Malnutrition

Malnutrition

Background

  • Needs to meet two or more of following criteria:
    • Insufficient energy intake
    • Weight loss
    • Loss of muscle mass
    • Loss of subcutaneous fat
    • Localized fluid accumulation that may mask weight loss
    • Diminished functional status as measured in handgrip strength

 

  • Reversible causes of malnutrition: ​​​​​​​
    • Food security (poverty)
    • Dental status (dentition, gum health)
    • Dietary restrictions
    • Food-related functional status (shop, prepare meals, feed self)
    • Depression
    • Dementia
    • Alcoholism
    • Swallowing ability

 

Evaluation

  • Assess for depression
  • Screening with Mini Nutritional Assessment (good sensitivity and specificity)
  • Order: CBC, CMP, TSH
  • Nutritional deficiencies: B12, folate, vitamin D
  • Consider CT CAP depending on history
      • Refeeding: K, Phos, Mg BID until stable and no longer having to replete Consider antipsychotics (black box warning increased risk of death in elderly)

 

Management

  • Manage Reversible causes of malnutrition as above
  • Medications: consider Remeron (7.5 mg nightly)
  • Nutritional Supplementation: oral enteral supplements (i.e. nutritional shakes)