Nutritional Disorders Presentation PDF

UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 1 § Nutrition disorders are disorders caused by nutritional imbalance, either over nutrition (nutritional excesses) or under nutrition (nutritional deficits). § Deficit in nutritional intake ca...

UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 1 § Nutrition disorders are disorders caused by nutritional imbalance, either over nutrition (nutritional excesses) or under nutrition (nutritional deficits). § Deficit in nutritional intake can result in I. stunted growth, II. reduced metabolic function, III. delayed or premature cessation of reproductive function and IV. increased risk for less serious illnesses. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 2  Mechanism of homeostasis  Three classic deficiency diseases are; I. scurvy, II. beriberi and III. pellagra. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 3  It is a disease resulting from a deficiency of vitamin C  Vitamin C is required for the synthesis of chollagen  The condition mostly occurs in infants of 6 – 24 months of age.  Clinical Manifestation I. Loss of appetite, II. delayed wound healing, III. tachypnoea, IV. digestive disturbances, V. growth cessation, VI. malaise, VII. irritability, VIII. bleeding gums UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 4 UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 5 Management  Daily administration of vitamin C 100-500mg should be given orally or parenterally.  If there is anaemia, haematinics such as folic acid, fersolate should be given.  Advise the patient to eat diet rich in vitamin C such as the citrus fruits, tomato juice and other vegetables. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 6  Breastfeeding protects against vitamin C deficiency throughout infancy.  In children consuming milk formula, fortification with vitamin C must be ensured.  Children consuming heat treated milk should consume adequate vitamin C rich foods in infancy.  Dietary or medicinal supplements are required in severely malnourished children, and chronic debilitating conditions such as malignancies and neurologic disorders. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 7  it is a disease caused by a deficiency of thiamin (vitamin B1) that affects many systems of the body, including I. the muscles, II. heart, nerves, and III. digestive system.  Thiamin (B1) is required for the synthesis of acetylcholine. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 8 Clinical manifestations  Early manifestations of the deficiency include I. fatigue, II. apathy, III. irritability, IV. depression, V. drowsiness, VI. poor mental concentration, VII. anorexia, VIII. nausea, and IX. abdominal discomfort. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 9  Signs of progression include I. peripheral neuritis with tingling, II. burning and Paresthesias of toes and feet, III. decrease tendon reflexes, IV. loss of vibration sense, V. tenderness and cramping of leg muscles, VI. congestive heart failure and VII. psychic disturbances. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 10  Later signs of I. increase intracranial pressure, II. meningismus and III. coma occur.  Types of beriberi I. Wet beriberi and II. Dry beriberi UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 11  Wet beriberi occurs in thiamin deficiency accompanied by severe physical exertion and high carbohydrate intake.  Dry beriberi occurs in thiamin deficiency accompanied by inactivity and low calorie intake. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 12 Management  Thiamin (B1) deficiency is treatment with large parenteral doses of thiamin chloride 50- 100mg/day is administered for the first few days followed by daily oral doses of 5-10mg/day.  All patients should simultaneously receive therapeutic doses of other vitamins of B complex, in addition to the large doses of thiamin chloride. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 13  It is a medical condition that occurs in advance deficiency of niacin and it affects all tissues of the body. Clinical Manifestation  The early symptoms of pellagra are vague. I. Anorexia, II. lassitude, III. weakness, IV. burning sensations, V. numbness and VI. dizziness. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 14  A long period of niacin deficiency results in the classic triad of pellagra which consists of the 3 Ds I. Dermatitis II. Diarrhoea III. Dementia UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 15 UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 16 Management  Niacin deficiency can be effectively treated with oral niacin, usually given as Nicotinamide.  A liberal and well balanced diet should be supplemented with doses ranging from 50 - 300 mg/day.  100 mg may be given intravenously in severe cases or in cases of poor intestinal absorption.  Patient diet should be supplemented with other vitamins especially with other members of the B complex. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 17  Sun exposure should be avoided during the active phase,  the skin lesions may be covered with soothing applications.  In severe anaemia, blood transfusion should be given.  Iron therapy should be given parenterally or orally in mild hypochromic anaemia. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 18  It occurs as a result of vitamin A deficiency.  Vitamin A deficiency is usually due to fat malabsorption syndromes such as I. celiac disease and II. chronic intestinal disorders.  The condition can also result from I. iron deficiency, II. hepatic and pancreatic diseases and III. chronic ingestion of mineral oil. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 19 UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 20  It occurs most between 2 – 3 years of age and urban poor. Clinical manifestation I. In the initial stage, the posterior segment of the eye is affected, with impaired of dark adaption resulting in night blindness. II. As the condition progresses, the patient may develop; a. Dryness of the conjunctiva (xerosis), b. the development of dry, silver-gray plagues or small white patches appear on the bulbar conjunctiva (bitot sports), UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 21 c. ulceration and necrosis of the cornea (keratomalacia), d. perforation, e. endophthalmitis, f. hyperkeratinization of the skin, g. photophobia and h. loss of taste UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 22 Management  Give 1,500 µg/kg/24 hours should be given orally for 5 days and then continued with intramuscular injection of 7,500 µg of vitamin A in oil daily until recovery occurs.  Advanced deficiency with corneal damage calls for administration of 20,000 ІU/kg body weight for at least 5 days. