Nutritional optimisation

Question 1

How would you identify patients in need of nutritional optimisation? Outline the advantages and disadvantages of the different types of nutritional support.

Answer 1

Introductory
Nutritional optimisation is an important consideration in the hospital setting depending on both disease and patient factors. Considering when and how to administer additional nutrition for patients is important for improving hospital recovery and reducing LOS.

Also important to identify types of nutritional support; micro vs macronutrient supplementation may be indicated in different settings.

Identifying the need for nutritional optimisation

• Thorough Hx/Ex/Ix
• will discuss advantages and disadvantages after

Question 2

nutritional optimisation - History

Answer 2

History

• presentation, surgical vs medical. Ask about pre-hospital condition, what nutrition was like prior to coming to hospital. Any recent unintentional weight-loss? quantify how much and over what time period.
• sx: fatigue, lethargy, pallor
• details of procedure, NBM? how long for? aspiration risk?
• PMHx: any underlying medical conditions (psych or otherwise), existing chronic disease (coeliac, crohns, cancer, etc), recent stroke, dysphagia
• sociocultural: alcohol and drugs intake (may require micronutrient

Question 3

Nutritional optimisation - Examination

Answer 3

Examination

• General appearance (wasting, cachexia)
• Vitals: Tacy, hypo, etc)
• Anthropometric measurements (BMI)
• Abdo exam: signs of chronic disease
• systems review

Question 4

Nutritional optimisation - Investigations

Answer 4

Investigations

- Bloods: hypoalbuminaemia, iron deficiency, B12/folate panel, other vitamins panel, FBC, UEC, LFT

Question 5

Nutritional optimisation - Types and advantages/disadvantages

Answer 5

Types

• Micronutrient (thiamine, B12/folate, iron infusion, electrolytes, etc)
• Macronutrients: TPN,

Routes

• Oral
• Enteral: NG, NJ, PEG tubes.
• Parenteral: IV

Enteral feeding

• more physiological, supplies nutrients to gut mucosa
• can clot and require replacement
• less infective risk to parenteral feeding

Parenteral

• risks of line sepsis
• hepatotoxic after prolonged use
• less physiological
• can be used in patients who are NBM