Protein Energy Malnutrition Flashcards Preview

Dems Unit 2 Part 2 YAAAY > Protein Energy Malnutrition > Flashcards

Flashcards in Protein Energy Malnutrition Deck (33):
1

spectrum of manifestations depends on what 5 factors?

severity
duration
age
cause
association w/ other problems

2

maramus

simple wasting of fat and muscle mass due to energy deficiency

3

kwashiorkor

-edematous without wasting and is attributed to protein deficiency
-related to metabolic stress and inflammation

4

marasmic kwashiorkor

combination of chronic energy deficiency with chronic or acute protein deficit manifested as wasting and edema

5

global burden malnutrition

-poor nutrition causes half of deaths of children under the age of 5

-1/5 global disease burden attributed to effects of protein energy malnutrition and micronutrient deficiency

6

FTT

mild protein energy malnutrition

7

malnutrition occurs in what percentage of hospitalized patients

50%
-is associated with higher rates of morbidity and mortality and longer hospital stays

8

anorexia nervosa

-represent a successful adaptation to starvation
-less than critical total lean tissue depletion, weight stability, normal plasma albumin, normal peripheral blood total lymphocyte count, intact immune response
-susceptible to abrupt decompensation with minor insult

9

5 at risk groups for protein energy malnutrition

1. 0-12mths: marasmus/severe wasting
2. 12-24mths: kwashiorkor/ edematous PEM
3. Older children: stunting common; milder wasting
4. pregnant/lactating women: PEM
5. Elderly: PEM

10

wasting deficit is represented by what ratio

weight for height

11

stunting deficit is represented by what ratio

height for age

12

alternative use of z scores

Stunting:

13

clinical features
marasmus > kwashiorkor

weight loss
loss of muscle
loss of fat

14

clinical features that are absent in marasmus

edema
hepatomegaly
skin lesions

15

+/- in marasmus but present in kwashiorkor

anorexia
hair changes

16

clinical features
kwashiorkor > marasmus

psychological impairment
infections

+/- in kwashiorkor:
anorexia
hair changes

absent in marasmus:
edema
hepatomegaly
skin lesions

17

clinical feature
marasmus = kwashiorkor

diarrhea

18

6 physiologic responses to severe acute malnutrition: marasmus

1. decreased energy expenditure (decreased activity, bradycardia, hypothermia)

2. decreased Na pump activity

3. fuel utilization to mobilization body fat (increased ketones, decreased gluconeogenesis)

4. muscle protein catabolism (decreased overall protein turnover)

5. decreased inflammatory response/ immune fxn

6. impaired GI fxn (dismotility, malnutrition)

19

hallmarks of adaptation to severe PEM

1. loss of functional reserve
2. loss of physiological responsiveness

20

pathophysiology of kwashiorkor

failure of normal adaptive response of protein sparing normally seen in fasting state

21

contributing factors to kwashiorkor

infectious stress, cytokine release, relative micronutrient deficiencies, free radical exposure, oxidative damage

-possible role of microbiome

22

why would some assume that nutritional status is adequate in kwashiorkor?

fat reserves and muscle mass unaltered

23

Signs of kwashiorkor

-Flaky paint: skin lesions
-Flag sign: hair texture/ color change
-moon facies: generalized edema

24

5 metabolic derangements associated with kwashiorkor

1. hypoalbuminemia & enlarged fatty liver --> edema

2. Increased permeability of biological cell membranes --> edema

3. impaired Na/K homeostasis (Na excess, K deficiency)

4. hypotransferrinemia (anemia)

5. Impaired immune system (infection)

25

things to avoid when resolving life threatening conditions in PEM

over-hydration
excessive Na
hypoglycemia

26

resolving life threatening conditions in PEM

1. restore circulation with enteral
2. K+ supplements (+/-) Mg
3. treat infections
4. small, frequent oral feeds

27

restore nutritional status

Goal= Maintain

-small, frequent

28

Nutritional rehabilitation

-advance energy intake to 1.5X normal and 3-4X protein needs
-prolonged restoration of appetite
-familiar foods
-physical activity: recover cardiorespiratory and skeletal function

29

when to start nutritional rehabilitation

1-2 weeks after initial stabilization

after resolution of edema

30

3 derangements seen in re-feeding syndrome that can lead to sudden death

Potassium: intracellular
Phosphorus: intracellular
Magnesium

31

Potassium in re-feeding syndrome

increased insulin secretion
-->
intracellular glucose and K+
-->
decreased serum K+
-->
altered nerve/ muscle fxn

32

phosphorus in re-feeding syndrome

increased insulin secretion
-->
intracellular P
-->
Increased intracellular phosphorylated intermediates
-->
P trapped in intracellular space

33

magnesium in re-feeding syndrome

increased metabolic rate
--> increased requirement

= cofactor for ATPase