PEM Flashcards
What is PEM?
It is a group of disorders arising from coincidental lack in varying proportions of proteins and calories, and sometimes micronutrient deficiency.
What are the components of PEM?
- Kwashiorkor
- Marasmus
- Marasmic kwashiorkor
What is the percentage of PEM in Nigeria?
24% - moderate and severe
11% - wasting
43% - stunting
Outline the etiology of PEM
- Inadequate food intake
- Impaired absorption
- Increased metabolic needs
Predisposing factors to PEM
Lack of food
Inadequate breastfeeding
Early or faulty weaning
Diarrheal diseases
Infections/infestations
What are the 2 methods of classifying PEM?
Wellcome classification (clinical)
Gomez classification (community)
What parameters are used in wellcome classification?
Weight for age and edema
What parameters are used in Gomez classification
Weight for age only
Grade PEM based on wellcome classification
<60% with edema - marasmic kwashiokor
<60% without edema - marasmus
60 - 80% with edema - kwashiorkor
60 - 80% without edema - underweight
Grade PEM based on Gomez classification
I (mild) - 70 - 90%
II (moderate) 60 - 70%
III (severe) <60%
What are the diagnostic criteria for SAM?
Bilateral edema
MUAC <11.5
Weight for height < -3SD
Severe wasting
What parameters are used for WHO classification of malnutrition
Symmetrical edema
Weight for height (wasting)
Height for age (stunting)
Age range and maximum incidence of kwashiorkor
Age range - 1 to 3 years
Maximum incidence - 2 years
Theories behind the Pathogenesis of kwashiorkor
- Protein deficiency
- Dysadaptatiin theory (Gopalan’ 68)
- Aflatoxin poisoning (Hendrikse)
- Free radicals (mike golden)
Describe the dysadaptation theory
Protective mechanisms that protect the liver at the expense of less essential tissues fail to operate
Describe the free radical theory
There is an imbalance between free radicals generated and the protective mechanisms that remove them
What are the cardinal features of kwashiorkor?
- Growth retardation
- Muscle wasting
- Bilateral pitting edema
- Psychomotor/mental changes
Mention the changes in different organs as seen in kwashiorkor
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
What is marasmus?
It is the end result of starvation or the adaptive response to starvation
What is the age range of children with marasmus and at what age do you find majority of cases?
Age range - 6 months to 3 years
Majority- 1 year
What are the features of marasmus?
Severe growth retardation
Severe muscle wasting
Severe loss of subcutaneous fat
Alert but miserable and hungry
What are the complications of PEM?
Hypoglycemia
Hypothermia
Electrolyte derangement
Infections/infestation
Diarrhea
Lactose intolerance
Depressed immunity
Anemia
Vitamin deficiency
Micronutrient deficiency
What laboratory investigations would you request for PEM?
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
What are the 2 phases of treatment in PEM
Stabilization
Rehabilitation
