C. difficile infections With Challenging Nutritional Intake Imbalances; Malnutrition

NurseCadeceus

A C. difficile infection effects the gastrointestinal system.

What Is the Gastrointestinal System?
The human gastrointestinal system or GI tract, is an organ system responsible for consuming and digesting food, absorbing nutrients, and expelling waste (fecal matter).  The whole digestive tract is about nine meters (30 feet) in length. (1)

  1. Food enters through the mouth and is broken down by saliva and the act of chewing. It passes through the esophagus until it reaches the stomach.
  2. The stomach uses acids and enzymes to convert food into a semi-liquid state called chyme. The stomach then expels the chyme into the small intestine.
  3. The small intestine is the portal for all nutrients to enter into the bloodstream. Crucial digestive enzymes and hormones secreted from the pancreas, liver, and gallbladder break down the semi-liquid chyme into molecules small enough to be absorbed into the bloodstream.
  4. Any leftover food goes into the large intestine, where it is converted into solid waste with the help of bacteria. Water and salts are extracted from any undigested food. The end-product (fecal matter) is expelled through the rectum and anus.

Malnutrition may be broadly defined as nutritional imbalance.

More specifically, it has been defined by the American Academy of Nutrition and Dietetics as consisting of any two or more of the following:

  • Insufficient  intake
  • Weight loss
  • Loss of muscle mass
  • Loss of subcutaneous fat
  • Localized or generalized fluid accumulation that may mask weight loss
  • Diminished functional status as measured by hand-grip strength

(1) http://naturopathconnect.com

Patients who are nutritionally challenged and have subsequently restrict their diets to an excessive degree are at higher risk for micro-nutrient and macro-nutrient deficiency. Deficiencies can arise from altered nutrition and poor intake from many illnesses.

A Zinc deficiency may present with a rash that can resemble contact dermatitis or seborrheic dermatitis and can be best described as eczematous pink scaly plaques that may evolve into vesicular, bullous, pustular, or desquamative lesions. Patients with severe zinc deficiency will experience growth delay, mental slowing, poor wound healing, anemia, photophobia, hypogeusia, and anorexia. Zinc is an essential mineral required by the body for maintaining a sense of smell, keeping a healthy immune system, building proteins, triggering enzymes, and creating DNA. Zinc also helps the cells in your body communicate by functioning as a neurotransmitter. A deficiency in zinc can lead to stunted growth, diarrhea, impotence, hair loss, eye and skin lesions, impaired appetite, and depressed immunity. Conversely, consuming too much zinc can lead to nausea, vomiting, loss of appetite, abdominal cramps, diarrhea, and headaches in the short term, and can disrupt absorption of copper and iron in the long term. If you have a zinc deficiency, then animal foods are better sources of zinc than plant foods.  Main foods high in Zinc:  Lamb, Wheat-germ, Spinach, Pork, Chicken, Beans.

Vitamin C plays an important role in maintaining connective tissue by virtue of its effect on the hydroxylation of proline and lysine. Patients with scurvy are prone to easy bruising, hemorrhage, fatigue, weakness, and gingivitis. Treatment consists of oral repletion of vitamin C. Foods high in Vitamin C include bell peppers (yellow), dark leafy greens, kiwis, broccoli, berries, citrus fruits, tomatoes, peas, and papayas.

The elderly patients, and patients nutritionally challenged (e.g. C. diff. infections, IBS, Crohn’s, etc.) are at higher risks for developing protein engery malnutrition (PEM) as a consequence of several factors. One is from the inability to maintain adequate nutrition due to the symptoms created by  a C. difficile infection and other GI diagnosis.  Secondary is related to the loss of employment and wages resulting in the inability to acquire food and food products/supplements. Long-term poor nutrition can also result in poor oral health and dental problems which can also lead to difficulty in chewing.  There are many factors that can lead to malnutrition. * Discussing dietary challenges with a healthcare provider is important and asking for a dietary consult with a Registered Dietician is always helpful *  Protein is also essential for the healing of wounds. Accordingly, increasing this patient’s protein intake is a priority. A deficiency in protein leads to muscle atrophy, and impaired functioning of the human body in general. High protein foods include meat, fish, cheese, tofu, beans, eggs, lentils, yogurt, Not everybody needs the same amount of protein. (2) Protein servings of meat, poultry, or fish, should be the size and thickness of the palm of your hand, That’s about a 3-ounce portion. Meat eaters eat no more than two palm-sized servings of meat a day to get enough — but not too much — protein.  Patients with decreased kidney functions need to discuss dietary needs with their healthcare professional and referral/consult with a Registered Dietician for guidance.  To look at it another way, protein should take up no more than one-third of your plate at meals, whether it’s in a form you can drink or chew, Include small amounts of protein foods at every meal to spread your intake evenly throughout the day. (2)

(2) Wedmd.com

Malnutrition can also be diagnosed with a CT scan: A patient can be diagnosed with malnutrition from inflammatory bowel disease (IBD), with significant weight changes and altered bowel habits. In addition, the albumin level, if checked, will be low = malnutrition.

Physical findings that are associated with PEM (Protein – energy Malnutrition) include the following:

  • Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and face
  • Edema: Areas that are most affected are the distal extremities and anasarca (generalized edema)
  • Oral changes: Cheilosis, angular stomatitis, and papillar atrophy
  • Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration
  • Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma
  • Nail changes: Fissured or ridged nails
  • Hair changes: Thin, sparse, brittle hair that is easily pulled out

Protein Studies include:  Measures of protein nutritional status include levels of the following:

  • Serum albumin
  • Retinol-binding protein
  • Prealbumin
  • Transferrin
  • Creatinine
  • Blood urea nitrogen

* If a loved one or if you are nutritionally challenged at any time, from any illness, contact your healthcare provider as soon as possible and discuss the symptoms and complications associated with maintaining an adequate nutritional diet or hydration.  Clear liquid diets are ONLY for three days and Full Liquid diets are ONLY to be used during the direct healthcare provider supervision and frequent monitoring.

 

* The information provided on the website is for educational use only and not for physical or mental health assessment, diagnosis, or treatment for any illness or symptoms.  Please see disclaimer.  Always seek medical care and contact healthcare providers as soon as possible for full medical exams, diagnosis, and treatments. Thank you.