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 23  It is a defective mineralization of the growing bone or osteoid tissue in childhood causing permanent bone deformities. Causes: deficiency in vitamin D, calcium and phosphorus. Clinical manifestation  In the early stages; I. craniotabes, II. thickening of the wrist and ankles, III. increased sweating, particularly around the head. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 24 UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 25  In advance stages: I. Eruption of the temporary teeth may be delayed II. There may be defective enamel III. Alopecia IV. Protruding chest V. Scoliosis VI. Kyphosis and Lordosis UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 26 Management  Natural and artificial light are effective therapeutically, but oral administration of vitamin D is preferred.  The daily administration of 50 - 150 µg of vitamin D3 or 0.5-2 µg doses of calcitriol will produce healing.  Exposure the skin of the patient to sunlight daily.  Diet rich in vitamin D should be given to the patient. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 27  Protein energy malnutrition has been described as two distinct syndromes. They are I. Kwashiorkor II. Marasmus v Kwashiorkor is a clinical syndrome that results from a severe deficiency of protein in the presence of adequate energy intake. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 28  Marasmus (infantile atrophy) is a clinical syndrome which originates from an inadequate caloric and protein intake. Clinical Manifestations of Kwashiorkor Early clinical evidence of PEM is vague but does include; § Lethargy § Misery, sadness, apathy, or irritability UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 29 In the advanced stage there is; §Swollen belly §Loss of muscular tone §Lack of stamina §Generalised oedema §Loss of appetite §Flabbiness of subcutaneous tissues, muscle tissues become thin and atrophic UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 30 § The skin becomes patchy and scaly/ flaky paint dermatitis § The colour of the hair changes to brownish red, sparse, thin and becomes straight. The hair also becomes dry and brittle and it is easily pulled out. § There is liver enlargement UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 31 § There is failure to gain weight which may be masked by oedema. § Infections and parasitic infestations such as vomiting and continued diarrhoea are common. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 32  Muscles wasting including the heart muscle  Brain development is stunted and learning is impaired  The body temperature becomes subnormal because metabolism is slow  There is failure to gain weight, followed by severe weight loss  The child has normal appetite UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 33  With loss of turgor, the skin becomes thin, dry and wrinkle with loss of subcutaneous fat  The face becomes shrunken and wizened  The patient looks anxious and apathetic UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 34  The treatment of severe protein energy malnutrition is a slow process requiring great care.  In initial stage, fluid and electrolyte abnormalities and infections will be treated.  More attention will be on replacement of K, Mg, and Ca since they were depleted from the body and folic acid and iron are usually used to correct the anaemia. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 35  The second phase of management will be the replacement of protein, energy and micronutrients.  Treatment is started with modest quantities of protein and calories (F-75) calculated according to the patient’s actual body weight, vitamins and minerals are also added.  Treatment is gradual; this is to prevent the condition from worsening. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 36  For severe dehydration, intravenous fluids are given for instance half-strength ringer lactate solution.  Rehydrated solution for malnutrition (ResoMal) is also given to patient who can tolerate oral feeds.  Effective antibiotics should be given parenterally for 5 - 10 days. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 37  For mild to moderate dehydration fluids (ResoMal) are administered orally or nasogastric tube.  When the dehydration is corrected, start oral feed with small, frequent feeds of diluted milk (F-75).  The strength and volume are gradually increased and frequency decreased over the next 5 days. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 38  By the 6-8 day, the child should receive 150ml/kg/day in 6 feeds.  In the recovery period, high-energy feeds (F-100) made with skim milk, vegetable oil, sugar, casein hydrolysates or synthetic amino acid mixture should be used to supplement the basic fluid and nutritional regimen. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 39  Celiac disease is a permanent intestinal intolerance to gliadin.  Cereals, wheat, rye and barley are toxic for patients with celiac disease.  Most symptoms are commonly seen in infants between 6 – 24 months of age after the introduction of weaning foods.  Cause: the actual cause is unknown UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 40 Clinical Manifestations The signs and symptoms of celiac disease depend upon the length if small intestine involved and the age at which the patient presents. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 41 Infants below 2 years are more likely to present with typical symptoms of malabsorption including: I. Chronic diarrhoea; loose to soft, large, floating, oily or greasy and foul smelling stools (steatorrhoea), II. Weight loss, III. Abdominal distension, IV. Weakness, V. Muscle wasting or growth retardation. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 42  In children (above 2 years): I. Chronic diarrhoea II. Dyspepsia or flatulence due to colonic bacterial digestion of malabsorbed nutrients, III. There may be weight loss, IV. Fatigue, V. Short stature UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 43  In severe cases: I. there will be loss of muscle mass or subcutaneous fat, II. pallor due to anaemia, III. excessive bruising due to vitamin K deficiency, IV. hyperkeratosis due to vitamin A deficiency, V. bone pain due to Osteomalacia, VI. peripheral neuropathy and ataxia due to vitamin B12 or E deficiency. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 44 Management  Patients should be given or encouraged to take rice, soybean, potato and corn flour.  Dietary supplements; folate, iron calcium and vitamin A, B12, D and E should be provided in the initial stages of therapy. UNIVERSITY OF ENERGY AND NATURAL RESOURCES 1/30/2021 45