Evaluation for Malnutrition:
- General Inspection: look for grooming, BMI <19, cachexia
- Vital signs: increased HR if intravascularly volume depleted
- Head & Neck: alopecia and brittle hair, glossitis (Iron, B12), bleeding gums (Vit C), angular cheilitis (Iron)
- Abdominal Exam: look for ascites, hepatomegaly, splenomegaly
- MSK: Muscle wasting. Pay particular attention to temporal muscle wasting, deltoids - note a 'boxing off' appearance, triceps, and quadriceps muscles. Also assess if ribs can be visualized through pectoral muscles. Note subcutaneous fat loss in these areas as well.
- Neuro: look for loss of deep tendon reflexes, peripheral neuropathy, optic atrophy, and evidence of subacute combined degeneration of the cord (B12).
A Rational Clinical Exam article from JAMA was published by local talent explains how to determine if your patient is malnourished via the Subjective Global Assessment. See below
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