PROTEIN ENERGY MALNUTRITION-ENGLISH
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PROTEIN
ENERGY MALNUTRITION-
•
Protein–energy
malnutrition (PEM), sometimes called protein-energy undernutrition
(PEU), is a form of malnutrition that is defined as a range of pathological
conditions arising from coincident lack of dietary protein and/or energy
(calories) in varying proportions. The condition has mild, moderate, and severe
degrees. PEM is of two types- Marasmus and Kwashiorkor.
MARASMUS-
•
Marasmus is a form of severe malnutrition
characterized by energy deficiency. It can occur in anyone with severe
malnutrition but usually occurs in children. Treatment of Marasmus is possible
but it can be life-threatening, if not treated.
CAUSES
OF MARASMUS-
•
Nutrient
deficiency is the main cause of marasmus. It occurs in children that don’t
ingest enough calories, carbohydrates,
and other important nutrients. This is usually due to-
•
poverty and a scarcity of food.
•
Insufficient
breast feeding.
•
Prolonged
feeding with dilated milk.
•
Chronic
infections (chronic TB, Respiratory infections and chronic worm infestations)
•
Congenital
disorders related to GIT.
•
Metabolic
disorders (Nutrients intolerance)
•
Chronic
diarrhoea and vomiting.
CLASSIFICATION
OF MARASMUS-
•
Grade
1- Loss of fat in axilla and groin.
•
Grade
2- Loss of fat from abdomen and spine +
grade 1.
•
Grade
3- Loss of fat from Chest and spine +
grade 1 & 2.
•
Grade
4- Loss of buckle fat + grade 1,2 and 3
SYMPTOMS
OF MARASMUS-
•
Weight
loss
•
Loose
skin
•
Chronic
diarrhea
•
Stomach
shrinkage
•
Fatigue
•
Bones
and joints becomes prominant
•
Difficulty
staying warm
•
Decreased
body temperature
•
Wrinkled
skin
•
Old
man appearance.
•
Less
active
•
Refusal
to eat.
DIAGNOSTIC
INVESTIGATIONS-
•
Physical
Examination
•
History
taking
•
Blood
investigations.
•
Measurement
of Height and weight
•
Nutritional
status assessment.
MANAGEMENT
OF MARASMUS-
•
Initial
treatment of marasmus often includes dried skim milk powder mixed with boiled
water. Later, the mixture can also include a vegetable oil such as sesame,
casein, and sugar. Casein is milk protein. The oil increases the energy content
and density of the mixture.
•
Once
a child starts to recover, they should have a more balanced diet that meets
their nutritional needs.
•
if
dehydration is a problem because of diarrhea, rehydration should also be a
priority. A child may not necessarily need fluids delivered intravenously. Oral
hydration may be sufficient.
•
Infections
are common among children with marasmus, so treatment with antibiotics or other
medications is standard. Treating infections and any other health issues can
help give them the best chance of recovery.
•
In
severe malnutrition with subnormal body temperature, provide warmth the baby by using warmer.
•
In
severe cases when the child refuses to eat they should be fed with nasogastric
tube.
•
Treatment
of associated problems such as worm infestations, fungal infections etc.
KWASHIORKOR-
•
Kwashiorkor is a form of severe protein
malnutrition characterized by edema and an enlarged liver with fatty
infiltrates. It is caused by sufficient calorie intake, but with insufficient
protein consumption. Kwashiorkor, also known as “edematous malnutrition”
because of its association with edema.
•
Most
people who are affected by kwashiorkor recover fully if they are treated
early. Children who develop kwashiorkor
may not grow or develop properly and may remain stunted for the rest of their
lives. There can be serious complications when treatment is delayed,
including coma, shock, and permanent mental and physical
disabilities. Kwashiorkor can be life-threatening if it’s left untreated. It
can cause major organ failure and eventually death
CAUSES
OF KWASHIORKOR-
•
Kwashiorkor
is caused by a lack of protein in the diet. Every cell in our body contains
protein. We need protein in your diet for your body to repair cells and make
new cells. If the body lacks protein, growth and normal body functions will
begin to shut down, and kwashiorkor may develop. Imbalance diet intake may be
due to poverty, ignorance or lack of awareness are causative factors of
kwashiorkor.
SYMPTOMS
OF KWASHIORKOR-
•
Change
in skin and hair color (to a rust color) and texture
•
Fatigue
•
Diarrhea
•
Loss
of muscle mass
•
Failure
to grow or gain weight
•
Edema
(swelling) of the ankles, feet, and belly.
•
Damaged
immune system, which can lead to more frequent and severe infections
•
Irritability
•
Erythema
of skin and hyper pigmentation
•
Enlargement
of liver (hepatomegaly)
•
Shock.
DIAGNOSTIC
INVESTIGATIONS-
•
Physical
Examination
•
History
taking
•
Blood
investigations.
•
Urine
Examination
•
Measurement
of Height and weight
MANAGEMENT
OF KWASHIORKOR-
•
The
management of kwashiorkor is stated with planned feeding. First of all thee
child is given carbohydrates , then
add in proteins, vitamins, and minerals. The reintroduction of food may
take a week or more to accomplish safely.
•
If
a child has been living without sufficient protein and nutrients for a long
time, they can find it difficult to take in food. It is, therefore, essential
to reintroduce food carefully to avoid refeeding syndrome.
•
•
Refeeding
syndrome involves life threatening electrolyte and fluid shifts that occur with
rapid refeeding of malnourished individuals.
•
Additionally, if a child’s condition is so
advanced that they are in shock, with low blood pressure and a high
heart rate, they may need to take medication to support their blood pressure.
•
In
severe cases blood transfusion may be required.
•
Infections
may be treated with the antibiotics.
•
Worm
infestations is treated with ant parasitic drugs.
•
Skin
rashes may need gentle skin cream and routine skin care to prevent further skin
breakdown.
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