1/9. Treatment of cachexia with recombinant growth hormone in a patient before lung transplantation: a case report.OBJECTIVES: To describe the effects of recombinant human growth hormone (rhGH) in a severely malnourished patient before lung transplantation. DESIGN: Case study. SETTING: intensive care unit. patients: A 38-yr-old severely malnourished (body mass index, 15.1 kg/m2) woman (receiving prednisone) with bronchiolitis obliterans evolving during 10 yrs presented with end-stage lung disease and required continuous noninvasive mechanical ventilation. INTERVENTIONS: Two courses of 35 days of 16 IU/day (0.42 IU/kg/day) rhGH administered subcutaneously, with an interruption of 5 wks between the two courses of rhGH. MEASUREMENTS AND MAIN RESULTS: weight gain of 14.7% and 12.8% fat-free mass, as measured by 50-kHz bioelectrical impedance analysis, during treatment during a 3.5-month period. nitrogen excretion decreased from 23.7 g/day before treatment to 8.0 g/day while receiving rhGH. Improvement of pulmonary function was also noted and allowed discharge of the patient from the hospital after the second course of rhGH. She underwent successful lung transplantation 2 months later and reached 48.8 kg of body weight 6 months later. CONCLUSIONS: rhGH treatment is a possible strategy that could be used with malnourished patients who are awaiting lung transplantation to improve the nutritional status and respiratory muscle function to prevent recurring respiratory infection and postoperative complications favored by malnutrition and possibly to decrease the length of hospital stay.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/9. hypothermia with acute renal failure in a patient suffering from diabetic nephropathy and malnutrition.We report a rare case of hypothermia with acute renal failure in a patient suffering from diabetic nephropathy. A 71-year-old male who had been receiving insulin therapy for the treatment of diabetes mellitus complicated with advanced diabetic nephropathy since 1998 was malnourished with an extremely decreased muscle mass. Without any prolonged exposure to excessively low external temperatures or hypothyroidism, pituitary insufficiency, adrenal insufficiency, sepsis, hypoglycemia, and diabetic ketoacidosis, acute hypothermia appeared together with an aggravation of diabetic nephropathy. His skin temperature fell to below measurable levels and his rectal temperature fell to 30.0 degrees C. His consciousness was drowsy and the hypothermia was not accompanied by shivering. Skeletal muscle is known to play an important role as a center of heat production and shivering thermogenesis in skeletal muscle mainly operates on acute cold stress. Therefore, in this case, hypothermia may have occurred because the shivering thermogenesis could not fully act on the acute cold stress due to the dramatically reduced muscle mass. We should always keep in mind that older, malnourished diabetic patients can easily suffer from impairments of the thermoregulatory system.- - - - - - - - - - ranking = 4keywords = malnutrition (Clic here for more details about this article) |
3/9. pellagra: a rare disease observed in a victim of mental and physical abuse.Lesions of the brain stem and cerebellum due to nutritional deficiencies are mostly seen in chronic alcohol abuse and more rarely in severe malnutrition. We report the case of a 27-year-old woman, found dead in the family flat. She presented cachexia (167 cm, 25 kg) and multiple hematomas of the limbs. Postmortem examination revealed lesions due to peritonitis. Neuropathological examination showed severe atrophy of the corpus callosum and central neuronal chromatolysis, which are observed in pellagra. Inflammatory colitis or celiac disease was not found. Toxicological analysis was negative, in particular no alcohol absorption. pellagra, which is due to nicotinamide deficiency, is a disease rarely seen in this country. In this case, nutritional deficiency was the consequence of failure to eat in a context of abuse. The woman was born of an incestuous relationship and presented intellectual retardation due to poor affective relations with her mother.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
4/9. Reversible focal splenial lesion of the corpus callosum on MR images in a patient with malnutrition.T2-weighted MR (magnetic resonance) images of a 19-year-old woman undergoing concurrent chemoradiotherapy for a nasopharyngeal carcinoma revealed a lesion marked by focal hyper signal intensity in the splenium of the corpus callosum. The lesion was not visible two weeks later. She suffered from malnutrition caused by appetite loss during chemotherapy. We concluded that the lesion revealed by the abnormal signal intensity in the splenium had been caused by malnutrition.- - - - - - - - - - ranking = 6keywords = malnutrition (Clic here for more details about this article) |
5/9. Malnutrition, a rare form of child abuse: diagnostic criteria.Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.- - - - - - - - - - ranking = 4keywords = malnutrition (Clic here for more details about this article) |
6/9. death resulting from overzealous total parenteral nutrition: the refeeding syndrome revisited.Although cachectic patients are relatively well adapted to their calorically deprived state, they are prone to acute metabolic imbalances when infused with hypertonic solutions of dextrose and amino acids. Of particular concern is hypophosphatemia and its associated disorders of cardiac, pulmonary, hematological, and neuromuscular functions. This report describes two chronically malnourished but stable patients who were given aggressive total parenteral nutrition support, which was rapidly followed by acute cardiopulmonary decompensation associated with severe hypophosphatemia and other metabolic abnormalities. Despite attempts at correction, progressive multiple systems failure led to death. In light of the high prevalence of hospital malnutrition and the ready availability of total parenteral nutrition, attention is brought to these examples of how overzealous nutrition repletion can paradoxically precipitate deterioration in clinical status.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
7/9. Ptosis associated with iatrogenic pneumothorax: a false lateralizing sign.Two cachectic, obtunded patients were seen with unilateral periorbital emphysema resembling ptosis as a primary manifestation of pneumothorax. Speculation is made as to the possible role of malnutrition in this unusual manifestation. Spontaneous pneumothorax should be considered in the obtunded patient with ptosis that is poorly explained by other neurologic findings.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
8/9. Malnutrition and hypernatremic dehydration in breast-fed infants.Despite the well-recognized advantages of breast-feeding to both mother and child, malnutrition of breast-fed infants can occur. We report two cases of breast-fed infants with cachexia, hypernatremia, and, in the one case in which it was measured, an elevated level of breast-milk sodium. These cases, along with several reported previously, emphasize the need for proper education and close and early follow-up of the nursing mother and infant, especially since a lack of parental awareness can be part of this syndrome.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
9/9. Enteral supplementation of phosphate does not prevent hypophosphatemia during refeeding of cachectic patients.hypophosphatemia due to parenteral nutrition has been described frequently. It was attributed to the lack of phosphorus content in parenteral nutrition solutions. With modern parenteral nutrition regimens containing phosphorus, this problem has been virtually eliminated. Enteral nutrition solutions contain adequate phosphate for patients with normal phosphate stores. hypophosphatemia has therefore rarely been reported in enteral nutrition. We describe two patients with protein-energy malnutrition who developed severe hypophosphatemia during tube feeding with phosphorus-containing formula diets. Chronic alcoholism and vitamin d deficiency due to malabsorption because of Crohn's disease were additional risk factors in these two patients. patients with depleted phosphate stores and high metabolic demand have a higher daily requirement for phosphorus than is available in routine isotonic enteral formulas. This case report emphasizes the importance of monitoring serum phosphate concentration daily during the first week of refeeding.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |