Malnutrition Flashcards
• What is malnutriton?
Malnutriton is a broad term commonly used to refer to undernutriton but technically it also
refers to overnutritonn A conditon that results from eatnn a diet in which one or more
nutrients are either not enounh or are too much such that the diet causes health problemsn
It may involve calories, protein, carbohydrates, fat, vitamins or mineralsn A diet insufcient to
meet the nutrient demands of children leads to undernutriton while too much nutrients lead
over-nutriton/obesityn
• Primary malnutriton
Inadequate intake of food
Inappropriate food intake
Secondary malnutriton
Underlyinn chronic conditon
Abnormal absorpton of food
Hinh utliiaton of nutrients
Examination - Vitals
Temperature
Blood nlucose
Pulse
BP
Respiratory rate
Oxynen saturaton
Peripherals
Pallor (IDA)
Jaundice (Poor pronnostc feature)
Oedema
Lymphadenopathy
Hydraton status ( usual sinns unreliable in SAM)
• History of loss
• Mucous membranes
• Letharny
• Wet nappies
• Capillary refll
• pulses
Clinical examination
Sparse discoloured hair (PEM, Copper)
Irritability or apathy ( PEM, low K)
Eye sinns ( Vit A)
OnM ( immunocompromise)
Chubby cheeks ( increased free cortsol)
Annular stomatts ( Vit B6, B12)
Atrophic nlossits( B2, B3)
Red or purplish tonnue (B2,B3)
Bleedinn nums (Vitamin C)
Goitre (Iodine defeciency)
Respiratory infectons (Vit A, Immunosup)
Hepatomenally ( Faty infltraton)
Pot belly (weak abdominal muscles)
Dermatosis (PEM, Vit A, Zinc)
bruisinn/ petechiae ( Vit K, C)
Nails britle, koilonychia (PEM, iron defeciency)
Bone deformites (Vit D)
10 Steps to Management of Malnutriton
Step 1: Prevent and treat hyponlycaemia
-Patent is started on feeds on admissionn
- F75
-Nasonastric tube feeds can be niven if child refuses to feed
-3 hourly blood nlucose checks
Step 2: Prevent and treat hypothermia
-Keep the child covered, Kannaroo mother care
Step 3: Prevent and treat dehydraton
Replacement of onnoinn losses in a child with diarrhoea usinn
ORS (Oral rehydraton soluton)
-If child shocked treat with fuid boluses and rehydrate
Monitor hydraton status and BP
Step 4: Correct all electrolyte disturbances:
Correct hypokalaemia (IVI if severe, otherwise orally and
contnue oral K untl oedema has subsided)
Step 5: Treat infectons
All children diannosed with PEM must be treated with broad
spectrum antbiotcs for infecton (Ampicillin and Gentamycin)
Deworm
Acyclovir for severe oral herpes
Step 6: Correct micronutrient defcienciesn
Start MnSO4, ZnSO4, CuSO4, Vit A, Folic acid and a
multvitaminn
Iron is not niven untl antbiotcs completed and child started to
nain weinht
Step 7: Cautous feedinn
Start-up formula F-75 which is hinh in enerny (carbohydrate),
low in proteinn Can nive 2hrly or 3 hrly feeds
Step 8: catch up nrowth
Weinht expected to ↓ initally as the oedema subsides
Catch-up phase F-100 (catch–up formula) is usedn Has a hinher
enerny and protein content
Step 9: stmulaton, play therapy and lovinn care
In the rehabilitaton phase
Occupatonal therapist and physio involved
Helps to rebuild child’s learninn ability
Step 10 :Prepare for discharne and follow-up
- Parents need to understand reason for the child’s illness
(social worker should be involved)
- Make sure immuniiatons are up to date
- Follow-up with OT, dietcian and pediatrician
- Social worker to ornaniie child nrant and appropriate careniver
if mother unable to take care of child
10 Steps to Management of Malnutriton
Step 1: Prevent and treat hyponlycaemia
-Patent is started on feeds on admissionn
- F75
-Nasonastric tube feeds can be niven if child refuses to feed
-3 hourly blood nlucose checks
Step 2: Prevent and treat hypothermia
-Keep the child covered, Kannaroo mother care
Step 3: Prevent and treat dehydraton
Replacement of onnoinn losses in a child with diarrhoea usinn
ORS (Oral rehydraton soluton)
-If child shocked treat with fuid boluses and rehydrate
