PEM

Question 1

PEM

most outstanding?

Answer 1

energy deficiency

Question 2

Marasmus

Answer 2

severe wasting

slower onset / better adapt

Question 3

Kwashiorkor

Answer 3

Edematous PEM
Generally w/o wasting
Protein deficiency (+ metabolic stress + MN deficiency/imbalance)
Rapid onset “mal-adaption”

Question 4

pure caloric deficiency

Answer 4

starvation

Question 5

cachexia

Answer 5

associated with inflammatory or neoplasm

not reversed by feeding alone

Question 6

sarcopenia

Answer 6

subnormal amount of skeletal muslce w/o weight loss

Question 7

% Global
Underweight
Stunted
Wasted 
Malnutrition related deaths

Answer 7

20
26
8
45

Question 8

Who is more at risk for marasmus and who is more at risk for kwashiorkor

Answer 8

marasmus - 0-12 mos

Kwash - 12-24 mos

Question 9

Underweight =

Answer 9

> 2SD below median (50%)

<3rd% for age

Question 10

Stunting =

Answer 10

Length for age
<2 Z score
< 3 Z score severe

Question 11

Wasting

Answer 11

Weight relative to length
% IBW
80-89 mild
75-79 moderate 
<75 severe 

OR
BMI <18
severe <16

Question 12

Fuel utilization during starvation - shifts?

Answer 12

glucose down
Ketones up
FA up

Question 13

Marasmus response to starvation

Answer 13

decrease BMR - hypotention/hypothermia/bradycardia

Question 14

Normal response to starvation - muscle - brain - liver - kidney

Answer 14

muscle - increased utilization of TGs/FAs - decreased protein degradation

brain - increased ketones

liver - gluconeogenesis

kidney - decreased urea production (by liver) and excretion

Question 15

Normal response to starvation

endocrine

Answer 15

decreased insulin and thyroid

increased Epi and cortisol

Question 16

Normal response to starvation

GI and heart

Answer 16

mucosal atrophy
decreased motility and secreation

heart - decreased CO

Question 17

Major consequence of normal response to starvation

Answer 17

decreased physiologic responsiveness to stress

Question 18

Kwashiorkor -

Answer 18

protein deficiency with adequate energy

abnormal response!!

Question 19

Kwashiorkor characteristic finding?

Answer 19

Hypoalbuminemia and edema

Question 20

Kwashiorkor - insulin and FA change?

Answer 20

increased insulin
decreased lipolysis
increased hepatic FA synthesis –> Fatty enlarged liver

Question 21

Signs of kwashiorkor

Answer 21

misery
edema - moon facies
hepatomegaly 
erythematous hyperpigmentation 
dry brittle hair

Question 22

Use Plus Signs+++
Marasmus vs Kwashiorkor
Weight loss
loss of muscle
loss of fat
edema
psych change
anorexia 
hepatomegaly 
infections 
diarrhea
skin changes
hair changes

Answer 22

WL 
\++++            ++
LM
\++++            +
LF
\++++             +
Edema
-                 ++++
Psych
\++                    ++++
Ana
\+/-                 ++++
Hepatomegaly 
-                 ++
infections 
\++             ++++
diarrhea
\+++            +++
skin
-                  ++
hair
\+/-                 ++

Question 23

Principles of management of PEM - esp Kwashiorkor

Answer 23

GO SLOW
Resolve associated life threatening conditions (infections)
Restore nutrition slowly

Question 24

Refeeding syndrome

Answer 24

Results from rapid shift from catabolic to anabolic

fluid shift - HF

Question 25

Refeeding syndrome

common derangements

Answer 25

K - decrease serum (increased insulin)
P - decreased serum (increased insulin)
Mg - incrased requirment bc increased BMR
Thaimin - rapid depletion with CHO –> CM +/- EC

Question 26

Refeeding syndrome - management

Answer 26

refeed slowly (50-70% BMR)
Avoid fluid overload 
monitor K.P.Mg
Monitor vitals
Resolve edema before full feeding (lose wt first)