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Malnutrition

Thomas Horton

Background

  • Needs to meet two or more of following criteria:
    • Insufficient calorie 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 C/A/P depending on history
  • Refeeding: K, Phos, Mg BID until stable and no longer having to replete

Management

  • Manage reversible causes of malnutrition as above
  • Medications: consider Remeron (7.5 mg nightly). Avoid Megace (NNH = 23 for death)
  • Liberalize dietary restrictions
  • Nutritional Supplementation: Oral enteral supplements (i.e. nutritional shakes)