Stressed malnutrition

Patients should be advised to rest and to avoid extreme heat. They should be warned that symptoms may be aggravated by illness, stress, malnutrition, pain, or surgery. Various drugs have been shown to worsen symptoms of myasthenia gravis. These include the aminoglycoside antibiotics such as tobramycin, gentamicin, and neomycin tetracyclines such as doxycycline and minocycline class 1 antiarrhythmics such as lidocaine, quinidine, and procainamide magnesium in calcium and multivitamin supplements beta-blockers such as timolol and propranolol calcium channel blockers such as verapamil and penicillamine. 

Careful monitoring and preventative care of high-risk patients can begin once these patients are identified. Intrinsic, or host-related, risk factors for the development of pressure sores include age greater than 75 years, limited mobility, loss of sensation, unconsciousness or altered sense of awareness, and malnutrition. Extrinsic, or environmental, risk factors include pressure, friction, shear stress, and moisture.37,42... 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

There are a number of conditions that are considered to reduce the effectiveness of the immune system and hence increase the risk of infections. These include malnutrition, stress and intense prolonged physical activity. 

Hypoglycemia can also be induced by concomitant diseases, for example renal disease, hepatic disease (cirrhosis), hypopituitarism, hypoadrenocorticalism, hypoglucagonism, hypothyroidism, malnutrition, anorexia nervosa, pregnancy, termination of pregnancy, recovery from infections, operations, or stress. 

For the adverse factors complicating malnutrition such as oxidative stress discussed in the chapter, explain what genetic factors would further exacerbate the problem. 

Bernstein LH, Ingenbleek Y Transthyretin its response to malnutrition and stress injury. Clinical usefulness and economic implications. Clin Chem Lab Med 40 1344-1348,2002. 

Whether these changes are primary or secondary to other factors such as oxidative stress, poor nutrition (i.e., protein and/or micronutrient malnutrition) is currently unknown. Importantly, similar deficiencies have been significantly improved by antioxidant supplementation in the elderly (K13). In this regard, zinc deficiency is also common in the elderly and has been reported in DS patients. This topic is more fully discussed later. 

Susceptibility increases in the population because of the migration of large populations, malnutrition, overcrowding in shelters and camps, open wounds, stress, and exposure to extremes of hot and cold temperatures. 

The whiskey equivalent of 1 ounce of pure ethanol per capita per day has been cited as healthful to adults to relieve stress and promote relaxation. However, it is often abused, which can lead to habituation with consequent liver damage, malnutrition, and a wide variety of other physical and mental problems, including the development of cancer. A fire hazard when exposed to heat or flame. To fight fire, use water, water spray, alcohol foam, CO2, dry chemical. See also ETHANOL and URETHANE. 

Patients with CKD are at increased risk of cardiovascular disease, independent of the etiology of their kidney disease. While a clearly unique pathogenesis of cardiovascular disease specific to CKD has not been identified, it is known that manifestations of kidney disease are contributory. Risk factors for cardiovascular disease in this population include hemodynamic and metabolic abnormalities, as well as hypertension, dyslipidemia, elevated homocysteine levels, anemia, hyperparathyroidism, malnutrition, and oxidative stress. Hypertension induced by volume expansion and increased systemic vascular resistance increases myocardial work and contributes to development of left ventricular hypertrophy (LVH). Hyperlipidemia may enhance atherogenesis, while some uremic toxins can decrease myocardial contractflity. In addition, uremic toxins can induce pericarditis, a potentially fatal complication. Currently, measures to screen this high-risk population for cardiovascular risk factors are not routine. ... 

Mixedmarasmus/kwashiorkor is a form of severe protein-calorie malnutrition that develops in chronically ill, starved patients during periods of hypermetabolic stress. There is reduced visceral protein synthesis superimposed on wasting of somatic protein and energy (adipose tissue) stores. Immunocompetence is lowered, increasing the incidence of infection, and wound healing is compromised. 

ALB was one of the first identified biochemical markers of malnutrition and has long been used in population studies. ALB is a relatively insensitive index of early protein malnutrition because there is a large amount normally found in the body (4 to 5 g/kg of body weight), it is highly distributed in the extravascular compartment (60%), and it has a long half-life (18 to 20 days). However, chronic protein deficiency in the setting of adequate nonprotein calorie intake leads to marked hypoalbuminemia because of a net ALB loss from the intravascular and extravascular compartments (kwashiorkor). Serum ALB concentrations also are affected by moderate-to-severe calorie deficiency hepatic, renal, and GI disease and infection, tramna, stress, and burns. In many cases, interpretation of serum ALB concentrations relative to nutrition status is difficult however, a positive correlation between decreased serum ALB concentrations and poor clinical outcome has been demonstrated in a variety of settings. Additionally, serum ALB concentrations of 2.5 g/dL or less can be expected to exacerbate ascites and peripheral, pulmonary, and GI mucosal edema due to decreased colloid oncotic pressure. 

Tonkiss J, Trzcinska M, Galler JR, et al. 1998. Prenatal malnutrition-induced changes in blood pressure dissociation of stress and nonstress responses using radiotelemetry. Hypertension 32(1) 108-114. 

The third set of variables lies in the postnatal environment. These include the physical environment (outdoors and in) and the social environment (family, peers, neighborhood, socioeconomic status, education, culture, and so on). Many of these variables affect the development of emotions, learning, language skills, and the processing of information by the brain—and can also affect gene expression via stress, infection, malnutrition, and toxins in air (for example, lead), water (for example, arsenic), and food (for example, mercury). Those effects that occur during early development can be extremely critical. 

Many factors can affect the quantity and quality of an immune response, most of which have been mentioned previously. Other factors that affect the immune response are stress, pregnancy, surgery, concomitant infections, extremes of temperature, and especially malnutrition. All these factors reduce the quantity and quality of the immune response, and when the immunoassayist performs seroepidemiological surveys to assess the herd immunity among various populations, these factors must be taken into account prior to determining levels of adequate protection within a population. 

In an excellent treatise. The Biology of Human Starvation (Keys et al., 1950), it is suggested that perhaps half of mankind suffers from chronic undernourishment. To reach a true understanding of the effects of chronically low food intake on the members of this half of humanity, they themselves must be studied in their normal life situation, in their own mental and social environment, and while under the multiple stress factors to which they are subjected. It may be that the observations here reported approach this objective since they have been made on subjects suffering not from acute starvation but from true chronic malnutrition, and taken from their normal habitat only when their undernourishment was accentuated, or when the clinical manifestations of this undernourishment became evident for one reason or another. 

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