Copy of PROTEIN ENERGY MALNUTRITION (2).pptx

presentation on protein energy malnutrition

1. PROTEIN ENERGY MALNUTRITION GROUP MEMBERS: Zainab ddns02153104 Zunaira Fatima ddns02153107 Sumaira Zakir ddns02153106 Mariam Jamil ddns02153110 Bisma Javed ddns02153108 Memoona Abid ddns02153113 Rabia Basri ddns02153096 Iraj Ali ddns02153090 Aiman Talha ddns02153111 Momina ddns02153112 F a t i m a k h a n d d n s 2 1 5 3 1 6

2. CONTENTS INTRODUCTION OF PEM CLASSIFICATION CAUSES/FACTORS PREVALENCE LAB FINDINGS COMPLICATIONS PREVENTION TREATMENT RESTORATION TARGET

3. Protein Energy M alnutrition WHO defines Malnutrition as ‘’the cellular imbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance and specific functions’’. It is a condition that develops when the body does not get the right amount of the vitamins, minerals and other nutrients it needs to maintain healthy tissues and organ functions.

4. Etiology Multiple factors can lead to PEM in children. They are: Social and economic factors Biological factors Environmental factors Age of the host Infections

5. Cont . AMONG THE SOCIAL, ECONOMIC, BIOLOGICAL, AND ENVIRONMENTAL FACTORS THE MOST COMMON CAUSES ARE: Lack of breast feeding and giving diluted formula. Improve complementary feeding Over crowding in family Ignorance

6. Cont. Illiteracy Lack of health education Poverty Infection Familial disharmony

7. Cont. R ole of Free R adicals and Aflatoxin : two new theories have been postulated recently to explain the pathogenesis of kwashiorkor. These include free radical damage and aflatoxin poisoning. These may damage liver cells giving rise to kwashiorkor.

8. Cont. Age of host: frequent in infants and young children whose rapid growth increases nutritional requirement. PEM in pregnant and lactating can affect the growth, nutritional status and survival rates of their fetuses , new born and infants. Elderly can also suffer from PEM due to alteration of GI system.

9. Types Acute PEM: It is caused by severe recent food restriction; characterized in children by under weight for height (wasting) Chronic PEM: It is caused by long term food deprivation; characterized in children by short height for age (stunting)

10. Classification PM occurs in 3 forms: Marasmus Kwashiorkor Marasmic-kwashiorkor

11. Marasmus A form of PEM that results from severe deprivation, or impaired absorption of energy, protein, vitamins and minerals.

12. Clinical Features of Marasmus Onset: Infancy less than 2 years Severe deprivation: Impaired absorption of protein, energy, vitamins and minerals. Development: develop slowly (chronic) Severe weight loss Severe wasting Thin, old man face

13. Cont . Growth: less than muscle wasting-for age No fatty liver Anxiety Good appetite possible Hair : spare , thin, dry Skin: dry, thin easily wrinkles

14. Kwashiorkor A form of PEM that results from inadequate protein intake and infections.

15. Clinical features of kwashiorkor Older infants and young children (1 to 3 years) Inadequate protein. Rapid (acute) Moon face Anemia Skin depigmentation

16. Cont. Some weight loss Some muscle waste Growth: 60-80% weight for age Edema Enlarged fatty live Irritability Loss of appetite Hair: dry ,brittle, changes color Skin: develop lesions.

17. Marasmic-kwashiorkor A severely malnourished child with features of both marasmus and kwashiorkor.

18. Prevalence

19. Lab Tests Full blood counts Blood glucose profile Septic screening Stool & urine for parasites & germs Electrolytes, Calcium, Phosphorus & ALP, serum proteins CXR & Mantoux test Exclude HIV & malabsorption

20. CONSEQUENCES Sugar deficiency (hypoglycemia) Hypothermia Electrolyte imbalance (hypokalemia) Deficiency of iron, vitamins and micronutrients Infection and septic shock

21. Prevention Improve nutritional status Improve water supply Proper sanitation Health education Social worker visits, Reduce infection rate Immunization Supervision of feeding Good weaning practice Long term community health measures Effective for one generation

22. MEDICAL NUTRITION THERAPY

23. Treat H ypoglycemia 59ml of 10% glucose or sucrose solution orally Feed with starter F-75 2hrly. F-75= formula 75 (a therapeutic milk product) Uses: treat severe malnutrition Function: action against hunger

24. Treat Hypothermia Avoid rapid rewarming Clothe with warm clothes Always keep child covered. Place bed away from windows and doors. Feed 2hourly starting immediately after admission.

25. Treat Dehydration Use reduced osmolarity ORS with potassium supplements for rehydration and maintenance. Initiate feeding within 2-3 hrs. of starting rehydration with F-75 formula with reduced osmolarity ORS. Be alert for signs of over hydration.

26. ReSoMal Severely malnourished children have low potassium and abnormally high sodium ORS should contain less sodium and more potassium than the standard WHO- recommended solution. Magnesium, zinc and copper should also be given to correct deficiencies of these minerals. ReSoMal can be prepared by:

27. Cont. Diluting 1 pack of standard ORS in 2 liters of water and add 50g sucrose and 40ml of mineral mix solution.

28. Treat Electrolyte I mbalance Supplemental potassium at 3-4 mEq /kg/day for at least 2 weeks. Magnesium 0.8-1.2mEq/kg/day Prepare food without adding salt because excess body sodium exist.

29. Treat M i cronutrient D eficiencies Use up to twice the RDA of various vitamins and minerals Vitamin A: Age more than 1 year=2lac IU Age 6-12 months=1lac IU Age 0-5 months=50,000 IU

30. Cont. Copper =0.2-0.3mg/kg/day Folic acid = 1mg/day Iron =3mg/kg/day, once child start growing weight, after the stabilization phase. ANEMIA: In severe anemia=5-10ml/kg In mild to moderate condition= 2-6mg/kg elemental iron after patient has been stabilised

31. Initiate Re-feeding Frequent small feeds Fluid recommended is 130ml/kg/day In severe edema reduce as 100ml/kg/day Start with F-75 starter feeds q 2 hourly F-75 contains 75kcal/100ml with 1g protein/100ml If persistent diarrhea, cereal based lactose free F-75 diet as starter diet

32. Sensory stimulation & emotional support A cheerful, stimulating environment Age appropriate structured play therapy for at least 15-30 minutes Age appropriate physical activity Tender loving care

33. Achieve Catch up Growth Once appetite returns in 2-3 days, encourage higher feeds Increase volume offered in each feed and decrease the frequency of feeds to 6 feeds/day Continue breast feeding or formula feeding on demand Make a gradual transition from F-75 to F-100

34. Cont. F-100 contains 100 kcal/100ml with 2-3g protein/100ml Increase calories to 150-200 kcals/kg/day and protein to 4-6g/kg/day.

35. Restoration Calories and protein goal is: 150-200 kcal/kg 3-4g protein/kg 100-165ml fluid/kg 50% calories from CHO 15% from protein 35% from fat Coconut oil as fat which is rich in MCTs

36. Target A weight gain of 0.5kg/week in children and 70g/kg/week in infants is the target 150-200g/week is expected in newborns and young infants Restoration of weight for height may take about 8-12 weeks Edema clears and social smile returns in 1-2 weeks

37. REFERENCES Understanding Nutrition Book UNECEF DATA (2000-2016) The treatment and management of severe PEM (WHO) (Book)