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Pem Final

1) Protein-energy malnutrition (PEM), commonly known as marasmus or kwashiorkor, is caused by inadequate protein and calorie intake and can range from mild to severe forms. 2) Kwashiorkor is characterized by edema and results from insufficient protein intake despite adequate calories. Marasmus is caused by lack of all nutrients and presents as wasting without edema. 3) Treatment involves rehydration, feeding by nasogastric tube or orally, correcting micronutrient deficiencies, managing infections, and educating caregivers to prevent recurrence. Complications can include infection, hypoglycemia, heart failure, and developmental delays.

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61 views

Pem Final

1) Protein-energy malnutrition (PEM), commonly known as marasmus or kwashiorkor, is caused by inadequate protein and calorie intake and can range from mild to severe forms. 2) Kwashiorkor is characterized by edema and results from insufficient protein intake despite adequate calories. Marasmus is caused by lack of all nutrients and presents as wasting without edema. 3) Treatment involves rehydration, feeding by nasogastric tube or orally, correcting micronutrient deficiencies, managing infections, and educating caregivers to prevent recurrence. Complications can include infection, hypoglycemia, heart failure, and developmental delays.

Uploaded by

chirusdunna
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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PROTEIN ENERGY

MALNUTRITION
PROTEIN ENERGY
MALNUTRITION
• Definition : ( WHO)
• * Marasmus Weight less than 60% of expected weight - no
oedema.
• Kwashiorkor Weight between 60-80% of expected weight +
oedema
No oedema Oedema

80% Under weight for age Kwashiorkor 80%

Marasmus 60% 60%Marasmic-


Kwashiorkor

Wellcome Classification
Gomez Classification for
Malnutrition
1ry PEM is a spectrum ranging from:

* mild form
Decrease weight for length.

*severe form
Decrease length and weight for age.
Aetiology of (PEM)
• Leading cause of death (less than 5 years of age)

• 1ry:. Protein + energy intakes below requirement for normal


growth
• 2ry:the need for growth is greater than can be supplied.
• : decreased nutrient absorption
• : increase nutrient losses

Linear growth ceases

Static weight

Weight loss

Wasting

Malnutrition and its signs


Kwashiorkor:
• Ga language of West Africa = Supplanted one - Child
who recently have been weaned
• (Pregnant mother) and emotional deprivation
History:
1933 Cecily * Ghanaian children
* Weaned recently
* Oedema and hair changes
* Fatty liver
1967 Mc-Cane * Anaemia
* Cardiac
* Skin changes
1971 Frood-Paskitt * Biochemical
Pathogenesis:
Kwashiorkor:
• Normal energy intake, Lack of protein
• Edema:1970.decrease oncotic pressure,
– Recent> Increase Renin activity,N a and fluid
retention.
• Amino aciduria due to proximal tubular
dysfunction
• Failure of adaptation
• .Hepatomegaly due to fatty infiltration from
lipogenesis of excess CHO
• - Biochemical and haematological changes
•
Pathogenesis:
Marasmus:
• - Lack of all nutrients stimulate cortisone secretion
which result in muscle wasting, the released a. a will
synthesize albumin to prevent edema.
• - Growth and energy expenditure limited, in response
to dietary stress
• - Adaptation to reduce protein + energy
• - Biochemical and haematological tests within normal
• -Abdomin,flat due to ms wasting, OR distended due
to 2ry lactose intolerance.
•
Causes:
Social.ecomomic.poverity.ignorance.maternal
malnutrtion.enviromental.
Kwashiorkor:
• Insufficient intake of protein of good biological value.
• Impaired absorption of protein e.g. chronic diarrhoea.
• Abnormal losses of protein e.g.
severe nephrosis . Severe or prolonged infection
• Failure of protein synthesis e.g.
chronic liver diseases.
Marasmus:

Inadequate caloric intake due to insufficient diet .


• Improper feeding habits .
• Emotional deprivation.
• Metabolic abnormalities
• Congenital malformation
• Severe impairment of any body system
Management:
- Accurate history of social and economic factors.
poverety,ignorance. environmental factors .
diet history: maternal malnutrition, breast milk and other feeding
habits .food allergies ,food taboos.
chronic illness ,burns .HIV. cystic fibrosis .malignancies .inborn
error of metabolism ,
- Evaluation of growth parameters: weight, height, head
circumference
- Evaluation of the degree of illness and dehydration:
skin fold thickness - Biochemical evaluation
* mild * moderate * severe
1) Mild - moderate with no complication
• - Home management
• food increase calories + energy
• Multivitamin 1st week
• Iron replacement 2nd week.
• ± antibiotics for infection
2) Severe marasmic or severe kwashiorkor
Complicated cases or marasmic kwashiorkor
Hospital management

INITIAL PHASE
1st day: History --- clinical exam -- rehydration
Prevent heat loss
NGT feeding ORS, IVF (glucose and electrolytes)
Treatment of infection,bacterial and parasitic.

2nd -7th day:


a) Continue rehydration by NGT,
b) start diet by NGT .calories 80-100/kg/day ,Protein 3-4 g/kg/d. small volumes
2hourly then 4hourly to6 hourly. and increase calories gradually
, c) multivitamin. Vit A, folic acid. Without IRON for the 1 st week.
d) Correct anaemia ( packed RBC carefully)

If diarrhea starts or fails to resolve may be lactose intolerance lactose free milk or cow milk
protein intolerance start soy protein hydrolysate formula.
Rehabilitation phase week2-6
a) Start oral feeding
b) Continue antibiotics
c) Start iron
Oedema disappear ,, appetite improvement .the child is
more interested in the surrounding
Follow up phase
Discharge..
Supervising the mother in cooking
parental education to prevent an additional episodes
Follow-up:
1st sign of improvement:
-Awareness in the child
-Appetite (kw)
-Weight loss (kw)

Weight gain
rapid  Marasmus

Slow (10th day) Kwashiorkor


Failure of improvement:
1) Combined marasmic -kwashiorkor

2) Infection TB ,,,parasite

3) drowsiness -Severe hypokalemia


-Hepatic failure
-Protein intolerance

4) Rapid gain of weight - Cardiac failure


- Grossly disturbed metabolism
- Unable to tolerate the rate of re feeding (oedema)

5) Profuse diarrhea
- GIT infection
- Food intolerance (discharidase)
- Other nutrients deficiency
Complications:
1) Infection:
1. Immunological defect
- Cell mediated> humoral
- Measles> fatal disease

2. Subtle infection
- Lack of fever
- Hypothermia
- No increase in WBC
- Inability to localize infection
Complications (cot’n)

2) Hypoglycaemia apnoea
3) Hypothermia bradycardia
4) Heart failure death
5) Vit deficiencies Vit A  blindness
6) Permanent growth stunting
7) Prolonged illness developmental delay
cognitive function
slow intellectual achievement
Prevention:
Improve nutritional status Improve water supply
Without change in food supply Proper sanitation
Health education
Social worker visits,
Reduce infection rate Immunization
Supervision of feeding
Good weaning practice

Long term community


Effective for
health measures
one generation
Prognosis:
Marasmus due to under feeding  good

Kwashiorkor MR 10-25%

Marasmus I Kwashiorkor  worse progress

End point of nutritional


stress failure
of adaptation

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