Nutrition Flashcards
What do you want to know about a Childs nutritional status?
Hypotherimia, hypoglycaemia, any signs of infection, parasitic worms, HIV, hx of measles, Hb
What constitutes acute severe malnutrition?
Wt for length/ht <-3SD or <60% weight for age
MUAC <11.5cm up to puberty (over 2 and under 11)
Oedema bilaterally
Need 2/3
What is complicated SAM?
Decreased appetite plus SAM
Stages of correction of malnutrition
1) initial - hypothermia, hypoglycaemia, dehydration are priorities
2) Day 3-7 feeding and electrolytes
3) Rehab phase
Initial oral rehydration - how and with what?
WHO ORS or ReSoMal
- 5ml/kg every 30 mins for 2 hrs
- 5-10ml/kg per hr for 4-10 hrs
First few hrs
What do you start after oral rehydration in a malnourished child?
Feeding formulas
F75 vs F100 difference?
F75 prevent death, low protein/fat/sodium - for first week - days 2-7
F100 promote growth, high protein/fat/sodium - after first week
Other treatment considerations in malnourished child?
Vit A 5000u/day
Only if clinical signs - toxicity exists!
Or if hx of measles
Which criteria would you accept outpt Rx?
Good appetite
Alert
No other medical issues
EVEN if they have SAM
Discharge criteria from malnutrition service?
No oedema for >2 weeks
Wt/ht >2 S.Ds
MUAC >12.5cm
What is minimum calories per day required per person?
2100kcal/person/day (minimum!)
Add 100kcal for every 5 degrees <20 degrees
Add more for poor nutrition and health status
In first two weeks of nutrition programme for severely malnourished patients, what % of protein and fat do you want?
10% protein
20% fat
Capped to avoid referring syndrome
Phenotypic and aetiological assessment for malnutrition
Need 1 phenotypic and 1 aetiological criterion to meet criteria for malnutrition
What might decrease the amount of micronutrients in harvested crops?
Soil quality, time of harvest, processing of the crops
Oedematous legs. Wet beri beri - caused by?
Thiamine deficiency (wholegrain, meat, eggs, nuts)
Symptoms of dry beri beri? Caused by?
parasthesia, muscle pain, weakness.
Thiamine deficiency
what is PICA?
Eating non food items
Caused by nutrient deficiency
Causes GI obstruction, nutrient deficiency, heavy metal consumption, dental damage
Pellagra caused by? Symptoms?
Niacin deficiency (B4)
Diarrhea
Dermatitis
Dementia
Death
What drug typically causes pellagra?
Isoniazid (Also causes B6 def - pyridoxine)
Causes of vitamin A deficiency?
Fat soluble vitamin - therefore low fat diet, steatorrhoea
Symptoms of vitamin A def?
Symptoms:
* Kidney stones
* Anaemia
* Cessation of bone growth
* Painful joints
* Night Blindness
* Blindness/Keratinization
Vitamin A Deficiency – Bitot’s spot
Dry, ulcerated cornea
Corneal scarring
Deep corneal ulceration
Keratomalacia
Xerophthalmia
Zinc deficiency, symptoms?
- Arrested growth/development
- Vitamin A deficiency symptoms
- Altered taste
- Impaired immunity
- Hair loss, poor skin integrity
Symptoms of B12 deficiency
Deficiency: pernicious anemia; smooth, sore
tongue, fatigue, paralysis, skin hypersensitivity
Deficiency usually due to poor absorption:
* Atrophic gastritis
* Achlorhydria
* Lack of intrinsic factor
Vitamin D deficiency?
Rickets
* Failure of bones to calcify properly
Osteomalacia
* Adult form of rickets
Osteoporosis
* Increased risk of fracture
Symptoms of iodine deficiency?
Goitre
Delayed mentation
What vitamin deficiency is related to malaria?
Vitamin A deficiency
What is the difference between shunting and wasting?
Wasting = low weight for height
Shunting = low height for age
Important aspects of the examination of a severely malnourished child?
Dehydration, shock, hypothermia
Mouth ulcers, skin changes
Oedema
Pallor, palmar pallor
Signs of vit A deficiency
Key priorities in management of Severe malnutrition?
Correct hypoglycaemia
Correct hypothermia: skin to skin contact with mum
Correct dehydration - Oral if possible, if not NG
- 5ml/kg every 30 mins in first 2h, then 5-10ml/kg/h for next 4-10h
- IV fluid if in shock
Key priority when giving F75 in addition to this?
Encourage breastfeeding
Do you give antibiotics in severe malnutrition?
Yes!
Uncomplicated SAM: PO amox for 5 days
Complicated SAM: benpen / ampicillin, plus gent
Who do you give Vit A sups to?
5000 iu/day
If corneal ulceration / recent malarias
What is the key difference between who you admit for inpatient management vs who you can discharge in case of severe malnutrition?
Appetite - if good can go home
If poor must be inpatient
Also if has any other infections - IP
Which infections would you screen for in case of severe malnutrition?
HIV, TB, malaria, parasitic helminths
Goal of nutrition?
200kcal/kg/day
Difference between F75 and F100?
Low protein, sodium, fat - F75
High protein, sodium, fat - F100
What is RUFT?
Ready to Use Therapeutic Feed
- Plumpy nut
- F100
Supplemental feeding frequency once initial concerns of dehydration/hypoglycaemia are corrected?
2 hrs
