âu trả lời là C. (Chap. 78) Điều trị bệnh nhân chán ăn tâm thần nghiêm trọng (75% trọng lượng cơ thể dự kiến ) đòi hỏi phải cẩn thận chăm sóc y tế và tâm thần. Bệnh nhân có thâm hụt trọng lượng nặng nên phải nhập viện, tại thời gian đó một chương trình phục hồi dinh dưỡng với ăn uống với thực phẩm | IV. Nutrition Answers 31 IV-4. The answer is C. Chap. 78 Treating patients with severe anorexia nervosa 75 of expected body weight requires careful medical and psychiatric care. Patients with such severe weight deficits should be hospitalized at which time a program of nutritional restoration with oral feeding with food or liquid supplements can be undertaken. However much support and education are required to reassure the patient that the weight gain will not be permitted to get out of control. Psychiatric treatment focuses on emotional support and improving self-esteem. Complications of re-feeding can be as severe as congestive heart failure abnormal liver function tests and low levels of magnesium and phosphate have been reported. Tricyclic antidepressants are contraindicated due to the possibility of prolongation of the QT interval in the setting of abnormal electrolyte levels. No psychotropic medicine has been shown to be beneficial in this disorder. IV-5. The answer is E. JAMA282 1568-1575 1999. Studying mutations in obese rodents has provided important insights into the mechanism of obesity in humans. Genetically obese ob ob mice have a mutation in the gene that encodes the peptide leptin. Leptin is normally secreted by adipose fat cells and acts through the hypothalamus to provide a homeostat for adipose energy stores. Patients who are leptin deficient develop severe obesity insulin resistance and hyperphagia as well as overly efficient metabolism. Although high leptin levels in mice are associated with decreased food intake and increased energy expenditure patients with common obesity do not respond significantly to administration of recombinant leptin. Most obese people do have increased leptin levels and do not have mutations of either leptin or its receptor. Therefore it is not surprising that administering leptin to such individuals has no benefit. Typical obese people may have leptin resistance. IV-6. The answer is A. Chap. 77 .