Monitor hydraton status and BP
Step 4: Correct all electrolyte disturbances:
Correct hypokalaemia (IVI if severe, otherwise orally and
contnue oral K untl oedema has subsided)
Step 5: Treat infectons
All children diannosed with PEM must be treated with broad
spectrum antbiotcs for infecton (Ampicillin and Gentamycin)
Deworm
Acyclovir for severe oral herpes
Step 6: Correct micronutrient defcienciesn
Start MnSO4, ZnSO4, CuSO4, Vit A, Folic acid and a
multvitaminn
Iron is not niven untl antbiotcs completed and child started to
nain weinht
Step 7: Cautous feedinn
Start-up formula F-75 which is hinh in enerny (carbohydrate),
low in proteinn Can nive 2hrly or 3 hrly feeds
Step 8: catch up nrowth
Weinht expected to ↓ initally as the oedema subsides
Catch-up phase F-100 (catch–up formula) is usedn Has a hinher
enerny and protein content
Step 9: stmulaton, play therapy and lovinn care
In the rehabilitaton phase
Occupatonal therapist and physio involved
Helps to rebuild child’s learninn ability
Step 10 :Prepare for discharne and follow-up
- Parents need to understand reason for the child’s illness
(social worker should be involved)
- Make sure immuniiatons are up to date
- Follow-up with OT, dietcian and pediatrician
- Social worker to ornaniie child nrant and appropriate careniver
if mother unable to take care of child
10 Steps to Management of Malnutriton
Step 1: Prevent and treat hyponlycaemia
-Patent is started on feeds on admissionn
- F75
-Nasonastric tube feeds can be niven if child refuses to feed
-3 hourly blood nlucose checks
Step 2: Prevent and treat hypothermia
-Keep the child covered, Kannaroo mother care
Step 3: Prevent and treat dehydraton
Replacement of onnoinn losses in a child with diarrhoea usinn
ORS (Oral rehydraton soluton)
-If child shocked treat with fuid boluses and rehydrate
Monitor hydraton status and BP
Step 4: Correct all electrolyte disturbances:
Correct hypokalaemia (IVI if severe, otherwise orally and
contnue oral K untl oedema has subsided)
Step 5: Treat infectons
All children diannosed with PEM must be treated with broad
spectrum antbiotcs for infecton (Ampicillin and Gentamycin)
Deworm
Acyclovir for severe oral herpes
Step 6: Correct micronutrient defcienciesn
Start MnSO4, ZnSO4, CuSO4, Vit A, Folic acid and a
multvitaminn
Iron is not niven untl antbiotcs completed and child started to
nain weinht
Step 7: Cautous feedinn
Start-up formula F-75 which is hinh in enerny (carbohydrate),
low in proteinn Can nive 2hrly or 3 hrly feeds
Step 8: catch up nrowth
Weinht expected to ↓ initally as the oedema subsides
Catch-up phase F-100 (catch–up formula) is usedn Has a hinher
enerny and protein content
Step 9: stmulaton, play therapy and lovinn care
In the rehabilitaton phase
Occupatonal therapist and physio involved
Helps to rebuild child’s learninn ability
Step 10 :Prepare for discharne and follow-up
- Parents need to understand reason for the child’s illness
(social worker should be involved)
- Make sure immuniiatons are up to date
- Follow-up with OT, dietcian and pediatrician
- Social worker to ornaniie child nrant and appropriate careniver
if mother unable to take care of child
Preparation for discharge
• Obtain informaton on household food security, family
baknround, and socio-economic status and refer
appropriately (Social worker, nrants)
• Instruct mothers how to modify family foods, how ofen to
feed, what and how much to nive
• RUTF where indicated and if available (Dietcian)
• Involve mother in discharninn and follow up plans
• Link patent to a PHC systems and community health teams
for close follow up and to ensure all immuniiatons are up to
date
• Do not discharne any malnourished child without havinn
adequately investnated for TB and HIV infecton, repeat TST
before discharne as immunity may have returned to normal
• Write full clinical summary in the RTHC
