Protein Energy Malnutrition PEM
Pediatric Nutrition course
Protein energy
malnutrition Definition:
It is a range of pathological conditions
arising from coincidental lack of proteins and calories, in varying
proportions, occurring most frequently in infants and young children.
•
PEM takes several forms
MARASMUS
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Marasmus is severe PEM
characterized by body weight less than 60% of the average for age.
•
It is mainly caused by
inadequate but more or less balanced diet deficient in both proteins and
calories.
•
Clinical
manifestations
•
Growth failure:
Weight is less than 60% of the expected
average for age.
•
Loss of subcutaneous fat:
old face appearance.
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Muscle wasting:
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General: anxious look,
irritable and have good appetite.
•
Associated infections:
UTI and Otitis Media
•
Micronutrient deficiency:
Iron deficiency anemia and vitamin A and D
deficiencies may be present.
•
Complications:
•
Complication of diarrhea as
dehydration and electrolyte disturbances.
•
Infections: infection in
Marasmus may have silent course with no fever.
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Hypoglycemia.
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Hypothermia.
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Mental sub normality.
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Prognosis
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Death rate: 1 – 2% of
those who is severely that will need admission.
•
Death occurs due to
dehydration or infections.
•
KWASHIORKOR
•
Kwashiorkor is a sever form
of PEM characterized by under weight between 60 – 80% of the expected average
for age and edema
•
It occurs mainly due to
provision of inadequate, unbalanced diet, deficient mainly in proteins and
consist mainly of carbohydrates
•
It usually develops in the
weaning and post-weaning period (The weanling dilemma)
•
Clinical manifestations
•
Under weight, weight
between 60 –80% of the average for age.
•
Edema. It is evident on the
feet, lower parts of legs and dorsum of the hands. The cheeks become bulky,
pale waxy in appearance.
•
Subcutaneous fat is
preserved.
•
There is generalized muscle
wasting.
•
General: Miserable look,
apathetic and not interested in the surroundings. There is anorexia and general
weakness .
•
MOON FACE.
•
Hair changes: Hair is
sparse, brittle and depigmented.
.
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SKIN DEPIGMENTATION.
•
ANAEMIA
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Complications:
•
Complications of diarrhea
as dehydration and electrolyte disturbances.
•
Infections.
•
Hypothermia.
•
Hypoglycemia
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Heart failure
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Marasmic Kwashiorkor
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Management
Initial Phase:
•
Involves resuscitation,
treatment of infection and correction of disordered metabolism. (electrolyte
imbalance, specific deficiencies, hypoglycemia, hypothermia, dehydration, heart
failure and shock)
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Bacterial infection must
treated with broad spectrum antibiotics.
•
supplements of vitamin A
and folic acid are also recommended.
•
Iron is contraindicated
because of its potential toxicity and aggravation of infection
•
Rehabilitation Phase
•
Increased appetite and
improvement of major abnormalities including loss of edema.
•
The principles of
management change to include feeding to appetite, stimulating emotional and
physical development and preparing for home
•
At this stage, the formula
feed is changed to one that provides more energy and protein for growth
•
supplementary iron is
necessary during this phase for new hemoglobin synthesis.
Follow-Up Phase commences
•
Home management, when the
child has reached –1 SD weight-for-length or height, equivalent to 90% of WHO
reference
•
Ideally, the child is recalled
or visited at increasing intervals for up to 3 years to ensure that recurrence
of malnutrition is prevented and that healthy physical and mental development
is promoted, supported and achieved.
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