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gihep 17: obesity + eating disorders (ii) (Marasmus (symptoms (hunger,…
gihep 17: obesity + eating disorders (ii)
Marasmus
inadequate kcals
muscle + fat wasting
symptoms
hunger
diminished weight + height
bradycardia
hypotension
atrophy of fat + muscle
emaciated (thin +weak)
Kwashiorkor
muscle atrophy BUT normal body fat
inadequate protein (adequate kcals)
symptoms
anorexia
severe general oedema (round cheeks)
dry/peeling skin
distended abdomen
hypopigmented hair
starvation severity
determined using growth charts (height as z-scores)
for wasting (acute):
moderate = -2 - -3
severe: <-3
for stunting (chronic):
moderate: -2 - -3
severe: <-3
starvation treatment
initial phase
rehydrate (orally if possible)
80-100 kcal/kg/day or 75 kcal/100ml
tacle hypoglycaemia, hypothermia, infection
rehab phase
increase (SLOWLY) feeding to 220 kcal/kg/day or 100kcal/100ml
increase until zscore > -1
supplements, esp vit A, Fe + folate
refeeding syndrome
increased risk with high weight loss + rapid regain
hypophosphataemia, hypokalaemia, hypomagnesemia, vit + min deficiencies, oedema
treatment of eating disorders
nutritional rehab
increase intake by 300-400 kcals every 3-4 days
1kg gain/week
psychotherapy
pharmacotherapy
antidepessants (fluoxetine) for bulimia+BED
anti epileptics for bulimia+BED
antipsychotics possibly beneficial for anorexia