Introduction
  Evaluation
  Short of breath
  Too tired
  The dwindles
  Weight loss
  Healing
  Chemotherapy
  Mom to be
  Very sociable
 
   Thanks To
   Quiz
 
 
 
 Mark W. Braun, MD
 braunm@indiana.edu

 
   Nutrition and Diagnosis-Related Care

 

 
 

Fixing cardiac cachexia is not as easy as you might think.
  • Physiological systems are interdependent, and just like a cat's cradle, when you pull on one string, there may be far reaching consequences.
  • First, the problem is linked to a failing heart, which may not be fixable.
  • The basic approach is:
    • Improve heart function and reduce tissue hypoxia.
    • Prevent infections and other conditions that further debilitate the patient.
    • Meet hyperbolic state with adequate calories.
  • Many CHF patients also have diabetes and renal impairment which complicates things, especially with regard to daily carbohydrate and protein intake.
Dietary and nutritional factors that might help.
  • Small, frequent meals to prevent high serum glucose levels and rapid fat infusion.
  • Preferred foods, at least those that are reasonable, to improve appetite and intake.
  • The so called 'heart healthy' diet may have to wait, rather focus on intake for now.
  • Calories are generally figured at 1.5 times calculated daily need.
  • High protein diet may not be indicated particularly if there is renal impairment
  • Restrict sodium and adjust potassium based on lab values.
  • Supplement vitamins and minerals
    • Thiamine, folate, B12, B6, and E
    • Magnesium, zinc and possibly iron (careful with iron, check serum levels first).
  • Enteral or parenteral (intravenous) nutrition may be needed.

Our next patient is a 32 year-old Native American woman who complains of lethargy.

 
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