Nutrition

Question 1

What do you want to know about a Childs nutritional status?

Answer 1

Hypotherimia, hypoglycaemia, any signs of infection, parasitic worms, HIV, hx of measles, Hb

Question 2

What constitutes acute severe malnutrition?

Answer 2

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

Question 3

What is complicated SAM?

Answer 3

Decreased appetite plus SAM

Question 4

Stages of correction of malnutrition

Answer 4

1) initial - hypothermia, hypoglycaemia, dehydration are priorities
2) Day 3-7 feeding and electrolytes
3) Rehab phase

Question 5

Initial oral rehydration - how and with what?

Answer 5

WHO ORS or ReSoMal
- 5ml/kg every 30 mins for 2 hrs
- 5-10ml/kg per hr for 4-10 hrs
First few hrs

Question 6

What do you start after oral rehydration in a malnourished child?

Answer 6

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

Question 7

Other treatment considerations in malnourished child?

Answer 7

Vit A 5000u/day
Only if clinical signs - toxicity exists!
Or if hx of measles

Question 8

Which criteria would you accept outpt Rx?

Answer 8

Good appetite
Alert
No other medical issues
EVEN if they have SAM

Question 9

Discharge criteria from malnutrition service?

Answer 9

No oedema for >2 weeks
Wt/ht >2 S.Ds
MUAC >12.5cm

Question 10

What is minimum calories per day required per person?

Answer 10

2100kcal/person/day (minimum!)
Add 100kcal for every 5 degrees <20 degrees
Add more for poor nutrition and health status

Question 11

In first two weeks of nutrition programme for severely malnourished patients, what % of protein and fat do you want?

Answer 11

10% protein
20% fat

Capped to avoid referring syndrome

Question 12

Phenotypic and aetiological assessment for malnutrition

Answer 12

Need 1 phenotypic and 1 aetiological criterion to meet criteria for malnutrition

Question 13

What might decrease the amount of micronutrients in harvested crops?

Answer 13

Soil quality, time of harvest, processing of the crops

Question 14

Oedematous legs. Wet beri beri - caused by?

Answer 14

Thiamine deficiency (wholegrain, meat, eggs, nuts)

Question 15

Symptoms of dry beri beri? Caused by?

Answer 15

parasthesia, muscle pain, weakness.
Thiamine deficiency

Question 16

what is PICA?

Answer 16

Eating non food items
Caused by nutrient deficiency
Causes GI obstruction, nutrient deficiency, heavy metal consumption, dental damage

Question 17

Pellagra caused by? Symptoms?

Answer 17

Niacin deficiency (B4)
Diarrhea
Dermatitis
Dementia
Death

Question 18

What drug typically causes pellagra?

Answer 18

Isoniazid (Also causes B6 def - pyridoxine)

Question 19

Causes of vitamin A deficiency?

Answer 19

Fat soluble vitamin - therefore low fat diet, steatorrhoea

Question 20

Symptoms of vitamin A def?

Answer 20

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

Question 21

Zinc deficiency, symptoms?

Answer 21

• Arrested growth/development
• Vitamin A deficiency symptoms
• Altered taste
• Impaired immunity
• Hair loss, poor skin integrity

Question 22

Symptoms of B12 deficiency

Answer 22

Deficiency: pernicious anemia; smooth, sore
tongue, fatigue, paralysis, skin hypersensitivity

Deficiency usually due to poor absorption:
* Atrophic gastritis
* Achlorhydria
* Lack of intrinsic factor

Question 23

Vitamin D deficiency?

Answer 23

Rickets
* Failure of bones to calcify properly

Osteomalacia
* Adult form of rickets

Osteoporosis
* Increased risk of fracture

Question 24

Symptoms of iodine deficiency?

Answer 24

Goitre
Delayed mentation

Question 25

What vitamin deficiency is related to malaria?

Answer 25

Vitamin A deficiency

Question 26

What is the difference between shunting and wasting?

Answer 26

Wasting = low weight for height
Shunting = low height for age

Question 27

Important aspects of the examination of a severely malnourished child?

Answer 27

Dehydration, shock, hypothermia
Mouth ulcers, skin changes
Oedema
Pallor, palmar pallor
Signs of vit A deficiency

Question 28

Key priorities in management of Severe malnutrition?

Answer 28

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

Question 29

Key priority when giving F75 in addition to this?

Answer 29

Encourage breastfeeding

Question 30

Do you give antibiotics in severe malnutrition?

Answer 30

Yes!
Uncomplicated SAM: PO amox for 5 days
Complicated SAM: benpen / ampicillin, plus gent

Question 31

Who do you give Vit A sups to?

Answer 31

5000 iu/day
If corneal ulceration / recent malarias

Question 32

What is the key difference between who you admit for inpatient management vs who you can discharge in case of severe malnutrition?

Answer 32

Appetite - if good can go home
If poor must be inpatient
Also if has any other infections - IP

Question 33

Which infections would you screen for in case of severe malnutrition?

Answer 33

HIV, TB, malaria, parasitic helminths

Question 34

Goal of nutrition?

Answer 34

200kcal/kg/day

Question 35

Difference between F75 and F100?

Answer 35

Low protein, sodium, fat - F75
High protein, sodium, fat - F100

Question 36

What is RUFT?

Answer 36

Ready to Use Therapeutic Feed
- Plumpy nut
- F100

Question 37

Supplemental feeding frequency once initial concerns of dehydration/hypoglycaemia are corrected?

Answer 37

2 hrs