PROTEIN ENERGY MALNUTRITION Flashcards
(28 cards)
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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
