disorders of nutrition
Undernutrition
Treatment of Undernutrition
Feeding, usually by mouth Treatment of the cause Sometimes tube or intravenous feeding For severe undernutrition, sometimes medications For most people, treatment of undernutrition involves gradually increasing the number of calories consumed. Eating several small, nutritious meals each day is the best way. For example, people who have been starving are first fed small amounts of food often (6 to 12 times a day). Then, the amount of food is gradually increased. If children have diarrhea, feedings may be delayed for a day or two so that the diarrhea does not become worse. During this interval, they are given fluids. People who have difficulty digesting solid food may need liquid supplements or a liquid diet. Often, lactose-free or reduced lactose supplements (such as yogurt-based supplements) are used because many people have trouble digesting lactose (a sugar in milk products), and undernutrition can make the problem worse. If such people consume foods that contain lactose, diarrhea usually results. Multivitamin supplements are also given to make sure people are getting all the nutrients they need. Disorders that may be contributing to undernutrition (such as infection) are treated. Some experts recommend giving antibiotics to all severely undernourished children, even if no infection is apparent. If undernutrition is severe, people may need to be hospitalized. Feeding people too quickly after severe undernutrition can cause complications, such as diarrhea and imbalances in body water, glucose (a sugar), and other nutrients. These complications usually resolve if feeding is slowed. Nutrients are given by mouth whenever possible. If they cannot be given by mouth, nutrients may be given using one of the following: A tube inserted into the digestive tract (tube feeding) A tube (catheter) inserted into a vein (intravenous feeding) Tube Feeding (enteral nutrition) may be used to feed people whose digestive tract is functioning normally if they cannot eat enough to meet their nutritional needs (such as people with severe burns) or if they cannot swallow (such as some people who have had a stroke). For tube feeding, a thin plastic tube (a nasogastric tube) is passed through the nose and down the throat until it reaches the stomach or small intestine (called nasogastric intubation). If tube feeding is needed for a long time, a feeding tube can be inserted directly into the stomach or small intestine through a small incision in the abdomen. Food given through a tube should contain all the nutrients a person needs. Special solutions, including some for people with specific needs (such as restricted fluid intake), are available. Or, solid foods may be processed and given through a nasogastric tube. Tube feedings may be given slowly and continuously or in a larger amount (called a bolus) every few hours. Tube feeding causes many problems, and the problems may be life threatening. For older adults, aspiration is the most common problem caused by tube feeding. Aspiration of food can lead to Aspiration Pneumonia and Chemical Pneumonitis . Food is less likely to be aspirated when the solution is given slowly and when the head of the bed is elevated for 1 to 2 hours after tube feeding, reducing the risk of spitting food up (regurgitation). Diarrhea and abdominal discomfort:Changing the solution or giving it more slowly may lessen these problems. Irritation of tissues:The tube may irritate and erode tissues of the nose, throat, or esophagus. If tissues become irritated, the feeding tube can usually be removed, and feedings can be continued using a different type of tube. Intravenous Feeding (parenteral nutrition) is used when the digestive tract cannot adequately absorb nutrients (for example, in people with a Food given intravenously can supply part of a person’s nutritional requirements (partial parenteral nutrition) or all of them (total parenteral nutrition). Because total parenteral nutrition requires a large intravenous tube (catheter), it is inserted into a large vein, such as the subclavian vein, located under the collarbone. Intravenous feeding can also cause problems, such as the following: Infection:Infection is a constant risk because the catheter is usually left in place for a long time and the solutions that pass through it contain a lot of glucose (a sugar), which promotes the growth of bacteria. People receiving total parenteral nutrition are closely monitored for signs of infection. Too much water (volume overload):Giving too much water can cause fluid to collect in the lungs, making breathing difficult. Thus, doctors monitor the person’s weight and the amount of urine excreted regularly. They can sometimes reduce the risk by calculating the amount of water required before starting feedings. Nutritional imbalances and deficiencies:Rarely, deficiencies of certain vitamins and minerals occur. Doctors periodically measure the blood levels of dissolved minerals (electrolytes), glucose, andurea(a measure of kidney function) to identify certain nutritional imbalances. They can then adjust the solution accordingly. Decreased bone density:Total parenteral nutrition, when given for more than about 3 months, causes bone density to decrease in some people. The reason is unknown, and the best treatment is to temporarily or permanently stop this type of feeding. Liver problems:Total parenteral nutrition can cause liver malfunction, most commonly in preterm infants. Blood tests are done to monitor liver function. Adjusting the solution may help. Gallstones may develop. Treatment involves adjusting the solution and, if possible, providing food by mouth or a feeding tube. People who are very undernourished are sometimes given medications to increase appetite, such asdronabinolormegestrol, or medications to increase muscle mass, such as growth hormone or an anabolic steroid (for example, nandrolone ortestosterone). 