Diferencia entre revisiones de «Failure to thrive»
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==Differential Diagnosis== | |||
* Chronic or recurrent infections | * Chronic or recurrent infections | ||
* Immunodeficiency | * Immunodeficiency | ||
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** Anticholinergics, antiepileptics, benzodiazepines, beta blockers, central alpha antagonists, diuretics, steroids, neuroleptics, opioids, SSRIs, and TCAs are common culprits | ** Anticholinergics, antiepileptics, benzodiazepines, beta blockers, central alpha antagonists, diuretics, steroids, neuroleptics, opioids, SSRIs, and TCAs are common culprits | ||
==Evaluation== | |||
* History and physical examination are often sufficient to make the diagnosis. Many elderly patients with failure to thrive will be unable to provide an accurate history, so family members or caregivers must be involved. | * History and physical examination are often sufficient to make the diagnosis. Many elderly patients with failure to thrive will be unable to provide an accurate history, so family members or caregivers must be involved. | ||
** A thorough review of medications is necessary, as polypharmacy may contribute to failure to thrive. | ** A thorough review of medications is necessary, as polypharmacy may contribute to failure to thrive. | ||
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** CBC with cultures, CMP, ESR, CRP, TSH, UA, HIV, RPR, PPD, and CXR are usually indicated. | ** CBC with cultures, CMP, ESR, CRP, TSH, UA, HIV, RPR, PPD, and CXR are usually indicated. | ||
==Management== | |||
*If a specific medical cause can be identified, treatment should be tailored to the etiology, taking into account the potential risks for already frail patients. | *If a specific medical cause can be identified, treatment should be tailored to the etiology, taking into account the potential risks for already frail patients. | ||
*Oftentimes, treatment will involve nutritional supplementation, physical/occupational/speech therapy, modifications of living environment, and treatment of depression and/or dementia. | *Oftentimes, treatment will involve nutritional supplementation, physical/occupational/speech therapy, modifications of living environment, and treatment of depression and/or dementia. | ||
Revisión del 22:01 21 oct 2017
Background
- Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand.
- Usually multifactorial and seen in patients with chronic illnesses.
- Patients often have a combination of physical impairment, malnutrition, depression, and cognitive impairments.
- Defined as unintended weight loss >5% from baseline, decreased appetite, poor nutrition, inactivity, and often accompanied by dehydration, depressive symptoms, and impaired immune function.
Clinical Features
Differential Diagnosis
- Chronic or recurrent infections
- Immunodeficiency
- Endocrine disorder
- Cancer
- Chronic lung disease
- Chronic renal insufficiency
- Heart failure
- Hepatic failure
- Chronic wounds
- Hip or other large bone fracture
- Inflammatory bowel disease
- Malabsorption or malnutrition
- Rheumatologic diseases
- Stroke
- Depression
- Dementia
- Psychosis
- Medication side effects or interactions
- Anticholinergics, antiepileptics, benzodiazepines, beta blockers, central alpha antagonists, diuretics, steroids, neuroleptics, opioids, SSRIs, and TCAs are common culprits
Evaluation
- History and physical examination are often sufficient to make the diagnosis. Many elderly patients with failure to thrive will be unable to provide an accurate history, so family members or caregivers must be involved.
- A thorough review of medications is necessary, as polypharmacy may contribute to failure to thrive.
- A Mini Mental Status Exam (MMSE) should be performed to screen for cognitive decline.
- Limited laboratory and imaging studies are recommended to screen for treatable medical conditions that may contribute to failure to thrive.
- CBC with cultures, CMP, ESR, CRP, TSH, UA, HIV, RPR, PPD, and CXR are usually indicated.
Management
- If a specific medical cause can be identified, treatment should be tailored to the etiology, taking into account the potential risks for already frail patients.
- Oftentimes, treatment will involve nutritional supplementation, physical/occupational/speech therapy, modifications of living environment, and treatment of depression and/or dementia.
Disposition
- Most patients can be discharged from the ER with PCP follow up.
- If failure to thrive is severe or refractory to treatment, goals of care discussions with the patient and their family should be initiated, and a hospice referral may be indicated.