7. Undernutrition. Protein-energy malnutrition in childhood. Flashcards
leading cause of death among children younger than 5 years old
protein energy malnutrition
what are the types of protein malnutrition ?
Primary PEM - by social or economic factors that result in a lack of food.
Secondary PEM - in various conditions associated with
– increased caloric requirements (infection, trauma, cancer)
– increased caloric loss (malabsorption)
– reduced caloric intake (anorexia, cancer, oral intake restriction, social factors)
– a combination of these three variables.
what are the classification guidelines for pediatric under nutrition ?
wasting - low weight for height
weight/age = normal /low
height / age = normal
weight / height = <5th percentile
%IBW = <90 percent
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stunting - observed with longer term malnutrition - low height for age
weight/age = <5th percentile
height / age = <5th percentile
weight/height = normal
IBW = normal
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moderate malnutrition
weight for age = normal / low
height / age = normal
weight/height = <5th percentile
IBW = 70-80 percent
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kwashiorkor
weight for age = 60-80 percent
height/age = normal/liw
weight/height = normal (EDEM)
IBW = normal
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marasmus (severe wasting)
weight for age percentage = <
60%
height/age = normal/low
weight/height <5th percentile
%IBW <70 percent
what is wasting associated with ?
Wasting is defined as a low weight-for-height
associated with insufficient food intake (nutrient and energy density), and disease
peeks at second year of life
what is adequate IBW
80%-89%
how do you classify malnutrition according to severity ?
80-90% of IBW = mild malnutrition.
70-80% of IBW = moderate malnutrition.
Less than 70% of IBW = severe malnutrition
Marasmic PEM often associated with chronic diseases such as?
cystic fibrosis, tuberculosis, cancer, AIDS, celiac disease
signs and symptoms of marasmus?
deficiency in All major nutrients
Profound muscle wasting (“broomstick extremities”)
Loss of subcutaneous fat
Pronounced chest bone, ribs, facial bones
head may appear large, but generally is proportional to the body length.
Edema usually is absent.
The skin is dry and thin, and the hair may be
thin, sparse, and easily pulled out.
may be apathetic and weak.
bradycardia (exacerbated by acute fluid or solute loads) and hypothermia signify severe and life-threatening malnutrition.
Atrophy of the filiform papillae of the tongue
(deficiency Riboflavin, iron, niacin, folate, vitamin B12) and monilial stomatitis is frequent (thrush by candiasis / riboflavin iron def?)
smooth tongue (iron)
Red tongue (glossitis) B6, B12, niacin, riboflavin, folate
Inappropriate or inadequate weaning practices and chronic diarrhea are common findings in developing countrie
what is the cause of kwashiorkor ?
inadequate protein intake in the presence
of fair to good caloric intake
or can be infection
clinical manifestation of Kwashiorkor?
atrophy of muscle mass
bilateral pitting edema
Apathetic affect
Distended abdomen
due enlarged fatty liver (decrease apoprotein synthesis- decrease hepatitis triglycerides )
what are the physical examination findings of PEM?
Body t0 (measured with a thermometer) - low temperatures to detect hypothermia a
Ocular manifestations - Corneal lesions associated with vitamin A deficiency
lab diagnosis of PEM
↓ Serum albumin and transferrin (especially in Kwashiorkor)
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anemia
Hypoglycemia exists if the level is lower than 3 mmol/L.
Stool examination by microscopy: Parasites and blood are indicative of dysentery
treatment of PEM
Calories - safely started at 20% above the child’s recent intake
If no estimate of the caloric intake is available, 50% to 75% of the
normal energy requirement is safe
caloric intake can be increased 10% to 20% per day
Monitor for electrolyte imbalances, poor cardiac function, edema, or feeding intolerance - if any occurs, further caloric increases are not made until the child’s status stabilizes
Caloric intake is increased until appropriate catch- up growth is initiated
Vitamin and mineral intake in excess of the daily recommended
what is not recommend in the treatment ?
Iron supplements are not recommended during the acute rehabilitation phase, especially for children with Kwashiorkor, for whom ferritin is often high
Additional iron may pose an oxidative stress, and Fe supplementation has been associated with higher morbidity and mortality
what is a complication of treatment ?
Refeeding syndrome if nutritional rehabilitation occurs too rapidly (sudden shift from a catabolic to an anabolic state): It is characterized by fluid retention, hypophosphatemia, hypomagnesemia, and hypokalemia.
