Nutritional Disorders PDF

NUTRITIONAL DISORDERS MED 7710 CHILDREN’S HEALTH ELEUS J, FAJARDO, M.D., MHA FPPS, FPPSAP  OBJECTIVES 1.Differentiate the cause, characteristics and pathophysiology of the different kinds of , ,enutritional disorder. ...

NUTRITIONAL DISORDERS MED 7710 CHILDREN’S HEALTH ELEUS J, FAJARDO, M.D., MHA FPPS, FPPSAP  OBJECTIVES 1.Differentiate the cause, characteristics and pathophysiology of the different kinds of , ,enutritional disorder.  PROTEIN-ENERGY UNDERNUTRITION * Previously called protein-energy malnutrition *% It is an energy deficit due to chronic deficiency of all macronutrients. + It can commonly include deficiencies of micronutrients, ) (Severity ranges from subclinical deficiencies t. Vim Obv ious wasting, to starvation Tie, Fall ae ite aR Pi: Ae la + bi Hhyi! sari) yh J Li  CLASSIFICATION 1. Primary - caused by inadequate nutrient intake 1.1. Kwashiorkor 1.2. Marasmus 2. Secondary - results from disorders or drugs that interfere with nutrient use  RASMUS Also called the dry form of PEU It is characterised by weight loss and depletion of fat and muscle. It is the most common form of PEU in developing countries rit, Fayy. nn sY, who are involved are much older “ey  KWASHIORKO * Also called wet, swollen or oedematous form * Found mostly in children who were breastfed for a short period of time * Tends to be older than marasmus 8 It may result from acute illnesses or infection (\ ‘probably due to cytokine release in a child who nas 4 Be PEU. at Atis more often caused by less protein than enetay. iy 4 iit  %* Cell-mediated immunity is impaired in both marasmus and kwashiorkor, increasing susceptibility to infections * Infections in these infants result in release of cytokines which causes anorexia, worsen muscle. wasting and causing a marked decrease in serum ( i «albumin levels ) tBy ay eo gie. Ws rvation is a complete lack of nutrients and NN Toi, ay occur even when food is available om, ~- fanorexta) or wren there is lack of it (paring iy  CAUSES OF SECONDARY PEU Commonly results from: 1, Disorders that affect the Gi function either through;* 1,1, conditions that interfere with digestion A 1.2, conditions that interfere with absorption arn 1.3, conditions that interfere with lymphatic D “©, » _ transport of nutrients J V2 Wasting disorders : AeA, Renal failure Ss - (2,2. End-stage heart failure a és fi 3 e Gon itions that mmcrease metabolic demas AN ge } i ie ! | Wh 1 m, { ] rh Wi hi i if } ay i " j f a ai be A 4 nt i fie ) ae " J f i ea ja 1 es rm " q ; 1 + Baa F  PATHOPHYSIOLOGY A. In children with PEU, the initial metabolic responses is decrease metabolic rate B. To supply energy, the body first breaks down adipose tissue C, Later, adipose becomes deleted and the body uses protein for energy resulting in negative y nitrogen balance \ WD. visceral haha’ and muscle are broken down and \ ps as the liver are the hearband, diy  YMPTO D SIGNS OF MARASMUS @ Marasmus causes: 1.Hunger 2. Weight loss 3. Growth retardation 4, Wasting of subcutaneous fat and muscle —__§, Ribs and facial bones appear prominent _f, §, Loose, thin skin hangs in folds a?) fyapoms & Signs of Marasmus  SIGNS AND SYMPTOMS OF KWASHIORKOR It is characterised by peripheral and periorbital edema due to decrease in serum albumin * Abdomen protrudes because the abdominal muscles are weakened, the intestine is distended, the liver is enlarge and ascites is present % Skin is dry, thin and wrinkled with hyper pigmentation and is fissured of ny Skin later becomes hypo pigmented, friable and atrophic Fae ! Hair becomes thin, reddish brown or gray with the scal p (> hair. falling out easily, becoming sparse NOW | Seeteyelash hair may grow excessively iat : KE Alter oil episodes of undernutrition and adequate’) | nuthi my cause the hair to have a dratese NYG  GROWT FAILURE APARTHY IRRITABILITY HAIR CHANGES 1 ANEMIA FATTY LIVER VILLOUS ATROPHY OF SMALL INTESTINE -).) DEPIGMENTATION | OOF SKIN DERMATOSES EDEMA (HYPERALBUMINEMIA) | G2 >  DIAGNOSIS OF PEU * Based on history % Tocheck for severity: 1. BMI 2. Serum albumin 3. Total lymphocyte count 4, CD4+ count 5, To diagnose complications and consequences:  PHYSICAL E ATION 1. Measurement of height and weight 2. Inspection of body fat distribution 3. Anthropometric measurements of lean body mass LABORATORY TESTS «Required if dietary history does not clearly indicate ae inadequate caloric intake f 1... Measurement of serum albumin he Total lymphocyte count By,» CD4+ lymphocytes ‘Ac. Transferrin bX] se to skin antigens — dy. s vilMeg de termine the candty of Rev or fit iy if F , hy y " ee Flin Wedé i i H Bi th, A i flit Wee 5 | iit i A We F ii: Pal a /1 gy il j i 1 Nf i } iy Values Commonly Used to Grade the Severity of Protein nergy Underrsariion Nov rsal weight (4) 9-110 85-40 13-45 «7S ody remind eG abs) eta) |e