Protein Energy Malnutrition Year 4 Paediatrics Notes

Protein Energy Malnutrition Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.3 / Munge / NUTRITION -- Slide 1 Protein Energy Malnutrition Dr Rose Munge Slide 2 Objective To gain a basic understanding of Protein energy malnutrition and its management Slide 3 Definition WHO defines malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.“\n Protein-energy malnutrition (PEM) applies to a group of related disorders that include marasmus, kwashiorkor and intermediate states of marasmus-kwashiorkor. Slide 4 Children with kwashiorkor have nutritional edema and metabolic disturbances, including hypoalbuminemia and hepatic steatosis\nMarasmus is characterized by severe wasting. Studies suggest that marasmus represents an adaptive response to starvation\nKwashiorkor represents a maladaptive response to starvation.\nChildren may also present with a mixed picture of marasmus and kwashiorkor or with milder forms of malnutrition. Slide 6 Aetiology Worldwide, the most common cause of malnutrition is inadequate food intake. Another significant factor is ineffective weaning secondary to ignorance, poor hygiene, economic factors, and cultural factors.\n The prognosis is worse when protein-energy malnutrition occurs with human immunodeficiency virus (HIV) infection. Slide 7 Gastrointestinal infections can precipitate clinical protein-energy malnutrition because of associated diarrhoea, anorexia, vomiting, increased metabolic needs, and decreased intestinal absorption.\nIn addition, parasitic infections play a major role in many parts of the world. Seen primarily in resource-limited countries.\nOverall, malnutrition has decreased worldwide, but the rates vary by region. Slide 8 Malnutrition can be classified as acute versus chronic. \nFeatures of chronic malnutrition include stunted growth, mental apathy, developmental delay, and poor weight gain. Acute malnutrition manifests in two major forms: marasumus (the most common form) and kwashiorkor Some patients' condition may manifest as a combination of both forms (marasmic kwashiorkor). Slide 9 Children with marasmus are often low weight-for-height and have a reduced mid-upper arm circumference, as well as a head that appears large relative to the rest of their body. \nOther findings include dry skin, thin hair, and irritability. \nKwashiorkor is characterized by peripheral pitting edema, as well as "moon facies," hepatomegaly, and a pursed mouth. Slide 10 Pathophysiology Marasmus occurs when there is an insufficient energy intake to match the body's requirements.\nThe body draws on its own stores, resulting in emaciation.\nIn kwashiorkor, adequate carbohydrate consumption and decreased protein intake lead to decreased synthesis of visceral proteins.\nThe resulting hypoalbuminemia contributes to extravascular fluid accumulation. Impaired synthesis of B-lipoprotein produces a fatty liver. Slide 11 Pathophysiology cont. Protein-energy malnutrition also involves an inadequate intake of many essential nutrients.\nLow serum levels of zinc have been implicated as the cause of skin ulceration in many patients Serum zinc levels correlated closely with the presence of edema, stunted growth, and severe wasting.\nThe classic "mosaic skin" and "flaky paint" dermatosis of kwashiorkor bears considerable resemblance to the skin changes of acrodermatitis enteropathica, the dermatosis of zinc deficiency Slide 12 Marasmus and kwashiorkor can both be associated with impaired glucose clearance that relates to dysfunction of pancreatic beta-cells. Slide 13 Pathophysiology Marasmus most commonly occurs in children younger than 5 years. This period is characterized by increased energy requirements and increased susceptibility to viral and bacterial infections.\nWeaning occurs during this high-risk period and is often complicated by geography, economy, hygiene, public health, culture, and dietetics.\nIt can be ineffective when the foods introduced provide inadequate nutrients, when the food and water are contaminated, when the access to health care is inadequate, and/or when the patient cannot access or purchase proper nourishment. Slide 14 Clinical Presentation Obtain a detailed dietary history, growth measurements, body mass index (BMI), as well as perform a complete physical examination. Low intake of calories or an inability to absorb calories is the key factor in the development of kwashiorkor.\n In children, the findings of poor weight gain or weight loss; slowing of linear growth; and behavioral changes, such as irritability, apathy, decreased social responsiveness, anxiety, and attention deficit may indicate protein-energy malnutrition.\nIn particular, the child is apathetic when undisturbed but irritable when picked up. Slide 15 Patients with protein-energy malnutrition can also present with nonhealing wounds.\nThis may signify a catabolic process that requires n