nutritional disorders
Protein Energy Undernutrition (PEU)
Key Points
PEU can be primary (ie, caused by decreased intake of nutrients) or secondary to gastrointestinal disorders, wasting disorders, or conditions that increase metabolic demand. In severe forms of PEU, body fat and eventually visceral tissue are lost, immunity is impaired, and organ function slows, sometimes resulting in multiple organ failure. To determine severity, measure body mass index (BMI), serumalbumin, total lymphocyte count, CD4 count, and serum transferrin. To diagnose complications and consequences, measure complete blood count, electrolytes, bloodureanitrogen, glucose, calcium, magnesium, and phosphate. For mild PEU, recommend a balanced diet, sometimes avoiding foods that contain lactose. For severe PEU, hospitalize patients, give them a controlled diet, correct fluid and electrolyte abnormalities, and treat infections; common complications of treatment (refeeding syndrome) include fluid overload, electrolyte deficits, hyperglycemia, cardiac arrhythmias, and diarrhea. 