Background
Pathophysiology
Prolonged fasting
Re-feeding
Key elements and minerals
Phosphorus
Potassium
Magnesium
Glucose
Vitamin deficiency
Sodium, nitrogen and fluid
Management
Early identification of at-risk patients
• Oncology patients |
• Chronic Alcoholism |
• Postoperative patients |
• Anorexia Nervosa |
• Elderly patients (comorbidities, decreased physiological reserve) |
• Uncontrolled Diabetes Mellitus (electrolyte depletion, diuresis) |
• Chronic Malnutrition |
- Marasmus |
- Prolonged fasting/hypocaloric feeding |
- Morbid obesity with profound weight loss |
- High stress patient unfed for >7 days |
- Malabsorptive syndrome e.g. inflammatory bowel disease, chronic pancreatitis, cystic fibrosis, short bowel syndrome |
• Chronic antacid users (Mg/Al salts bind phosphate) |
• Chronic diuretic users (loss of electrolytes) |
Nutritional assessment
Patient has one or more of the following: |
- BMI less than 16 kg/m2 |
- unintentional weight loss greater than 15% within the last 3–6 months |
- little or no nutritional intake for more than 10 days |
- low levels of potassium, phosphate or magnesium prior to feeding. |
Or patient has two or more of the following: |
- BMI less than 18.5 kg/m2 |
- unintentional weight loss greater than 10% within the last 3–6 months |
- little or no nutritional intake for more than 5 days |
- a history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics. |