Protein Energy Malnutrition

Question 1

PEM

Answer 1

negative energy balance + obligatory negative nitrogen balance

Question 2

Marasmus

Answer 2

slow onset response to starvation
-utilize fat stores to minimize muscle wasting
-decreased basal metabolic rate
-hypothermia, hypotension, bradycardia
-decreased insulin & thyroid hormones, increased cortisol and epinephrine
-GI muscle atrophy, myocardial atrophy–> decreased cardiac output
NO LIVER ENLARGEMENT/ABD DISTENTION

Question 3

Kwashiorkor

Answer 3

rapid onset
hypoalbuminemia, infectious stress, cytokines, oxidative damage
protein deficiency, edema, increased FA synthesis and fatty liver
-Misery & HEPATOMEGALY & edema
-Erythematous, hyperpigmented “flaky paint” rash (pellagroid)
-dry, brittle, depigmented hair (flag sign)
-moon facies (edema)

Question 4

Management of PEM

Answer 4

very slow restoration of nutritional replacement.

resolve life-threatening condition (infection etc)

Question 5

refeeding syndrome

Answer 5

massive fluid shift (3rd spacing) because of the sudden arrival of osmoles –>HF and respiratory arrest
metabolism of nutrient input requires energy, enzymes, precursors, which they don’t yet have.