1、Am I at Risk?Am I at Risk?Recognizing Common Nutrient DeficienciesRecognizing Common Nutrient DeficienciesJodi Wolff,MS,RD,FANDFinancial Disclosures Medical Affairs Baxter Learning ObjectivesRecognize the signs and symptoms of common nutrient deficienciesIdentify physical signs of malnutrition Learn

2、 how to discuss findings with medical team for further evaluation and treatmentCauses of Nutrient Deficiencies Inadequate Intake Nutritional Regimen Shortages Intolerance Losses Diarrhea Vomiting Medications Medical ConditionsVitaminLength of ReservesVitamin B123 to 5 YearsVitamin A1 to 2 YearsThiam

3、in and Biotin 4 to 10 DaysVitamin D,E,K,C2 to 6 WeeksFolate 3 to 4 monthsModern Nutrition in Health and Disease 12th EditionMedical Conditions and Deficiency RiskGreen Corkins K.Nutrition-focused physical examination in pediatric patients.Nutr Clin Pract.2015;30(2):203-209.doi:10.1177/08845336155726

4、54Medical Conditions and Deficiency RiskGreen Corkins K.Nutrition-focused physical examination in pediatric patients.Nutr Clin Pract.2015;30(2):203-209.doi:10.1177/0884533615572654Micronutrient Exam Color,texture,thickness,hair lossHair Vision changes,lesions,color of whites of eyes and eyelid linin

5、gEyes Lesions,cracks,fissures,colorMouth Color,Texture,shape,growthNails Color,texture,rash,lesionsSkinNon-Nutrition Related Physical Findings Stress of illness Medication side effect Hormonal changes Endocrine disorders Poor hygiene Rheumatoid disorders Age related changesHair and ScalpJodi Wolff w

6、ith permissionCDC Public Health Image LibraryCDC Public Health Image LibrarySeborrheic Dermatitis Vitamin B6 DeficiencyVitamin B6 Deficiency Risk:Malnutrition,Dialysis,Sickle Cell,Malabsorption,Diuretics,Rheumatoid arthritis,Anticonvulsants,Oral ContraceptivesMordarski B,Wolff J.Nutrition Focused Ph

7、ysical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Hair and Skin Scaly Dermatitis-Dry,flaking,peeling skin Hair LossEssential Fatty Acid DeficiencyEssential Fatty Acid Deficiency:Malabsorption,chylothorax,pancreatic insufficiency,cholestatic disease,long-term PN with lipid restriction,hypocalo

8、ric tube feeding regimenJodi Wolff with permissionJodi Wolff with permissionMordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Fatty Acid Composition1.ILE-Safety-Recommendations-Adult_10.18.21.pdf(nutritioncare.org)Product MANUFACTURERFresenius KabiB.Bra

9、unFresenius KabiBaxterFresenius KabiSoybean oil(%Fatty Acids)MCT(%Fatty Acids)003000Olive oil(%Fatty Acids)0025800Fish oil(%Fatty Acids)00150100Linoleic acid(mg/ml)88-.81-7-linolenic acid(mg/ml)8-22 8-224.54.72Linoleic acid and-linolenic acid are considered indispensable in h

10、umansEFAs cannot be manufactured in the body and must come from our diet2-4%calories from linoleic acid should prevent deficiencyDaily ILE to prevent EFAD and provide adequate balanced nutritionFollow provider prescriptionILE-Safety-Recommendations-Adult_10.18.21.pdf(nutritioncare.org)EyesBitots Spo

11、tsNight BlindnessVitamin A DeficiencyCDC Public Health Image Library Vitamin A Deficiency Risk:Limited Diet,Fat malabsorption,pancreatic insufficiency,CF,Short Bowel Syndrome Pale Conjunctive Anemia(Iron.Folate,B-6,B-12)CDC Public Health Image Library Mordarski B,Wolff J.Nutrition Focused Physical E

12、xam Pocket Guide.Acad of Nutr and Dietetics,2015.Hair Follicles-SkinFollicular HyperkeratosisVitamin A or Vitamin C DeficiencyCorkscrew HairVitamin C DeficiencyVitamin A Deficiency Risk:Limited Diet,Fat Malabsorption,Alcoholism,CF,Short Bowel SyndromeVitamin C Deficiency Risk:Limited diet,Infants on

13、 Cow Milk,Dialysis,Malabsorption,exposure to second-hand smokeMordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Mouth Angular Stomatitis or CheilosisRiboflavin,Niacin,Iron,Vitamin B6Deficiency or Vitamin A Toxicity Scorbutic Tongue,Bleeding gumsVitamin

