Failure to thrive: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*CBC, CMP, UA, and CXR are usually indicated. | |||
*Consider | |||
**cultures, ESR, CRP, TSH, HIV, RPR, PPD | |||
**[[Mini Mental Status Exam]] to screen for cognitive decline | |||
===Diagnosis== | |||
* 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. | ||
==Management== | ==Management== | ||
Revision as of 05:04, 30 October 2017
This page is for adult patients; see failure to thrive (peds) for pediatric patients.
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
Workup
- CBC, CMP, UA, and CXR are usually indicated.
- Consider
- cultures, ESR, CRP, TSH, HIV, RPR, PPD
- Mini Mental Status Exam to screen for cognitive decline
=Diagnosis
- 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.
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.