Podcast
Questions and Answers
What is the primary cause of primary acute malnutrition in children?
What is the primary cause of primary acute malnutrition in children?
- Inadequate food supply (correct)
- High metabolic rate
- Chronic diseases
- Genetic disorders
Which of the following factors is NOT a contributor to primary acute malnutrition?
Which of the following factors is NOT a contributor to primary acute malnutrition?
- Chronic liver disease (correct)
- Household food insecurity
- Poor breastfeeding practices
- Low birth weight
What physiological adaptation occurs due to inadequate energy intake in acute malnutrition?
What physiological adaptation occurs due to inadequate energy intake in acute malnutrition?
- Enhanced muscle growth
- Increased basal metabolic rate
- Loss of visceral mass (correct)
- Increased total energy expenditure
Which hormone is typically found at reduced levels during acute malnutrition?
Which hormone is typically found at reduced levels during acute malnutrition?
What condition is associated with poor water quality and hygiene practices contributing to acute malnutrition?
What condition is associated with poor water quality and hygiene practices contributing to acute malnutrition?
In the context of secondary acute malnutrition, what is the most common underlying cause?
In the context of secondary acute malnutrition, what is the most common underlying cause?
What are the initial effects of acute malnutrition on glucose levels?
What are the initial effects of acute malnutrition on glucose levels?
Which process is involved in the protein conservation phase of malnutrition?
Which process is involved in the protein conservation phase of malnutrition?
What characterizes the brain changes associated with acute malnutrition?
What characterizes the brain changes associated with acute malnutrition?
Which of the following signs is NOT commonly associated with marasmus?
Which of the following signs is NOT commonly associated with marasmus?
Kwashiorkor is primarily attributed to a deficiency in which of the following?
Kwashiorkor is primarily attributed to a deficiency in which of the following?
What is a common physiological effect of acute malnutrition on children?
What is a common physiological effect of acute malnutrition on children?
At what age are the effects of malnutrition on brain development potentially irreversible?
At what age are the effects of malnutrition on brain development potentially irreversible?
Which of the following describes a significant indicator of severe malnutrition in children?
Which of the following describes a significant indicator of severe malnutrition in children?
What differentiates marasmus from kwashiorkor in terms of nutrient deficiency?
What differentiates marasmus from kwashiorkor in terms of nutrient deficiency?
Which of the following symptoms is typical for children affected by marasmus?
Which of the following symptoms is typical for children affected by marasmus?
What is the primary clinical feature that distinguishes kwashiorkor from marasmus?
What is the primary clinical feature that distinguishes kwashiorkor from marasmus?
In which demographic is kwashiorkor most commonly found?
In which demographic is kwashiorkor most commonly found?
What is a common skin manifestation associated with kwashiorkor?
What is a common skin manifestation associated with kwashiorkor?
Which of the following is a significant laboratory indicator used in the assessment of malnutrition?
Which of the following is a significant laboratory indicator used in the assessment of malnutrition?
What characterizes marasmic kwashiorkor?
What characterizes marasmic kwashiorkor?
Which dietary components are most commonly associated with the development of kwashiorkor?
Which dietary components are most commonly associated with the development of kwashiorkor?
During the assessment of malnutrition, what is the role of biochemical analysis?
During the assessment of malnutrition, what is the role of biochemical analysis?
What is the grading scale for edema in kwashiorkor characterized by?
What is the grading scale for edema in kwashiorkor characterized by?
What is the recommended management for children with primary moderate acute malnutrition?
What is the recommended management for children with primary moderate acute malnutrition?
What should be included in the diet for children with primary acute malnutrition?
What should be included in the diet for children with primary acute malnutrition?
In cases of severe acute malnutrition without complications, where is the recommended place for management?
In cases of severe acute malnutrition without complications, where is the recommended place for management?
Which symptom may indicate the need for hospitalization in a child with severe acute malnutrition?
Which symptom may indicate the need for hospitalization in a child with severe acute malnutrition?
What initial treatment is recommended for hypoglycemia in a lethargic child?
What initial treatment is recommended for hypoglycemia in a lethargic child?
What rehydration method is preferred for treating dehydration in malnourished children?
What rehydration method is preferred for treating dehydration in malnourished children?
Which antibiotic is suggested initially for a child with no complications of severe acute malnutrition?
Which antibiotic is suggested initially for a child with no complications of severe acute malnutrition?
How should severe acute malnutrition with complications be treated?
How should severe acute malnutrition with complications be treated?
What is the purpose of introducing carefully monitored feeding in a child after admission?
What is the purpose of introducing carefully monitored feeding in a child after admission?
Which formula is recommended for initial feeding in children admitted for malnutrition?
Which formula is recommended for initial feeding in children admitted for malnutrition?
What is a potential risk when preterm or low-birth-weight infants are given aggressive enteral feeding?
