Dr Jonathan Bardgett and Dr Francesca Moroni discuss the importance of recognising and treating malnutrition in the acutely ill patient. This episode offers practical advice on assessing malnourished patients and provides an overview on available interventions from simple dietary adjustments to artificial feeding. Particular interest is posed on recognising patient at risk of refeeding syndrome and how to prevent it. A multidisciplinary approach to the malnourished patient is key in the successful management of malnutrition with specific focus on the fundamental role of the dieticians.

Dr Moroni touches upon different tubes and feed modalities and practical advice on managing high NG aspirates. A brief mention on parenteral nutrition can stimulate the listener to read more about it. The extreme malnutrition scenario is offered by patients with anorexia nervosa who require admission in acute medicine. These patients should be treated with extreme caution and involvement of gastroenterologist, dietician and psychiatrist should be priority.

MUST Tool: https://www.bapen.org.uk/screening-and-must/must/introducing-must

Reefeeding risks: National Institute for Health and Care Excellence. Nutrition support in adults. Clinical guideline 32: https://www.nice.org.uk/guidance/CG32

Moroni F, Metcalfe E, McKinlay A. Assessing the nutritional status of an acutely ill patient. BMJ 2017; 357 doi: https://doi.org/10.1136/sbmj.j1448 (Published 31 May 2017)

MARSIPAN Guidelines: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr189.pdf

Recording date: 4 January 2021