Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Malnutrition

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In one line

·The body is not getting enough fuel from food, so it starts eating itself to survive.

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Normal physiology

·Normally, the food you eat—carbs, fats, and protein—gets broken down in your gut, absorbed into your blood, and delivered to every cell. Carbs and fats burn for energy. Protein builds and repairs muscle, skin, organs, and the white blood cells that fight germs. Your body constantly balances what comes in with what it burns and uses, so your weight and muscle mass stay steady.

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What goes wrong

·Malnutrition means the body is not getting enough fuel from food. This can happen in four main ways: not eating enough (lost appetite from depression, dementia, poverty, or trouble swallowing after a stroke), the gut cannot absorb food (like in Crohn disease, celiac disease, or after part of the bowel is removed), the body burns fuel too fast (like in cancer, bad infections, or an overactive thyroid), or the body loses food before it can be used (constant vomiting, diarrhea, or draining wounds). No matter the cause, the result is the same: the body runs out of incoming fuel and starts breaking down its own muscle and fat to survive.

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Hallmark signs

·Weight loss over time — you drop pounds without trying
·Muscle wasting — arms and legs look thinner, you feel weak
·Low energy and constant tiredness
·Swelling in the legs, feet, or belly (edema)
·Skin problems — dry, peeling, slow to heal, or bruises easily
·Hair loss or hair that pulls out easily
·Pale skin and inside of eyelids (anemia)
·Confusion, trouble concentrating, or mood changes

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Red flags · escalate now

·Sudden, large weight loss (more than 10 percent of body weight in 3–6 months) — the body is burning through reserves too fast and may soon fail to keep vital organs working
·Swelling in the belly or legs that keeps getting worse — a sign that the liver or heart may be struggling because protein levels are critically low
·Confusion, severe weakness, or inability to get out of bed — the brain and muscles are starving and shutting down; this is a medical emergency
·Repeated infections or wounds that will not heal — the immune system is too weak to fight off germs, and the body cannot repair itself

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Workup

·Serum albumin
·Prealbumin (transthyretin)
·Complete blood count (CBC)
·Basic metabolic panel (BMP) with phosphate and magnesium
·Thiamine (vitamin B1) level
·C-reactive protein (CRP)

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Treatment

·Find and fix the upstream cause (not eating enough, cannot swallow, cannot absorb food, or burning calories too fast from illness)
·Start feeding slowly at 50% of goal calories, then increase over 3 to 5 days (called cautious refeeding)
·Give phosphate, magnesium, potassium, and thiamine before or with the first feedings
·Use mouth eating first, feeding tube (enteral) second, IV feeding (parenteral) only as last resort
·Work with a dietitian to build a meal plan and treat depression, food insecurity, or other reasons the person stopped eating
·Add light resistance exercise once eating is steady and calories are coming in reliably

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NCLEX trap

·Start with 50% of what they need and add more slowly over days. Too much food too fast causes refeeding syndrome — the body floods cells with phosphate, magnesium, and potassium so fast that the heart stops or the brain seizes. Feed carefully and watch blood levels closely in malnutrition.
·Find out WHY they are not eating. Is it poverty? Trouble swallowing? Depression? No teeth? Cancer? Each cause needs a different fix. Just adding food does not work if you do not fix the reason behind the malnutrition.
·Low albumin happens in malnutrition because the body does not have protein to make it. Check prealbumin too — it drops faster (half-life 2 days versus albumin's 20 days) and shows you malnutrition is happening right now, not weeks ago.
·Add phosphate, magnesium, potassium, and thiamine slowly before or with food. In malnutrition, cells are starved and will suddenly suck in these minerals when you feed the patient. If levels drop too low in the blood, the heart can stop. Go slow and check labs daily.
·Try eating by mouth first. If that does not work, use a feeding tube in the stomach (enteral feeding). Use IV feeding only as a last resort when the gut does not work. The gut stays healthier and infection risk is lower when you feed through the stomach in malnutrition.
·Pressure sores in malnutrition happen because the body has no fat or muscle cushion to protect skin over the bones. The sores will not heal without food and protein to rebuild tissue. It is a whole-body problem, not just skin care.

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