Failure to thrive: Difference between revisions
No edit summary |
|||
| (5 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
{{Adult top}} [[failure to thrive (peds)]] | |||
==Background== | ==Background== | ||
* Usually multi-factorial and seen in patients with chronic illnesses. | |||
* Defined as unintended weight loss >5% from baseline, decreased appetite, poor nutrition, inactivity, and often accompanied by [[dehydration]], [[depression|depressive symptoms]], and impaired immune function. | |||
==Clinical Features== | |||
* Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand. | * Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand. | ||
* Patients often have a combination of physical impairment, malnutrition, depression, and cognitive impairments. | * Patients often have a combination of physical impairment, malnutrition, depression, and cognitive impairments. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Chronic or recurrent | * Chronic or recurrent [[infection]]s | ||
* Immunodeficiency | * Immunodeficiency | ||
* Endocrine disorder | * Endocrine disorder | ||
* Cancer | * Cancer | ||
* Chronic lung disease | * Chronic lung disease | ||
* Chronic renal insufficiency | * Chronic [[renal failure|renal insufficiency]] | ||
* Heart failure | * [[Heart failure]] | ||
* Hepatic failure | * [[Hepatic failure]] | ||
* Chronic wounds | * Chronic wounds | ||
* Hip or other large bone fracture | * Hip or other large bone [[fracture]] | ||
* Inflammatory bowel disease | * [[Inflammatory bowel disease]] | ||
* Malabsorption or malnutrition | * Malabsorption or malnutrition | ||
* Rheumatologic diseases | * Rheumatologic diseases (e.g. [[RA]], [[SLE]] | ||
* Stroke | * [[Stroke]] | ||
* Depression | * [[Depression]] | ||
* Dementia | * [[Dementia]] | ||
* Psychosis | * [[Psychosis]] | ||
* Medication side effects or interactions | * Medication side effects or interactions | ||
** 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== | ==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. | ||
*CBC, CMP, [[UA]], [[ECG]], and [[CXR]] are usually indicated | |||
*Consider: | |||
**[[troponin]], cultures, [[head CT]], ESR, CRP, TSH, HIV, RPR | |||
**[[Mini Mental Status Exam]] to screen for cognitive decline | |||
==Management== | ==Management== | ||
| Line 46: | Line 42: | ||
==Disposition== | ==Disposition== | ||
* | *Some 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 | *Evaluate for ability to care for at home and possible need for placement | ||
*If failure to thrive is severe or refractory to treatment, consider goals of care discussions and a hospice referral | |||
==See Also== | ==See Also== | ||
Latest revision as of 23:05, 28 November 2019
This page is for adult patients. For pediatric patients, see: failure to thrive (peds)
Background
- Usually multi-factorial and seen in patients with chronic illnesses.
- 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
- Non-specific term indicating inappropriate weight loss or insufficient weight gain, due to insufficient caloric intake, insufficient caloric absorption, or excessive caloric demand.
- Patients often have a combination of physical impairment, malnutrition, depression, and cognitive impairments.
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 (e.g. RA, SLE
- 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.
- CBC, CMP, UA, ECG, and CXR are usually indicated
- Consider:
- troponin, cultures, head CT, ESR, CRP, TSH, HIV, RPR
- Mini Mental Status Exam to screen for cognitive decline
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
- Some patients can be discharged from the ER with PCP follow up.
- Evaluate for ability to care for at home and possible need for placement
- If failure to thrive is severe or refractory to treatment, consider goals of care discussions and a hospice referral