73 WEIGHT LOSS General Discussion Clinically significant weight loss can be defined as the loss of 10 pounds or more than 5% of the usual body weight over 6 to 12 months, especially when the weight loss is progressive. Weight loss greater than 10% represents protein-energy malnutrition, which is associated with impaired physiologic function such as impaired cell-mediated and humoral immunity. Weight loss greater than 20% represents severe protein-energy malnutrition and is associated with organ dysfunction. Dieting and eating disorders, such as anorexia nervosa and bulimia nervosa, explain most cases of intentional weight loss. Unintentional weight loss can be divided into four problems: anorexia, dysphagia, weight loss despite normal intake, or socioeconomic problems. Malignancies account for approximately one-third of all patients presenting with unintentional weight loss. Gastrointestinal disorders are the most common nonmalignant organic etiologies in patients with unintentional weight loss, accounting for about 15% of cases. Medications are a frequently overlooked potential etiology of unintentional weight loss, particularly in elderly patients. Adverse effects of medications, such as anorexia, nausea, diarrhea, dysphagia, and dysgeusia may alter the intake, absorption, and utilization of nutrients. Weight loss occurs commonly in elderly individuals. Among the noninstitutionalized elderly, depression, cancer, and benign gastrointestinal tract diseases are the most common causes of weight loss. Among nursing home residents, psychiatric and neurologic illnesses account for the greatest proportion of weight loss. In most patients, the etiology of unintentional weight loss may be identified through a detailed history and physical examination. The first step in evaluating a complaint of weight loss is quantifying the weight loss. The symptoms acquired from the history can guide the clinician to one of the four causal categories: anorexia, dysphagia, weight loss despite normal intake, and social factors. The suggested laboratory evaluation is outlined below. Additional testing should be directed by findings on history, physical examination, or initial laboratory evaluation. Patients with normal physical and laboratory findings are unlikely to have a serious physical illness. Medications Associated with Weight Loss ACE inhibitors Alendronate Allopurinol Amantadine Amphetamines Antibiotics • Atovaquone • Ciprofloxacin • Clarithromycin • Doxycycline • Ethambutol • Griseofulvin • Metronidazole • Ofloxacin • Pentamidine • Rifabutin • Tetracycline Anticholinergics Anticonvulsants Antihistamines Benzodiazepines Bisphosphonates Calcium-channel blockers Carbamazepine Chemotherapeutic agents Clonidine Corticosteroids Decongestants Digoxin Dopamine agonists Gold Hormone replacement therapy Hydralazine Hydrochlorothiazide Iron Levodopa Lithium Metformin Methimazole Neuroleptics Nicotine Nitroglycerin NSAIDs Opiates Penicillamine Pergolide Phenytoin Potassium Propranolol Quinidine SSRIs Selegiline Spironolactone Statins Theophylline Tricyclic antidepressants Causes of Weight Loss Alcoholism Cardiovascular disease • Congestive heart failure Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM TRANSAMINASE ELEVATION Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on WEIGHT LOSS Full access? Get Clinical Tree
73 WEIGHT LOSS General Discussion Clinically significant weight loss can be defined as the loss of 10 pounds or more than 5% of the usual body weight over 6 to 12 months, especially when the weight loss is progressive. Weight loss greater than 10% represents protein-energy malnutrition, which is associated with impaired physiologic function such as impaired cell-mediated and humoral immunity. Weight loss greater than 20% represents severe protein-energy malnutrition and is associated with organ dysfunction. Dieting and eating disorders, such as anorexia nervosa and bulimia nervosa, explain most cases of intentional weight loss. Unintentional weight loss can be divided into four problems: anorexia, dysphagia, weight loss despite normal intake, or socioeconomic problems. Malignancies account for approximately one-third of all patients presenting with unintentional weight loss. Gastrointestinal disorders are the most common nonmalignant organic etiologies in patients with unintentional weight loss, accounting for about 15% of cases. Medications are a frequently overlooked potential etiology of unintentional weight loss, particularly in elderly patients. Adverse effects of medications, such as anorexia, nausea, diarrhea, dysphagia, and dysgeusia may alter the intake, absorption, and utilization of nutrients. Weight loss occurs commonly in elderly individuals. Among the noninstitutionalized elderly, depression, cancer, and benign gastrointestinal tract diseases are the most common causes of weight loss. Among nursing home residents, psychiatric and neurologic illnesses account for the greatest proportion of weight loss. In most patients, the etiology of unintentional weight loss may be identified through a detailed history and physical examination. The first step in evaluating a complaint of weight loss is quantifying the weight loss. The symptoms acquired from the history can guide the clinician to one of the four causal categories: anorexia, dysphagia, weight loss despite normal intake, and social factors. The suggested laboratory evaluation is outlined below. Additional testing should be directed by findings on history, physical examination, or initial laboratory evaluation. Patients with normal physical and laboratory findings are unlikely to have a serious physical illness. Medications Associated with Weight Loss ACE inhibitors Alendronate Allopurinol Amantadine Amphetamines Antibiotics • Atovaquone • Ciprofloxacin • Clarithromycin • Doxycycline • Ethambutol • Griseofulvin • Metronidazole • Ofloxacin • Pentamidine • Rifabutin • Tetracycline Anticholinergics Anticonvulsants Antihistamines Benzodiazepines Bisphosphonates Calcium-channel blockers Carbamazepine Chemotherapeutic agents Clonidine Corticosteroids Decongestants Digoxin Dopamine agonists Gold Hormone replacement therapy Hydralazine Hydrochlorothiazide Iron Levodopa Lithium Metformin Methimazole Neuroleptics Nicotine Nitroglycerin NSAIDs Opiates Penicillamine Pergolide Phenytoin Potassium Propranolol Quinidine SSRIs Selegiline Spironolactone Statins Theophylline Tricyclic antidepressants Causes of Weight Loss Alcoholism Cardiovascular disease • Congestive heart failure Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM TRANSAMINASE ELEVATION Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on WEIGHT LOSS Full access? Get Clinical Tree
