Nutrition
Requirements
- Energy sources
- Respiratory quotient: ratio of volume of CO2 produced to volume of oxygen consumed
| Energy | Resp quotient | RDA | Notes |
|
| Fat | 9.3kcal/g | 0.7 |
|
|
| Glucose | 4.1kcal/g | 1.0 |
|
|
| Protein | 4.1kcal/g | 0.8 | 0.8g/kg/day (nitrogen 0.15g/kg/day) |
|
| Amino acids |
|
|||
| Minerals |
|
|||
| Vitamins |
|
Starvation = Inadequate energy intake
Cachexia = Chronic deprivation of energy and nutrients irrespective of adequacy of intake (Maligant IL10)
Marasmus = Inadequate nutrients and energy
Kwashiokor = Lack of protein (but some intake of energy)
Fasting = State of energy deprivation last no more than a few days
- Glucose obtained from glycogen stores (liver, skeletal muscle)
- Supply lasts +24hours
- Then hepatic gluconeogenesis (from glycerol from fatty acids, amino acids from muscle protein, lactate) takes over
- Increased generation of ketone bodies (acetone, acetoacetone, B-hydroxybutyrate) as source of energy during starvation
- Hormones mobilised in starvation: Glucocorticoids, catacholamines, glucagon, thyroid hormone, insulin
Assessment
- Clinical
- Physical appearance
- Hand grip strenght
- PFTs
- Anthropometric measurements
- Height / weight - BMI
- Fat: triceps skin fold
- Lean fat: mid-arm circumference
- Biochemical measurements
- Serum protein - Albumin
- 24 hour creatinine
- Immunological studies - total lymphocyte count, immune function
| Enteral |
Parenteral | |
| Indications | Functionally intact gastro-intestinal system that cannot meet daily nutritional requirements | Critical illness resulting in malnutrition with impaired gastrointestinal function (eg fistula, short bowel, IBD, enteritis) |
| Diet types |
|
Components
|
| Mode of delivery |
|
|
| Bowel effects |
|
|
| Complications |
|
|
