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PROTEIN ENERGY MALNUTRITION > PEM > Flashcards

PEM Flashcards

1
Q

What is PEM?

A

It is a group of disorders arising from coincidental lack in varying proportions of proteins and calories, and sometimes micronutrient deficiency.

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2
Q

What are the components of PEM?

A
  1. Kwashiorkor
  2. Marasmus
  3. Marasmic kwashiorkor
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3
Q

What is the percentage of PEM in Nigeria?

A

24% - moderate and severe
11% - wasting
43% - stunting

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4
Q

Outline the etiology of PEM

A
  1. Inadequate food intake
  2. Impaired absorption
  3. Increased metabolic needs
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5
Q

Predisposing factors to PEM

A

Lack of food
Inadequate breastfeeding
Early or faulty weaning
Diarrheal diseases
Infections/infestations

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6
Q

What are the 2 methods of classifying PEM?

A

Wellcome classification (clinical)
Gomez classification (community)

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7
Q

What parameters are used in wellcome classification?

A

Weight for age and edema

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8
Q

What parameters are used in Gomez classification

A

Weight for age only

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9
Q

Grade PEM based on wellcome classification

A

<60% with edema - marasmic kwashiokor
<60% without edema - marasmus
60 - 80% with edema - kwashiorkor
60 - 80% without edema - underweight

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10
Q

Grade PEM based on Gomez classification

A

I (mild) - 70 - 90%
II (moderate) 60 - 70%
III (severe) <60%

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11
Q

What are the diagnostic criteria for SAM?

A

Bilateral edema
MUAC <11.5
Weight for height < -3SD
Severe wasting

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12
Q

What parameters are used for WHO classification of malnutrition

A

Symmetrical edema
Weight for height (wasting)
Height for age (stunting)

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13
Q

Age range and maximum incidence of kwashiorkor

A

Age range - 1 to 3 years
Maximum incidence - 2 years

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14
Q

Theories behind the Pathogenesis of kwashiorkor

A
  1. Protein deficiency
  2. Dysadaptatiin theory (Gopalan’ 68)
  3. Aflatoxin poisoning (Hendrikse)
  4. Free radicals (mike golden)
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15
Q

Describe the dysadaptation theory

A

Protective mechanisms that protect the liver at the expense of less essential tissues fail to operate

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16
Q

Describe the free radical theory

A

There is an imbalance between free radicals generated and the protective mechanisms that remove them

17
Q

What are the cardinal features of kwashiorkor?

A
  1. Growth retardation
  2. Muscle wasting
  3. Bilateral pitting edema
  4. Psychomotor/mental changes
18
Q

Mention the changes in different organs as seen in kwashiorkor

A

Skin - depigmentation, flaky paint dermatosis
Liver - hepatomegaly from fatty infiltration
GI - intractable diarrhea, atrophy of intestine and pancreas
Immune - impaired cell mediated immunity
CVS - microcardia
Genitourinary - small kidneys

19
Q

What is marasmus?

A

It is the end result of starvation or the adaptive response to starvation

20
Q

What is the age range of children with marasmus and at what age do you find majority of cases?

A

Age range - 6 months to 3 years
Majority- 1 year

21
Q

What are the features of marasmus?

A

Severe growth retardation
Severe muscle wasting
Severe loss of subcutaneous fat
Alert but miserable and hungry

22
Q

What are the complications of PEM?

A

Hypoglycemia
Hypothermia
Electrolyte derangement
Infections/infestation
Diarrhea
Lactose intolerance
Depressed immunity
Anemia
Vitamin deficiency
Micronutrient deficiency

23
Q

What laboratory investigations would you request for PEM?

A

FBC
Blood sugar
Stool and urine microscopy and culture
Blood film for malaria parasite
Mantoux test
E/U
Calcium
Phosphorus
Serum protein
Zinc
Iron
Iodine
Blood culture
Uptime creatine/proline
HIV screen

24
Q

What are the 2 phases of treatment in PEM

A

Stabilization
Rehabilitation

25
Q

How would you treat PEM

A

A) Supportive treatment

Resuscitation
Prevent and treat complications
- nurse in a warm room
- correct fluid and electrolytes imbalance
- potassium supplement
- treat infections/infestations
Multivitamin, vitamin A, folic acid, minerals

B) Definitive treatment

10 step WHO

26
Q

What is the criteria for discharge for PEM?

A

Good appetite
Good weight gain
No edema
No infections
Child weaned into home food
Mother fully counseled

27
Q

Causes of mortality in PEM

A

Hypoglycemia
Hypothermia
Severe anemia
Sepsis
Severe dehydration

PROTEIN ENERGY MALNUTRITION (1 decks)

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