Malnutrition, Weight Loss and Eating Disorders — Differential Diagnosis — Clinical Pathway: ICU and Inpatient

Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient

Differential Diagnosis

Includes medical conditions that can lead to malnutrition due to infection, inflammation, malabsorption, poor appetite, nausea and mental health conditions that can lead to malnutrition due to decreased appetite, loss of interest in food.

  • Infections
    • HIV
    • Tuberculosis
  • Endocrine
    • Thyroid disease
    • Addison’s disease
    • Turner Syndrome
  • Oncology
  • Rheumatology
  • Food insecurity
  • Behavioral health
    • Severe depression
    • Psychosis
  • Gastrointestinal
    • Irritable bowel disease (IBD)
    • Celiac disease
    • Ulcers
    • Superior mesenteric artery (SMA) syndrome
    • Wilson’s disease

Lab studies to:

Evaluate for potential inflammation, malabsorption that leads to malnutrition and nutritional deficiencies secondary to malnutrition.

On admission:

  • Electrolytes: complete metabolic panel (CMP), magnesium, phosphorous
  • EKG

On next lab draw:

  • CBC
  • TSH
  • ESR or CRP
    • CMP, Magnesium, Phosphorous
    • Prolactin
    • Celiac Screen
  • Estradiol (females)
  • or
  • Total Testosterone (males)
  • Vitamin/mineral labs
    • Ferritin
    • Methylmalonic acid
    • Vitamin D 25 OH

 

  • Ferritin – the best measure of iron stores in children. Someone may be iron deficient without having anemia.
  • Methylmalonic acid – an early marker of B12 deficiency because MMA and homocysteine levels generally increase before low serum cobalamin can be detected.
  • If the levels of estradiol or testosterone are very low, then order LH and FSH at the outpatient follow-up appointments.
  • When concerns for primary endocrine disorders (Turner’s ovarian failure), LH and FSH should be ordered while inpatient.

    • In cases of readmission:

    • Always check CMP, magnesium, phosphorous
    • If < 6 months: do not check abnormal values again until at least 6-8 weeks have passed since initial testing
    • If > 6 months: recheck everything if > 10% weight loss