PROTEIN ENERGY MALNUTRITION Flashcards
Kwashiorkor:
Edematous PEM, generally w/o wasting
Protein deficiency (+ metabolic stress + micronutrient deficiency/imbalance)
Rapid onset, “mal-adaptation”
Protein Energy Malnutrition
Marasmus
Severe wasting, due to energy deficiency
Slower onset, better adaptation
Protein Energy Malnutrition
BMI
Protein Energy Malnutrition
Of the world’s children…
20% underweight (> 2 S.D.
PEM: “Underweight”
Low Weight-for-Age
> 2 SD below median (50th%)
PEM: Stunting aka “______”
chronic malnutrition
Gets a “z-score”
Length-for-Age
% of Median
measurement
Wasting measured in
“Ideal Body Weight”
50th % Wt/ht
Marasmus:“Normal” Response to Starvation
↑ FA and trigly in m ↑ Ketones for brain ↓ Gluconeogen in liver ↓ Urea ↓ m. aa degrading (aa start to recycle)
“Normal” Responses to Starvation
Result: Utilization of fat stores, minimize muscle wasting–> ↓ Basal Metabolic Rate
Kwashiorkor:“Abnormal” Adaptive Response
Hypoalbuminemia + edema
protein deficiency
↑ insulin, ↑ FA synth, ↓ lipolysis
Signs of Kwashiorkor
- Misery, edema, hepatomegaly**
- Erythematous, hyperpigmentation, “Flaky Paint”
- Dry, brittle, depigmented “Flag Sign”
Principles of Management Severe PEM: (esp Kwashiorkor – higher mortality)
GO SLOWLY!!
Resolve life-threatening conditions first
Restore nutritional status w/o abruptly disrupting homeostasis / “adapted state”
Ensure nutritional rehabilitation (Macronutrients + micronutrients)
Broad range of metabolic consequences occurring due to rapid reinstitution of nutrients ( energy/substrate) in pt w/ PEM; can result in sudden death
Refeeding Syndrome
Catabolic state –> anabolic state:
-Fluid shifts –> heart failure
Common derangements: K+, P+, Mg,++ Thiamine
Refeeding Syndrome: Management
Refeed slowly (start w/ 50-75% of basal needs)
Avoid fluid overload (enteral vs IV)
Monitor levels – supplement as necessary (K, P, Mg); provide micronutrients
Monitor vital signs
Monitor physical exam (e.g. edema, rash)
Resolution of edema before full feeding (wt loss first w/ edematous PEM)
Refeeding Syndrome- Potassium
↑ insulin secretion (in response to feeding) –> intracellular glucose and K+–>
↓ serum K+ ==> altered nerve/muscle function
Refeeding Syndrome
Phosphorus
↑ insulin secretion
↑ intracellular phosphorylated intermediates (including glucose); P “trapped” intracelluar
↓ serum P ==> altered nerve/muscle function