incidence,clinical features, management

1. MALNUTRITION
DR SHAMBHAVI SHARMA

2. WHO defines
Malnutrition as "the cellular imbalance between
the supply of nutrients and energy and the
bodys demand for them to ensure growth,
maintenance, and specific functions.“
Malnutrition is the condition that develops
when the body does not get the right amount
of the vitamins, minerals, and other nutrients
it needs to maintain healthy tissues and organ
function.

3. PROTEIN ENERGY MALNUTRITION
It is a group of body depletion disorders which
include:
• kwashiorkor,
• marasmus
• marasmic kwashiorkor

4. MARASMUS
• Represents simple starvation . The body
adapts to a chronic state of insufficient caloric
intake.
KWASHIORKOR
• is the body’s response to insufficient protein
intake but usually sufficient calories for
energy

5. AETIOLOGY:
 Social and Economic Factors: poor knowledge about
weaning and f
eeding,poverty,malpractices,inavailability of
food,lack of birth spacing
 Biological factors (disease): acute:
diarrhea,pneumonia,fever,worm infestation
Chronic: heart diseases ,
asthma,malabsorption
 Environmental factors: improper sanitation and poor
food hygiene
 Role of Free Radicals & Aflatoxin

7. Clinical features
The clinical presentation depends upon the
type, severity and duration of the dietary
deficiencies. Thefive forms of PEM are
: 1. Kwashiorkor
2. Marasmic-kwashiorkor
3. Marasmus
4. Nutritional dwarfing
5. Underweight child

8. Assessment
History:
• nutritional,developemntal,present or past acute
or chronic illness,socioeconomic status,family
history
Examination:
• anthropometry: height weight mid upper arm
circumference, skin fold thickness qnd charting in
growth chart
• Signs of acute or chronic ilnesses:
anemia,clubbing.jaundice,crepts in
chest,abdomen tenderness

9. KWASHIORKOR

21. Management
• Awareness of malnutrition as a problem
• Assessment of nutritional status
Anthropometry, Clinical examination, Dietary
history, Socioeconomic history
• Identify the type of malnutrition
• Detect the associated deficiencies and
complications
• Decides on the treatment plan

22. Management plan
Type Principle Method Place
Mild Provision of adequate diet to fulfill
the needed energy, protein and
micronutrients
Nutrition counseling
(NC) including
demonstration,
supervised feeding and
food supplementation if
needed
Home with support
from mother’s group,
SHP, Nutrition Rehab
Center
Moderate As above plus: identification and
treatment of underlying infectious
illness and MND
NC as above plus
feeding during illness
Home with support
from institutions in the
vicinity
Severe Resuscitation to prevent deaths
from complications
Dietary therapy
Treatment of underlying diseases
and MND
Medical management
of complications,
treatment of infections
and MND
NRC or hospital in
presence of
complications or OTP in
the absence of
complications

23. Severe malnutrition

24. 1.Prevention and treatment of life
threatening complications
Complications Action
Hypoglycemia (Blood sugar < 50 mg/dl) Immediate feeding with 10% glucose, IV glucose if
unconscious
Frequent feeding
Keep warm, start antibiotics
Hypothermia Keep warm with blankets, heater, feed frequently,
start antibiotics
Dehydration Give ReSoMal fluid orally or by NG tube slowly
Electrolyte imbalance Give extra potassium and magnesium
Infection If without complications Cotrimoxazole, If with
complications: Amoxicillin plus gentamicin, if fails
to improve within 48 hrs; add Chloramphenicol
Micronutrient deficiency Multivitamin Supplement plus zinc, copper; once
starts gaining weight add iron, Vit A

25. Associated conditions
Associated conditions Treatment
Eye problems: xerophthalmia Vitamin A on days 1, 2 and 14
Chloramphenicol or tetracycline eye dropsX4
times daily for 7-10 days
Instil atropine eye drops 1 dropX3 tid for 3-5
days
Cover with saline soaked eye pads
Bandage the eyes
Severe anemia Whole or packed cell blood transfusion if Hb
< 4 gms or 4-6 gms/dl with respiratory
distress, slowly, monitor frequently for
overload, give furosemide
Skin lesions Soak the area in KMnO4 Sol, apply zinc and
casto oil ointment
Continuing diarrhea Metronidazole
Lactose replacement, use lower osmolar
feeding formula
Tuberculosis Mantoux test, CXR: if positive treat
according to NTP

26. 2. Dietary management
• Start with feeds: F100
F75
These have fixed amount of callories and
proteins

27. 3. Nutritional and social rehabilitation
• Sensory stimulation: Provide tender loving
care, play therapy for 15-30 minutes a day,
physical activity as soon as the child is well
enough
• Maternal involvement in preparing the feeds,
taking care of the child, keeping the child
warm and in sensory stimulation
• Provide suitable toys in the ward

29. • Thank you