Malnutrition Flashcards
When are people malnourished?
When they have decreased caloric intake(malnutrition) or if their diet does not provide enough calories(over-nutrition)
What is protein energy malnutrition?
Malnutrition caused by insufficient food and defined as dietary energy intake below the minimum level
What is reductive adaptation?
When the body adapts to under-nutrition by maintaining vital functions, slowing down cell growth, and differentiation and decreasing the metabolic rate
How many more times will SAM cause death in children?
10 times more likely
Why does gas to-intestinal infections cause malnutrition?
Because often the child vomits, has diarrhea, anorexia, and increased metabolic needs
What information does height/length for weight give us?
Stunting and points more to a chronic illness
At what age do we stop measuring head circumference?
5 years
Ands we have to at least get 2 measurements for head circumference
Why does the head seem bigger in malnourished children?
Because the head circumference is the last to stop growing in chronic malnutrition
What does weight for height/length indicate?
Recent loss of weight(wasting)
When do we start calculating the BMI?
After 2 years
It is calculated with weight/height (m) squared
What is the MUAC and in which age group do we use it in?
6-59 months and it is a screening tool for malnutrition
What do these readings mean? MUAC: <11,5cm 11,5cm-12,4cm 12,5-13,5 cm >13,5 cm
- Severe acute malnutrition
- Moderate malnutrition
- Mild malnutrition
- Normal child
What are the signs of shock in a child?
- Cold hands
- Lethargic or unconscious
- Weak fast pulse
What lab tests can we do in malnutrition?
- Serum pre-albumin and albumin
- Transferrin
- Electrolyte abnormalities like hypokalaemia, hypocalcaemia, and hypomagnesemia are usually found as well
- CD4, CD8 indices usually fall as well
How do we define SAM?
- Presence of bipedal oedema not caused with other reasons
2. Severe wasting- weight for heigh
Why should we restrict sodium in malnourished children?
Because one of the cellular changes that happen is the conservation of sodium and the leakage of potassium into the urine
What happens to the heart in children with SAM?
Decreased contractility and bradycardia because of hypokalaemia
-the cardiac output and stroke volume are also decreased in proportion to the weight loss
What happens in the liver?
There is decreased metabolism and toxins
What happens with the urogenital system in these patients?
They have frequent UTI’s
Because of the reduced glomerular filtratration rate
The ability of the kidneys to excrete sodium, excess acid and water is greatly reduced
What happens in the gastro-intestinal tract?
Atrophy of the bowel mucosa with billows atrophy
Pancreatic enzyme secretion is decreased due to atrophy of the pancreas
-there is decreased secretion of gastric acid, decreased intestinal motility and bacterial motility overgrowth
What happens in the endocrine system?
- Patients have glucose intolerance and develop hypoglycemia during periods of infection and refeeding
What happens with metabolism?
- Heat production and heat loss are impaired
The child becomes hypothermic in a cold environment and hyperthermia in hot environments
What is the effect on the immune system?
- Malnutrition causes atrophy of the lymph glands, tonsils, the thymus, affecting cellular immunity the most
This causes delayed hypersensitivity so even typical signs of infection like leucocytosis and fever are frequently absent
What is the haematological effect on malnutrition?
There is low red cell count which results in anaemia which can be normochromic normocytic, microcytic and macrocytic
Anaemia of malnutrition may be caused by iron deficiency anaemia
What is the effect on the neurological system?
Behavioral changes like irritability and apathy, decreased social responsiveness and attention deficits
-severe malnutrition can causes decreasesd neurons, synapses and myelinations which leads to decreased brain size
What are the features of malnutrition on the skin, muscle and glands?
- Loose skin folds because the subcutaneous fat is atrophied
- The skeletal muscle is lost as lactate, amino acids and pyruvate