PROTEIN ENERGY MALNUTRITION Flashcards

1
Q

Kwashiorkor:

A

Edematous PEM, generally w/o wasting
Protein deficiency (+ metabolic stress + micronutrient deficiency/imbalance)
Rapid onset, “mal-adaptation”

Protein Energy Malnutrition

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2
Q

Marasmus

A

Severe wasting, due to energy deficiency
Slower onset, better adaptation

Protein Energy Malnutrition

BMI

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3
Q

Protein Energy Malnutrition

A

Of the world’s children…

20% underweight (> 2 S.D.

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4
Q

PEM: “Underweight”

A

Low Weight-for-Age

> 2 SD below median (50th%)

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5
Q

PEM: Stunting aka “______”

A

chronic malnutrition

Gets a “z-score”
Length-for-Age
% of Median
measurement

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6
Q

Wasting measured in

A

“Ideal Body Weight”

50th % Wt/ht

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7
Q

Marasmus:“Normal” Response to Starvation

A
↑ FA and trigly in m
↑ Ketones for brain
↓ Gluconeogen in liver 
↓ Urea 
↓ m. aa degrading (aa start to recycle)
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8
Q

“Normal” Responses to Starvation

A

Result: Utilization of fat stores, minimize muscle wasting–> ↓ Basal Metabolic Rate

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9
Q

Kwashiorkor:“Abnormal” Adaptive Response

A

Hypoalbuminemia + edema
protein deficiency
↑ insulin, ↑ FA synth, ↓ lipolysis

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10
Q

Signs of Kwashiorkor

A
  • Misery, edema, hepatomegaly**
  • Erythematous, hyperpigmentation, “Flaky Paint”
  • Dry, brittle, depigmented “Flag Sign”
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11
Q

Principles of Management Severe PEM: (esp Kwashiorkor – higher mortality)

A

GO SLOWLY!!

Resolve life-threatening conditions first

Restore nutritional status w/o abruptly disrupting homeostasis / “adapted state”

Ensure nutritional rehabilitation (Macronutrients + micronutrients)

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12
Q

Broad range of metabolic consequences occurring due to rapid reinstitution of nutrients ( energy/substrate) in pt w/ PEM; can result in sudden death

A

Refeeding Syndrome

Catabolic state –> anabolic state:
-Fluid shifts –> heart failure

Common derangements: K+, P+, Mg,++ Thiamine

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13
Q

Refeeding Syndrome: Management

A

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)

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14
Q

Refeeding Syndrome- Potassium

A

↑ insulin secretion (in response to feeding) –> intracellular glucose and K+–>

↓ serum K+ ==> altered nerve/muscle function

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15
Q

Refeeding Syndrome

Phosphorus

A

↑ insulin secretion

↑ intracellular phosphorylated intermediates (including glucose); P “trapped” intracelluar

↓ serum P ==> altered nerve/muscle function

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16
Q

Refeeding Syndrome

Magnesium

A

↑ requirement w/ ↑ metabolic rate; (= co-factor for ATPase)

17
Q

Refeeding Syndrome

Thiamine

A

rapid depletion (co-factor glycolysis) w/ CHO ==> cardiomyopathy +/- encephalopathy