Severe Acute Malnutrition Flashcards
True or False? Primary malnutrition results from inadequate dietary intake with no underlying illness while Secondary malnutrition accompanies any disease which disturbs appetite , digestion, absorption or utilisation of nutrients.
TRUE!!
Fill in the blanks. “ The Wellcome classification of malnutrition groups children based on which 2 criteria?
- The presence or absence of oedema
- Weight deficit of the child for his/her age
What are the different aspects of History taking are used in the Clinical assessment of the Malnutrition in children?
- Presenting History
- Past Medical History
- Perinatal History
- Immunisation
- Developmental History
- Family History
- Social History
- Dietary History
What is the Clinical Features of Marasmus?
- Apathetic
- Generalised Muscular Wasting
- Absence of subcutaneous fat
- ’ Skin and bones’ appearance
5.Hair- sparse, thin, dry , loss of sheen - Old person’s face - sunken cheeks due to disappearance of fat pads.
- Abdominal distention
- Skin- dry , thin, wrinkles easily
What are the Clinical Features of Kwashiorkor?
- Apathetic & irritable
- Pitting, painless oedema
- Dermatitis
- Hair changes
- Abdominal distension
- Hepatomegaly
The pathology ‘ Jowls ‘ is described?
Fullness of cheeks associated with oedematous malnutrition - also seen in Marasmus .
What are the different assessments apart of Anthropometry?
- weight
- Height
- Head circumference
- % weight/age
- % height/age
- weight/height
- z- scores
What are the clinical presentations of the MOUTH in a person with severe malnutrition?
- Angular Stomatisis
- Oral candidiasis
- Atrophic tondild
- Tongue - Hyperaemic , swollen
What are the clinical presentations of the HAIR in a person with severe malnutrition?
Scalp
- dully, dry, thin, fine, sparse, bald
- atrophy of hair roots- easily & painlessly placeable
- forest sign /flag sign
Eyelashes - long & luxuriant , colour change
Eyebrows- lost , colour change
Excess growth of Lanugo hair
What are the clinical presentations of the EYES in a person with severe malnutrition?
- Pale conjunctyiva
- Angular palpebritis
- Corneal & conductival xerosis
- Bitot’s spots
- Jaundice
What are the clinical presentations of BONES in patients with severe malnutrition?
- Enlargement of costochondral junction - rickety rosary ( calcium, vitamin D , Vitamin C, Copper , Phosphate deficiency ) .
- Frontal & Parietal bossing
3.Persistently open anterior fontanelle
- Knock - knees, bow legs
- X- ray- marked osteopenia
What is the treatment for patients with Severe malnutrition?
Resuscitative/ maintenance (1-2 weeks)
Rapid catch -up phase/ rehabilitation ( 4-6 weeks)
Preparation for home (1-2 weeks )
Follow - up after discharge
What happens during the Resuscitative phase of treatment for malnutrition?
To treat or prevent dehydration ( vomiting & diarrhoe)
- oral route preferred
- I.V. fluids only if there are definite signs of shock.
What is the first line treatment for infections and what is the duration of therapy?
Amoxil, Gentamycin , Flagyl - 10 days
What is the second line treatment for infections?
Cephalosporin & Amikacin
What is the treatment for Oral candidiasis?
Nyastin suspension
What is the treatment for Groin candidiasis ?
Antifungal cream
What is the treatment for Staphylococcus skin infection?
Cloxacillin
True or False? Iron must be given in the Resuscitative phase of Treatment of malnutrition?
FALSE!! Iron is NOT given in this phase
What are the signs of the end of the resuscitative phase?
- Treatment of infection
- Loss of oedema
- Return of appetite
- Return of affect
What is the aim of the rehabilitation phase of treating for malnutrition?
To encourage the child to eat as much as possible to gain as much weight in the shortest time period.
Fill in the blanks. “ Iron is added in the _________ phase .”
Rehabilitation
What are the different processes that happen in the Rehabilitation phase?
- FeSo4 is added
- Daily weights plotted on a graph
- Encouraged to complete feeds
- Feeds increased daily at TMRU until child fails to complete feeds
- Can be allowed out of crib for playtime - risk of cross infection is less, minimise delay in the mental development.
