Please enable JavaScript.

Coggle requires JavaScript to display documents.

Protein-Energy Malnutrition - Coggle Diagram

- - - - It develops in children and adults whose consumption of protein and energy (measured by calories) is insufficient to satisfy the body's nutritional needs. While protein deficiency can occur when a person's diet provides enough energy but lacks sufficient protein, in most cases the deficiency will be dual. PEM may also occur in persons who are unable to absorb vital nutrients or convert them to energy essential for healthy tissue formation and organ function.
        
        Types of PEM
        
        Kwashiorkor
        
        Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM characterized primarily by protein deficiency. This condition usually appears at the age of about 12 months when breastfeeding is discontinued, but it can develop at any time during a child's formative years. It causes fluid retention (edema); dry, peeling skin; and hair discoloration.
        
        Marasmus
        
        Primarily caused by energy deficiency, marasmus is characterized by stunted growth and wasting of muscle and tissue. Marasmus usually develops between the ages of six months and one year in children who have been weaned from breast milk or who suffer from weakening conditions like chronic diarrhea.
- - - - Losing 20% of body weight or more is generally classified as severe PEM. People with this condition can't eat normal-sized meals. They have slow heart rates and low blood pressure and body temperatures. Other symptoms of severe secondary PEM include baggy, wrinkled skin; constipation; dry, thin, brittle hair; lethargy; and pressure sores or other skin lesions.
    - - A thorough physical examination and a health history that probes eating habits and weight changes, checks body-fat composition and muscle strength, and assesses gastrointestinal symptoms, underlying illness, and nutritional status is often as accurate as blood tests and urinalyses used to detect and document abnormalities.
        Some doctors further quantify a patient's nutritional status by:
        
        comparing height and weight to standardized norms
        
        calculating body mass index (BMI)
        
        measuring skinfold thickness or the circumference of the upper arm
        
        TREATMENT
        
        Treatment is designed to provide adequate nutrition, restore normal body composition, and cure the condition that caused the deficiency. Tube feeding or intravenous feeding is used to supply nutrients to patients who can not or will not eat protein-rich foods.
        
        In patients with severe PEM, the first stage of treatment consists of correcting fluid and electrolyte imbalances, treating infection with antibiotics that don't affect protein synthesis, and addressing related medical problems. The second phase involves replenishing essential nutrients slowly to prevent taxing the patient's weakened system with more food than it can handle. Physical therapy may be beneficial to patients whose muscles have deteriorated significantly.
        
        PROGNOSIS
        
        Most people can lose up to 10% of their body weight without side effects, but losing more than 40% is almost always fatal. Death usually results from heart failure, an electrolyte imbalance, or low body temperature. Patients with certain symptoms, including semi-consciousness, persistent diarrhea, jaundice, and low blood sodium levels, have a poorer prognosis than other patients. Recovery from marasmus usually takes longer than recovery from kwashiorkor. The long-term effects of childhood malnutrition are uncertain. Some children recover completely, while others may have a variety of lifelong impairments, including an inability to properly absorb nutrients in the intestines and intellectual disability. The outcome appears to be related to the length and severity of the malnutrition, as well as to the age of the child when the malnutrition occurred.
  - - - Hospitalized patients
        
        Difficulty chewing, swallowing, and digesting food, as well as pain, nausea, and lack of appetite are among the most common reasons that many hospital patients do not consume enough nutrients. Nutrient loss can be accelerated by bleeding, diarrhea, abnormally high sugar levels (glycosuria), kidney disease, malabsorption disorders, and other factors. Fever, infection, surgery, and benign or malignant tumors increase the amount of nutrients hospitalized patients need. So do trauma, burns, and some medications.
      - Profound weakness accompanies severe marasmus. Since the body breaks down its own tissue to use as calories, people with this condition lose all their body fat and muscle strength, and acquire a skeletal appearance most noticeable in the hands and in the temporal muscle in front of and above each ear. Children with marasmus are small for their age. Since their immune systems are weakened, they suffer from frequent infections. Other symptoms include loss of appetite, diarrhea, skin that is dry and baggy, sparse hair that is dull brown or reddish yellow, intellectual disability, behavioral retardation, low body temperature (hypothermia), and slow pulse and breathing rates.