Malnutrition Notes

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Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Malnutrition essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Malnutrition:

Kwashiorkor

Marasmus

NOTES NOTES MALNUTRITION GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Supply/demand imbalance of nutrients, energy required for growth, maintenance, function ▪ Disease spectrum ▫ Kwashiorkor: inadequate protein intake with adequate total caloric intake ▫ Marasmus: inadequate protein, caloric intake ▪ Malnutrition impairs immune function → ↑ infection likelihood → ↑ nutritional demand → further malnutrition ▫ Malnutrition → atrophy of lymph glands, tonsils, thymus → impaired cellular immunity, delayed hypersensitivity loss ▫ Protein insufficiency → ↓ immunoglobulins, ↓ complement → impaired phagocytosis ▫ Acute-phase immune response loss → typical infection signs loss (leukocytosis, fever) ▪ Refeeding syndrome ▫ Metabolic disturbance: excessivelyrapid nutrition reintroduction to severely malnourished individual ▫ Rapid nutrient reintroduction → glycogen, fat, protein synthesis → serum potassium, magnesium, phosphorus consumption → mineral imbalance → cardiac, pulmonary, neurological sequelae (cardiac arrhythmias, cardiac failure, confusion, convulsions, coma) SIGNS & SYMPTOMS ▪ Kwashiorkor ▫ Bilateral pitting edema, distended abdomen, hair thinning, skin/hair depigmentation, dermatitis 276 OSMOSIS.ORG ▪ Marasmus ▫ Emaciated appearance (“wizened” facies), severe muscle wasting, subcutaneous-fat loss DIAGNOSIS DIAGNOSTIC IMAGING Chest X-ray ▪ Infection workup: respiratory distress LAB RESULTS ▪ Hypoglycemia ▪ Anemia (normochromic-normocytic or hypochromic-microcytic/macrocytic) ▪ Electrolyte levels (calcium, phosphate, magnesium, serum albumin, urea) → various deficiencies Infection workup ▪ Blood culture ▪ Common endemic infection tests (e.g. HIV, malaria, parasites) OTHER DIAGNOSTICS Anthropometry ▪ Body weight < 62.36% expected body weight for age ▪ Weight-for-height Z-score < -3 standard deviations → severe wasting ▪ Mean upper-arm circumference < 11.5cm/4.53in → severe wasting
Chapter 47 Malnutrition TREATMENT World Health Organisation (WHO) 10 steps for severe malnutrition management ▪ Treat/prevent hypoglycemia (blood glucose < 3mmol/L) ▫ Prevention: urgent small frequent feeds ▫ Treatment: dextrose water ▪ Treat/prevent hypothermia (rectal/oral temperature < 35.5°C/95.9°F) ▪ Treat/prevent dehydration ▫ Prevention: oral rehydration (sunken eyes, no urine passed for 12 hours, thirst) ▫ Treatment: intravenous fluid infusion (lethargy/consciousness loss) ▪ Correct electrolyte imbalances ▫ Total-body sodium excess (likely in severe malnourishment) avoid high sodium solutions, feeds ▫ Specialized refeeding milk feeds contain ▪ ▪ ▪ ▪ ▪ ▪ necessary electrolytes Treat infection ▫ Broad-spectrum antibiotics ▫ In endemic regions: children < one year of age, assume presence of parasitic infection → mebendazole Correct micronutrient deficiencies ▫ Supplements: multivitamin, vitamin A, potassium, magnesium, iron, folic acid, zinc, copper Start cautious feeding ▫ WHO recommended starter formula “F-75” Achieve catch-up growth ▫ WHO recommended catch-up formula “F-100” ▫ Reintroduce normal meals Provide sensory stimulation, emotional support Prepare for discharge, post-recovery follow-up KWASHIORKOR osms.it/kwashiorkor PATHOLOGY & CAUSES SIGNS & SYMPTOMS ▪ Sufficient calorie intake, severely inadequate protein intake ▪ AKA “the sickness the baby gets when the