What is a potential risk when preterm or low-birth-weight infants are given aggressive enteral feeding?
In the management of chronic liver disease, which dietary consideration is essential?
In the management of chronic liver disease, which dietary consideration is essential?
What is a characteristic of children with congenital heart disease in terms of their nutritional needs?
What is a characteristic of children with congenital heart disease in terms of their nutritional needs?
What type of dietary fat is recommended for children with chronic liver disease to aid absorption?
What type of dietary fat is recommended for children with chronic liver disease to aid absorption?
How does cachexia occur in children with cancer?
How does cachexia occur in children with cancer?
What is a key investigative step in managing secondary acute malnutrition?
What is a key investigative step in managing secondary acute malnutrition?
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Study Notes
Acute Malnutrition in Children
- Primary Acute Malnutrition:
- Caused by inadequate food supply due to socioeconomic, political, and environmental factors.
- Most common in low and middle-income countries.
- Contributing factors: household food insecurity, poverty, poor maternal nutrition, low birth weight, inadequate breastfeeding and complementary feeding, frequent infections, poor water, sanitation, and hygiene.
- Secondary Acute Malnutrition:
- Due to abnormal nutrient loss, increased energy expenditure, or decreased food intake.
- Frequently associated with chronic diseases like cystic fibrosis, chronic renal failure, chronic liver diseases, childhood malignancies, congenital heart disease, and neuromuscular diseases.
Pathophysiology of Acute Malnutrition
- Physiological Adaptations:
- Growth restriction, loss of body mass (fat, muscle, visceral), reduced basal metabolic rate, and reduced energy expenditure.
- Biochemical Changes:
- Changes in thyroid hormones, insulin, and growth hormone (GH).
- Decreased levels of tri-iodothyroxine (T3), insulin, and insulin-like growth factor-1 (IGF-1).
- Increased levels of GH and cortisol.
- Initial low glucose levels, followed by rapid gluconeogenesis and protein conservation with fat mobilization.
- Electrolyte changes: sodium retention and intracellular potassium depletion.
- Brain Development:
- Reduced number of neurons, synapses, dendritic arborizations, and myelination.
- Decreased brain size and cerebral cortex thinning.
- Delays in global function, motor function, and memory.
- Effects on brain development may be irreversible after age 3-4 years.
Clinical Syndromes of Acute Malnutrition
- Marasmus:
- Most frequent syndrome.
- Results from severe energy and nutrient deficiency over months to years.
- Characterized by wasting of body tissues, especially muscles and subcutaneous fat.
- Common in children under 5 years old due to higher caloric needs and infection susceptibility.
- Clinical signs: emaciation, weakness, lethargy, bradycardia, hypotension, hypothermia, xerotic wrinkled skin, and muscle wasting.
- Severe cases may involve facial muscle wasting, leading to an aged appearance.
- Kwashiorkor:
- Thought to result from inadequate protein but relatively normal calorie intake.
- Common in developing countries, particularly areas of famine or limited food supply.
- Characterized by edema (swelling) due to low serum albumin, increased cortisol, and impaired antidiuretic hormone activation.
- Clinical features: near-normal weight for age, dermatoses, hypopigmented hair, distended abdomen, hepatomegaly, and edema progression.
- Marasmic Kwashiorkor:
- Mixed features of marasmus and kwashiorkor.
- Wasting and edema are present.
- Mild cutaneous and hair manifestations.
- Enlarged palpable fatty liver is common.
Management of Acute Malnutrition
- Assessment:
- Nutritional Screening: Malnutrition Universal Screening Tool (MUST) or Mini Nutritional Assessment tool.
- Clinical Evaluation: detailed history taking and physical examination.
- Biochemical Analysis: blood tests for albumin, prealbumin, electrolytes, and other markers.
- Therapeutic Recommendations:
- Primary Acute Malnutrition:
- Moderate: home management, counseling, continued breastfeeding, and appropriate complementary feeding.
- Severe without complications: ready-to-use therapeutic food (RUTF), following WHO recommendations.
- Severe with complications: hospitalization, RUTF, and management of complications (hypoglycemia, hypothermia, shock, dehydration, infection).
- Secondary Acute Malnutrition:
- Identification of underlying disease is crucial.
- Individualized dietary approaches based on underlying disease:
- Preterm and low-birth-weight infants: exclusive breastfeeding for 6 months with iron supplementation.
- Mild inflammatory bowel disease: normal diet or specially prepared liquid formulas.
- Advanced chronic liver disease: protein-sparing diet, medium-chain triglycerides, and water-soluble vitamins.
- Chronic renal disease: high-energy and high-quality protein diet.
- Congenital heart disease: sufficient energy and protein without excessive fluid.
- Cancer: manage cachexia (muscle wasting syndrome).
- Primary Acute Malnutrition:
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