EpistemisProtein-calorie malnutrition in adults
Specialty: General.
Why it occurs
- Severe intestinal malabsorption syndromes (due to large intestinal resections, high-output enterocutaneous fistulas or HIV enteropathy)
- Prolonged hypercatabolic states (major burns, sepsis that is difficult to resolve or complex polytrauma in a prolonged recovery phase)
- Severe psychiatric disorders (severe adult anorexia nervosa, paranoid schizophrenia with delusions of poisoning or psychotic depression)
- Severe chronic alcoholism with total abandonment of dietary intake (associated with erosive gastritis and chronic pancreatitis with malabsorption)
- Extreme socioeconomic limitation or serious negligence in the care of vulnerable adults.
Initial workup
Serum protein profile (albumin, prealbumin, transferrin), complete serum electrolytes with phosphorus and magnesium (monitored daily at the beginning of nutritional support), total lymphocyte count, levels of thiamine and fat-soluble vitamins, and electrocardiogram.
red flags
Appearance of signs of refeeding syndrome (severe hypophosphatemia, hypokalemia, and hypomagnesemia) after reinitiation of feeding, extreme bradycardia (<45 bpm), severe hypothermia, generalized edema due to extreme hypoalbuminemia, or delirium due to Wernicke's encephalopathy.
Standard management
- Thiamine / Vitamin B1 — 100 to 300 mg intravenously or intramuscularly before starting any glucose intake to prevent Wernicke's encephalopathy
- Potassium Phosphate Supplement — according to electrolyte monitoring, vital to prevent cell lysis due to feedback
- Enteral or parenteral nutritional support personalized by a specialist.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- General
- Listed causes
- 5
- Treatment options
- 3