This document discusses malnutritional disorders in infants and children. It describes kwashiorkor and marasmus as the two main types of protein-energy malnutrition. Kwashiorkor mainly affects children aged 1-3 years and is characterized by edema, skin changes, fatty liver and hypoalbuminemia. Marasmus mainly affects children under 1 year of age and results in severe wasting and loss of muscle mass. The management of severe malnutrition involves immediate resuscitation, restoration of weight and nutritional rehabilitation over several weeks.
2. INTRODUCTION
Malnutrition is the cellular imbalance
between supply of nutrition and
energy and the bodyโs demand for
both of them to ensure normal
growth, maintenance and specific
tissue function
also K/A
โPROTEIN ENERGY MALNUTRITIONโ
P/B:- DR NIYATI PATEL 2
8. INTRODUCTION
๏ต MARASMUS โ EXTREME WASTING
๏ต CHILD IS ACTIVE, ALERT, GOOD APPETITE LATER
BECOMES IRRITABLE
๏ต WASTING - CHILD BECOMES SKIN & BONE, MAY
LEADS TO OLD MAN APPEARANCE DUE TO LOSS
OF BUCCAL PAD OF FAT
๏ต GRADING OF MARASMUS
๏ต GRADE 1 โLOOSE SKIN FOLDS IN AXILLA & GROIN
๏ต GRADE 2- BUTTOCKS AND THIGH WASTED
๏ต GRADE 3- CHEST & ABDOMEN WASTED
๏ต GRADE 4- BUCCAL PAD OF FAT WASTED
P/B:- DR NIYATI PATEL 8
9. PATHOLOGY
๏ต LACK OF ALL NUTRIENTS STIMULATES CORTISONE
SECRETION WHICH RESULT IN MUSCLE WASTING,
THE RELEASED A ๏ A WILL SYNTHESIZE ALBUMIN
TO PREVENT EDEMA
๏ต ADEQUATE RESPONSE OF ADRENAL CORTEX ๏
INCREASE IN PLASMA CORTISOL ๏
๏ต 1.PLASMA FREE FATTY ACID NORMAL๏ NO FAT
DEPOSITS IN LIVER
๏ต 2. GROWTH HORMONE DECREASED ๏ SEVERE
GROWTH RETARDATION
P/B:- DR NIYATI PATEL 9
10. CLINICAL FEATURES
๏ต PRONOUNCED WEIGHT LOSS WITH LOSS OF
MUSCLE FORMATION, PARTICULARLY ON
THE SHOULDERS AND GLUTEAL REGIONS
๏ต ABSENCE OF FAT UNDER THE SKIN
๏ต THIN, PAPERY SKIN WITH HANGING FOLDS
๏ต DARKEN SKIN, AS IF THE CHILD HAS A
SUNBURN
๏ต HAIR LOSS
P/B:- DR NIYATI PATEL 10
11. KWASHIORKOR MARASMUS
AGE 1-3 YEARS AGE <1 YEAR
APPETITE POOR APPETITE GOOD
LITTLE WASTING SEVERE WASTING
OEDEMA NO OEDEMA
SUBCUTANEOUS FAT PRESENT SUBCUTANEOUS FAT MINIMAL
DERMATOSIS NOT SEEN SKIN CHANGES
SERUM ALBUMIN LOW SERUM ALBUMIN NEAR
NORMAL
ANEMIA COMMON ANEMIA NOT PRESESNT
ENLARGED FATTY LIVER LIVER NORMAL
HIGH PREVALENCE OF
INFECTION
P/B:- DR NIYATI PATEL 11
12. Marasmic kwashiorkor
๏ต SOMETIMES AN INFANT OR YOUNG CHILD
PRESENTS WITH FEATURES OF BOTH
MARASMUS AND KWASHIORKOR (OEDEMA
WITH SEVERE MUSCLE WASTING).
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14. Immediate treatment
๏ 1. Resuscitation(1st phase) โ Correction of
fluid and electrolyte disturbances, such as
acidosis, hypoglycemia and hypothermia
and treatment of localized or generalized
infections (e.g. bronchopneumonia,
septicaemia).
o In kwashiorkor, an acute diarrhoeal illness
often compounds. Chronic infections,
such as tuberculosis and chest infections
are common.
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15. ๏ต 2. Restoration (2nd phase) โ to restore weight for
height
๏ต Stabilization โ Correction of hypoglycemia,
dehydration (glucose 25% IV 4 mL/kg bolus) and
fluid and electrolyte imbalances (e.g. potassium
chloride 4โ5mEq/kg/day).
๏ต Hypothermia - dealt with wrapping blankets,
radiant warmers to maintain rectal temperature at
37ยบC
๏ต Refeeding must be initiated gradually. Overfeeding
may also provoke acute liver failure. A suitable
regimen provides 80 kcal/kg body wt./day and 0.7
g protein/kg body wt/day
๏ต Banana, rice and dal, vegetable oil for calories.
๏ต Egg as a flip with milk and water is a good source of first
class protein.
๏ต Dal, rice and buttermilk can be given if lactose
intolerance.
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16. ๏ต 3. Nutritional rehabilitation follows when
the oedema has resolved and the child
has recovered clinically, has a good
appetite and begins to gain weight. This
may take several weeks
P/B:- DR NIYATI PATEL 16