14、C DeficiencyCDC Public Image Library CDC Public Image Library Mordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Mouth Magenta TongueB-12,Riboflavin,Niacin,Folate GlossitisRiboflavin,Niacin,Iron,Vitamin B6,B-12,FolateB-12 Deficiency Risk:Suboptimal intak

15、e,malabsorptive surgical procedures,SBBO,gastric bypass,sleeve gastrectomy,terminal ileum disease,PPIS,H2 blockersMordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Hair Follicles-Skin Perifollicular Hemorrhage Bruising,Bleeding GumsVitamin C or Vitamin

16、K Deficiency Jodi Wolff with permissionVitamin K Deficiency Risk:Malnutrition,Alcoholism,Long Term PN,High dose Vitamin E,Liver disease,CF,IBD,Nephrotic Syndrome,Leukemia,Celiac Disease,Chronic Pancreatitis,SBS,Cephalosporins,Warfarin,Sulfa Drugs,Anticonvulsants,newborns not receiving Vitamin K at b

17、irthMordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Nails KoilonychiaIron Deficiency Anemia Splinter HemorrhageVitamin C Deficiency White Nail BedsSelenium DeficiencySelenium Deficiency RiskSelenium Deficiency RiskHemodialysis,Chylous loss,PKU,Malabso

18、rptionMordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Skin Naso-labial DermatitisZinc Deficiency Vesico-bullous DermatitisZinc DeficiencyZinc Deficiency Risk:Prematurity,PN dependent,cholestasis,IV zinc shortage,diarrhea,celiac disease,Crohns Disease,

19、SBS,Liver Disease,Nephrotic Syndrome,Alcoholism,Trauma,Burns,Sleeve Gastrectomy,Mordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Skin Palmar Pallor Facial PallorAnemia(Iron,B12,folate,B-6)Iron Deficiency AnemiaIron Deficiency AnemiaInadequate Intake,bl

20、ood loss,long term PN without supplementMordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Malnutrition Fat Loss Muscle Wasting Decrease in Functional StatusFat Loss Orbital(Eyes)Buccal(Cheeks)Ribs(Front and back)Triceps(Arms)Hummell AC,Cummings M.Role o

21、f the nutrition-focused physical examination in identifying malnutrition and its effectiveness.Nutr Clin Pract.2022;37(1):41-49.Muscle Loss Temporalis(Temple)Pectoralis(Chest)Deltoid(Shoulder)Quadriceps(Thigh)Trapezius/Lats(Back)Gastrocnemius(Calf)Hummell AC,Cummings M.Role of the nutrition-focused

22、physical examination in identifying malnutrition and its effectiveness.Nutr Clin Pract.2022;37(1):41-49.Functional Status Activities of Daily Living/Activity Level Person Hygiene(Bathing,grooming,dressing)Cleaning Cooking Work Playing School Sports TherapyPay attention to changes in activities that

23、accompany weight loss,fat loss and muscle lossNext Steps if Abnormal Finding Schedule Visit/CallNotify Health Care Team Consider photo of abnormal finding Bring record of input/output(Include stool output,urine output,#emesis,weight changes)Bring all vitamin/mineral/herbal supplementsPrepare for Vis

24、it Health Care Team may request blood work,urine or stool samplesEvaluation/Monitor If supplement started,take entire course as prescribed and follow up Parenteral and enteral dosing varyInterventionInterventions/Prevention of Deficiencies and Malnutrition Work with your health care team to ensure y

25、our nutritional regimen is meeting your macronutrient needs and micronutrient needsDaily multivitamin and trace elementsEnsure lipid(fat)dosing meets essential fat requirements Consult with health care team during times of shortages to discuss plan for alternative(s)Return to prescribed plan when sh

26、ortage is over Discuss intolerance with health care team so regimen can be adjusted to improve tolerance Work with health care provider to adjust nutrition regimen if schedule is not working for lifestyleReferences and Resources ASPEN|Parenteral Nutrition Product Shortages(nutritioncare.org)ILE-Safe

27、ty-Recommendations-Adult_10.18.21.pdf(nutritioncare.org)Mordarski B,Wolff J.Nutrition Focused Physical Exam Pocket Guide.Acad of Nutr and Dietetics,2015.Green Corkins K.Nutrition-focused physical examination in pediatric patients.Nutr Clin Pract.2015;30(2):203-209.doi:10.1177/0884533615572654 Hummell AC,Cummings M.Role of the nutrition-focused physical examination in identifying malnutrition and its effectiveness.Nutr Clin Pract.2022;37(1):41-49.doi:10.1002/ncp.10797 Litchford MD.Nutrition Focused Physical Assessment:Making Clinical Connections.Case Software&Books;2013.