new baby comes” ▫ Older children in food-scarce environments weaned off breast milk → carbohydrate rich diet ▪ Characterization ▫ Inadequate adaptation; insufficient dietary nutrient intake ▫ Extreme protein deficiency → ↓ liver protein synthesis → osmotic imbalance → edema, abdominal distension ▫ ↓ lymphatic function → ↓ fluid recovery, low lipid absorption → further abdominal distension ▪ Bilateral pitting edema, distended abdomen (rarely ascites; typically weak abdominal musculature, hepatomegaly) ▪ Hepatomegaly (with fatty infiltration) ▪ Muscle wasting ▪ Integumentary change (thinning hair, skin/ hair depigmentation, dermatitis) ▪ Irritability, listless affect DIAGNOSIS DIAGNOSTIC IMAGING Chest X-ray ▪ Infection workup: respiratory distress OSMOSIS.ORG 277
LAB RESULTS ▪ Hypoglycemia ▪ ↓ blood lipids ▪ Hypoalbuminemia, hypoproteinemia (transferrin, essential amino acids, lipoprotein) ▪ Anemia (normochromic-normocytic/ hypochromic microcytic/macrocytic) ▪ Electrolyte depletion → hypocalcemia, hypophosphatemia, hypomagnesemia, hypokalemia Infection workup ▪ Blood culture ▪ Common endemic infection tests (e.g. HIV, malaria, parasites) OTHER DIAGNOSTICS Anthropometry ▪ Body weight < 62.36% expected body weight for age ▪ Weight-for-height Z-score < -3 standard deviations → severe wasting ▪ Mean upper arm circumference < 11.5cm/4.53in → severe wasting TREATMENT MEDICATIONS ▪ Prophylactic antibiotics ▫ Malnutrition-induced immunodeficiency compensation OTHER INTERVENTIONS ▪ Correct glycemic, electrolyte, hydration abnormalities ▪ Protein refeeding, gradually ↑ protein amount ▫ Excessively-rapid protein refeeding → protein catabolism → urea accumulation → may overwhelm already-impaired liver → liver failure 278 OSMOSIS.ORG Figure 47.1 A child with kwoshiorkor.
Chapter 47 Malnutrition MARASMUS osms.it/marasmus PATHOLOGY & CAUSES ▪ Severe malnutrition: inadequate calorie/ protein intake ▪ Insufficient energy balance → evolving adaptation ▫ ↓ intake, ↑ loss (e.g. emesis, diarrhea, burns), ↑ energy expenditure → negative energy balance ▫ Negative energy balance adaptations: ↓ physical activity, lethargy, ↓ basal metabolic rate, growth retardation, weight loss SIGNS & SYMPTOMS ▪ Emaciated appearance (“wizened” facial appearance), head (compared to body) appears disproportionately large ▪ Severe muscle wasting → redundant skin folds ▪ Subcutaneous fat loss ▪ Irritability, weakness, lethargy DIAGNOSIS DIAGNOSTIC IMAGING Chest X-ray ▪ Infection workup: respiratory distress Infection workup ▪ Blood culture ▪ Common endemic infection tests (e.g. HIV, malaria, parasites) OTHER DIAGNOSTICS Anthropometry ▪ Body weight < 62.36% expected body weight for age ▪ Weight-for-height Z-score < -3 standard deviations → severe wasting ▪ Mean upper arm circumference < 11.5cm/4.53in → severe wasting TREATMENT MEDICATIONS ▪ Prophylactic antibiotics ▫ Malnutrition-induced immunodeficiency compensation OTHER INTERVENTIONS ▪ Correct glycemic, electrolyte, hydration abnormalities ▪ Protein refeeding, gradually ↑ protein amount ▫ Excessively-rapid protein refeeding → protein catabolism → urea accumulation → may overwhelm already impaired liver → liver failure LAB RESULTS Hypotension Hypothermia Hypoglycemia Anemia (normochromic-normocytic/ hypochromic microcytic/macrocytic) ▪ Hyponatremia +/- non-specific electrolyte imbalances ▪ ▪ ▪ ▪ OSMOSIS.ORG 279

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Malnutrition essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Malnutrition by visiting the associated Learn Page.