PROTEIN ENERGY MALNUTRITION Flashcards
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(WHO)1 defines malnutrition as “the ____________________ between the ____________________ and ______________ and the ____________________ to ensure growth, maintenance, and specific functions.”
cellular imbalance
supply of nutrients
energy
body’s demand for them
The term protein-energy malnutrition (PEM) applies to a group of related disorders that include _________,___________ , and intermediate states of ____________________.
marasmus ; kwashiorkor
marasmus-kwashiorkor
Nutrition Components
1)________
2)Macronutrients
•________
•__________
•____________
3)micronutrients
Energy
Fat; protein; carbs
Malnutrition can either be acute (______) or chronic (_________)
Acute - ____/_____
Chronic - ______/______
Wasting; stunting
Weight; height
Height; Age
Epidemiology
Leading cause of childhood morbidity and mortality.
Age: __________ - ____________ (Period of high energy and caloric requirements, period of weaning and predisposition to viral and bacterial infections).
6 months-5 years
Aetiology
Marasmus(Marasmos-withering/wasting)- involves ____________________ and is characterized by ____________ . represents an adaptive response to __________.
inadequate intake of calories
emaciation
starvation.
The term kwashiorkor is taken from the Ga language of Ghana and means “the sickness of the _________.“Results from __________________ (with or without ?) reasonable caloric (energy) intake.
weaning
inadequate protein intake
With
Weight(%) : 80-60; presence of edema
=???
Kwashiorkor
Weight(%) : 80-60; absence of edema
=???
Underweight
Weight(%) : <60 ; presence of edema
=???
Marasmic kwashiorkor
Weight(%) : <60 ; absence of edema
=???
Marasmus
Acute malnutrition:xterized by _________ and _________.
Severe acute malnutrition(SAM):Standard deviation score (SD)based on ____________________ or ____________________
–
Chronic malnutrition: xterized by _____________.
wasting ; edema.
Weight for height or weight for length
stunting.
Primary Malnutrition: occurs as a result of only _________________________________ .
Secondary Malnutrition: occurs as a result of __________________________________
calorie and nutrient deficiency
an underlying pathology eg HIV/AIDS,TB etc.
Weight for height or weight for length<_____% NCHS/WHO median(____SD) or a _____ MUAC, or there is __________ of the feet signifies SAM
Moderate acute malnutrition: W/H between ——-% and _____% NCHS/WHO median
70
-3; low
Oedema
70; 80
Marasmus
History of ____________ /failure to ____________
History of ___________
Significant __________ , loss of ____________ tissue/skin turgor, bones and joints are prominent and the head appears ___________________________ for the body.
Have _____________ look but respond to attention, willing to feed hungrily too(C.f Kwashiokor)
Loss of ____________ fat-ominous sign
Abdomen :may be ________ or __________, visible __________(wasting of abd wall muscles
weight loss; gain weight
diarrhoea; emaciation
subcutaneous
disproportionately large
unhappy look
buccal pad
scaphoid ; distended
peristalsis
Severe Acute Malnutrition Marasmus
Severe weight loss and wasting
______ prominent
________ emaciated
Muscle wasting
May have ______ appetite
With correct treatment, good prognosis
Ribs; Limbs
good
Clinical features of Kwashiokor
History is insiduous and may occur over weeks(anorexia, vomiting, diarrhea)
Patient appears _________, apathetic, highly irritable, refuses to _______,(marked __________), __________ of subcut tissues and loss of _____________.
Edema is present usually _______________, if there is _______________ look for underlying cause for this.
miserable; feed; anorexia
flabiness; muscle tone
peripheral; significant ascites
Clinical features of kwashiorkor
Skin: variable appearance, dermatitis, classical is the ______________ -hyperpigmented, desquamating lesions with raw areas, _______ may be present.
