because
Liver synthesis of ketones is reduced
The body 'burns' tissue proteins as fuel during the catabolic phase because
Liver synthesis of ketones is reduced
Which of the following does not occur during starvation: slow weight loss, body protein is spares, metabolic rate increases, slight increase plasma catabolic hormones
Metabolic rate increase
Outline the meaning of the term 'malnutrition'.
Occurs when the diet contains insufficient (undernutrition) or an excess (over nutrition) of one or more nutrients or when the individual cannot absorb sufficient of the nutrient(s) to maintain the health.
State the 5 main causes of malnutrition.
Poor intake (quantity) Poor intake (quality) Increased metabolism Increased losses Defective utilisation
Response to injury
Rapid weight loss Increased metabolic rate Large increase in plasma catabolic hormones.
People frequently experience depression during PEM due to
Reduced synthesis of brain neurotransmitters
People frequently experience depression during protein energy malnutrition due to
Reduced synthesis of brain neurotransmitters
The first phase following injury is known as the
Shock phase
State the effects of protein energy malnutrition on brain function
The brain requires 100g a day but adapts to ketones as fuel only after 10 days when the adaptation takes place the patient is in a semi-comatose hypoglycaemia in the meantime. Reduced neurotransmitter synthesis can lead to depression.
The physiological responses of the shock phase support
The cardiovascular system
The physiological responses of the shock phase support is
The cardiovascular system
State the effects of protein energy malnutrition on immune system function
The immune system normally has a very high cell turnover which is suppressed in starvation leading to poor cell mediated immunity which can lead to opportunistic infections for example candida.
What is meant by the term 'nutritional status'?
The state of health produced by the balance between requirements and intake of nutrients.
State the effects of protein energy malnutrition on respiratory function
There is a decreased vital capacity and inspiratory force leading to 40% reduced ventilator drive and reduced oxygenation.
State the effects of protein energy malnutrition on cardiac function
There is reduced cardiac output, stroke volume, blood and venous pressure this contributes to reduced tissue perfusion.
State the effects of protein energy malnutrition on kidney function
When the renal function is reduced it can lead to poor concentration known as polyuria and poor acid secretion known as acidosis.
State the effects of protein energy malnutrition on gut function
With the gut epithelium mitosis diminishes decreasing surface area causing malabsorption. With mucosal atrophy the gut bacteria leak into the blood stream and can cause septicaemia. Reduced pancreatic enzyme secretion leads to maldigestion. Descreased stomach acid secretion causes a poor infection barrier.
