Chapter 52
Nutrition and the Hospitalized Patient
Malnutrition in the hospital
Nutritional Problems in Hospitalized Patients
It is estimated that 30-50% of patients admitted to hospitals have some degree of malnutrition, and as many as 75% deteriorate nutritionally while hospitalized. Malnutrition is a pathological state from a relative or absolute deficiency or excess of one or more essential nutrients.
Protein-calorie malnutrition takes distinct forms with very different clinical pictures and repletion strategies.
Why the Distinction Matters
Marasmus is well-adapted -- repletion must be cautious to avoid refeeding syndrome (hypokalemia, hypophosphatemia). Kwashiorkor and mixed marasmic-kwashiorkor have visceral protein depletion and immune dysfunction, so they need vigorous nutritional support.
📖 “30-50% of hospital admissions malnourished; up to 75% deteriorate while hospitalized. Malnutrition: deficiency/excess of essential nutrients. Marasmus: cautious repletion (refeeding risk). Kwashiorkor/mixed: vigorous support (visceral protein depletion, immune dysfunction).”