______ pallor, the hair appears ________ and _____________ . Angular stomatitis/cheilosis is common
Hepatomegaly is (common or rare?)
black paint dermatitis; Ulcers
Mild; thin and sparse
Common
Other clinical findings in kwashiorkor depends on the presence of complications:
– hypo_______
– Hypo_________
– Infections(_______,________)
– Severe _________
thermia
glycemia
Oral thrush, sepsis
anaemia
Admission procedures SCREENING/ TRIAGE
Admit if criteria is fulfilled:
W/H or W/L <______% or
MUAC < _______ mm with a Length > 65 cm or
Presence of ____________________
Check for complication and do __________ test.
If patient passes appetite test and no complications present then manage on outpatient basis.
If patient fails appetite test and there are complications then admit.
70
110
bilateral pitting oedema
appetite
Appetite test
Conducted using _______ from the packet
It is given to child by the —————
RUTF
caregiver
Investigations
Marasmus:There may be __________ derangements except if there is ____________ from __________ or significant ______________ or other infections
no significant
dehydration ; diarrhea
anaemia
Investigations for Kwashiokor
Hypo_____________(Total protein, serum albumin levels are low, transferrin levels low)
E/U:Hypo________, (alkalosis or acidosis?) , hypo_____________ ,reduced blood urea.
FBC: ________ , evidence of ________
Serum lipids are ____, exocrine pancreas function is depressed, Lactase deficiency occurs.
Corticosteroids, Growth hormone levels are ______
Pathology: Liver-Fatty infiltration, jejunal biopsy- villus atrophy
proteinemia; kalemia
acidosis; magnesima
Anaemia; sepsis; low
elevated
Treatment of PEM
Management is divided into 4 phases:
1.) __________________ phase
2) ___________ and __________________
3.) _________ and ______________
4.) _____________ and ___________ education
1.) Acute Resuscitative phase
2) Stabilization and establishing feeding
3.) Repair and Recuperation
4.) Rehabilitation and nutrition education
Acute resuscitative phase
1.) Assess for __________ , __________,and correct appropraitely. If anemia is severe ie PCV< _______% transfuse with __________ slowly
2.) Check __________ and correct __________. Keep patient warm.
3) Check for __________ and correct
4.) Treat infections: Broad spectrum antibiotics
5.) Clean and dress Severe skin lesions
dehydration ; shock ; correct
15% ; packed cells
Temperature ; hypothermia
hypoglycemia
Stabilization and establishing feeding
1.) Constant monitoring of infusions and vital signs
2.) Offer oral fluids especially __________ (oral rehydration solution for malnutrition) if there is sig dehydration and pt is able to take orally.
3.) Give small frequent feeds ( ________ is now recommended-starter formular which contains _____ Kcal and ____gprotein/100ml). Introduce as soon as possible and continue for __________ until child is stablilized.
Example of F75 recipe(milk, sugar, cereal flour, vegetable oil, mineral mix and water)
4.) Vitamin A, Folic acid, potassium , zinc and mg supplementation can be given . Avoid _______ therapy in this phase
Treat any eye complications.
Resomal
F75 ; 75 Kcal ; 0.9
2-7
Iron
Repair and Recuperation
Establishment of __________ feeding is the key component of this phase
Current recommendation is the introduction of the ______ formular which is used as a ______ formular to ___________.
It contains more calories and protein: _____Kcal and _____g protein per 100ml.Use of Local foods should be encouraged
full mixed feeding
F-100 ; catch up ; rebuild tissues.
100Kcal ; 2.9g
Summary of Management of Severe Acute Malnutrition(SAM)
Admit for in patient care with SD score of ____SD, ___________ or any life threatening complication.
Treat/prevent hypothermia and hypoglycemia by __________, _________ and treating infection.
Treat and prevent dehydration using ____________
Correct electrolyte derangement(by giving feeds and Resomal prepared with mineral mix or combined multivitamin mix)
-3; pitting edema
feeding ; keeping warm
ReSomal;
