0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
Marasmus 951■Nitrogen balance
■Cell-mediated immunity (skin test)
differential diagnosis
■Malignancy/cancer cachexia (blood testing, imaging studies,
exploratory
■surgeries to differentiate
■GI tract obstruction (imaging studies to differentiate)
■Malabsorption related to ulcerative colitis, celiac sprue, Crohn’s dis-
ease, inflammatory bowel disease, chronic liver disease (radiologic
exam or biopsy)
■AIDS (HIV blood testing)
■COPD (pulmonary function studies)
■Cystic fibrosis (sweat chloride test, chest x-ray, pancreatic enzyme
studies)
■Diabetes mellitus (fasting glucose to differentiate)
■Eating disorders (psychiatric evaluation to differentiate)
management
■Provide energy immediately
■Hydrate
■Replete electrolytes
■Treat infections
■Replete deficient vitamins and minerals
specific therapy
Treatment Options
■Oral or IV glucose to start, gradually add lactose-free liquids and
■progress to solids (30 cc/kg actual weight)
■High biological value proteins, 1.0–1.2 gm/kg actual weight
■Avoid over-feeding: 30–35 kcalories/kg actual weight for calculated
energy needs
➣metabolic cart for measured energy needs
■Add vitamin-mineral supplements, including thiamine
Contraindications to Treatment
■Refeeding syndrome
➣Hypophosphatemia
➣Hypomagnesemia
➣Hypokalemia
➣Hyperglycemia
➣Congestive heart failure
➣Sepsis