1/20. The advantages of intravenous renal anaemia treatment in an undernourished patient with chronic kidney disease.The subcutaneous (SC) treatment of renal anaemia in undernourished patients has potential limitations. In this case report we demonstrate the value of intravenous (IV) darbepoetin alfa in such a patient who experienced difficulty tolerating SC recombinant human erythropoietin (rHuEPO) therapy due to severe malnutrition. Intravenous treatment of renal anaemia in a malnourished patient is preferred because the absence of SC fat makes SC administration difficult. In such patients, darbepoetin alfa is the treatment of choice as it is administered less frequently than other erythropoietic therapies and is more effective at maintaining target haemoglobin (Hb) concentrations. In contrast to rHuEPO, darbepoetin alfa also has the additional advantage of bioequivalent IV and SC dose requirements.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/20. refeeding syndrome: implications for the inpatient rehabilitation unit.patients admitted to inpatient rehabilitation units commonly have underlying medical disorders and are at risk for poor oral intake and malnutrition, which may be compounded by dysphagia and anorexia. The refeeding syndrome is an underappreciated but clinically important entity characterized by acute electrolyte abnormalities, fluid retention, and dysfunction of various organ systems, which can result in significant morbidity and, occasionally, death. Reinstitution of nutrition by any route in a undernourished patient may lead to acute electrolyte shifts and fluid retention, which are hallmarks of the refeeding syndrome. As such, this article briefly summarizes the clinical manifestations and treatment of refeeding syndrome as it relates to patients admitted to the inpatient rehabilitation unit.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/20. Prolonged neuromuscular blockade as a result of malnutrition-induced pseudocholinesterase deficiency.Mivacurium is a short-acting neuromuscular blocking drug, ideal for short surgical procedures. The brief duration of action depends on rapid hydrolysis by plasma cholinesterase. An inherited or acquired deficiency of plasma cholinesterase can prolong the effect of mivacurium. We present an unusual case of unanticipated postoperative apnea following mivacurium administration, as a result of acquired plasma cholinesterase deficiency, in a patient with previous uneventful exposure to both mivacurium and suxamethonium (succinylcholine).- - - - - - - - - - ranking = 4keywords = malnutrition (Clic here for more details about this article) |
4/20. stroke and seizure following a recent laparoscopic Roux-en-Y gastric bypass.Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been an available operation for weight loss for the past decade, and bariatric surgery is increasing in the united states. Careful patient screening and follow-up have been the cornerstone for success against the complexities of morbid obesity. Neurologic complications have occurred, such as polyneuropathy and Wernicke-korsakoff syndrome. We report an 18-year-old female with morbid obesity, steatohepatitis, tobacco, recreational drug, and oral contraceptive use who at 4 months after LRYGBP experienced a generalized seizure and stroke. She was diagnosed with an acute ischemic stroke, possibly venous infarction. Her postoperative course had been complicated by malnutrition and dehydration, apparently related to nausea from chronic cholecystitis. She had a possible protein-S deficiency. Rare neurologic complications emphasize the importance of postoperative surveillance in these patients.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
5/20. malnutrition in older people--screening and management strategies.BACKGROUND: malnutrition in older people is not only common, but frequently overlooked. It can result in multiple medical complications, hospitalisation and even death. OBJECTIVE: This article focusses on the consequences, pathophysiology, diagnosis and management of this clinical syndrome. DISCUSSION: Nonphysiological causes of malnutrition include social, psychological, medical and medication related factors. With vigilance, early screening and the institution of simple therapeutic measures of correcting nonphysiological causes and following dietary guidelines for older people, the adverse effects of malnutrition may be minimised.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |
6/20. lymphoma creating colojejunal fistula: report of a case and review of the literature.Malignant fistula of the colon to the small bowel is rare and is most often due to adenocarcinoma. Colonic lymphoma is unusual, representing only 0.5 percent of all colonic malignancies. We report a case of intestinal lymphoma presenting with diarrhea and malnutrition. A colojejunal fistula was discovered during colonoscopy by biopsy of small bowel through a fistula in the sigmoid colon. Celiotomy revealed a 12 cm mass in the sigmoid colon with a fistula to the jejunum. pathology was consistent with T-cell lymphoma. This is a rare entity in a nonimmunocompromised host and has not been described in the English literature.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
7/20. Exfoliative erythema of malnutrition with zinc and essential amino acid deficiency.We present a patient with a desquamating predominantly flexural erythema and glossitis due to a combination of alcoholism, zinc deficiency and amino acid deficiency. A similar clinical picture to necrolytic migratory erythema can be seen with zinc deficiency or protein malnutrition, often in patients with alcoholic liver disease, in the absence of glucagonoma. The speed of clinical improvement following zinc replacement therapy, usually within days to weeks, is striking, confirming the clinical diagnosis.- - - - - - - - - - ranking = 5keywords = malnutrition (Clic here for more details about this article) |
8/20. Severe hypophosphatemia in a patient with anorexia nervosa during enteral refeeding.hypophosphatemia is a seldom but potentially fatal complication of the nutritional recovery or refeeding syndrome in patients with protein-calorie malnutrition or starvation. We report here the case of a 35-year-old anorexic patient who presented a severe but uncomplicated hypophosphatemia during enteral refeeding, despite phosphorus supplementation. serum phosphorus monitoring is recommended in severely malnourished anorexic patients, particularly during the first week of refeeding, be it parenteral or enteral.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
9/20. Nutritional deficiencies and the skin.malnutrition states are relatively uncommon in the UK but we have seen two recent cases which have heightened our awareness of both dermatological manifestations of malnutrition and of nutritional sequelae of a dermatological problem. Case 1 is a patient with anorexia nervosa presenting with features of pellagra. This condition is due to deficiency of niacin and responds rapidly to replacement therapy. Classical presentation is an erythematous rash on photoexposed sites, often related to heat or friction. There are three reported cases of pellagra occurring in patients with anorexia nervosa. Case 2 is an adult atopic with sensitizations to multiple foodstuffs. A self-imposed restriction diet caused multiple nutritional deficiencies. Restriction diets in adult atopics are not particularly common in the UK, but there is some evidence to suggest that they may cause significant nutritional deficiency. A nutrition screen may be indicated more frequently than is currently recognized.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
10/20. Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging.We report a clinical and neuroradiological description of a severe case of Wernicke's encephalopathy in a surgical patient. After colonic surgery for neoplasm, he was treated for a long time with high glucose concentration total parenteral nutrition. In the early post-operative period, the patient showed severe encephalopathy with ataxia, ophthalmoplegia and consciousness disorders. We used magnetic resonance imaging (MRI) to confirm the clinical suspicion of Wernicke's encephalopathy. The radiological feature showed hyperintense lesions which were symmetrically distributed along the bulbo-pontine tegmentum, the tectum of the mid-brain, the periacqueductal grey substance, the hypothalamus and the medial periventricular parts of the thalamus. This progressed to typical Wernicke-korsakoff syndrome with ataxia and memory and cognitive defects. thiamine deficiency is a re-emerging problem in non-alcoholic patients and it may develop in surgical patients with risk factors such as malnutrition, prolonged vomiting and long-term high glucose concentration parenteral nutrition.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
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