Pedia Exam 2 Malnutrition Anchores 071415

7/23/2019 Pedia Exam 2 Malnutrition Anchores 071415

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UPHR JONELTA FOUNDATION SCHOOL OF MEDICINE

S.Y. 2015 2016

Pedia IIMALNUTRITION AND VITAMIN DEFICIENCIES - Dra. Anchores

MALNUTRITION AND VITAMINDEFICIENCIES

Basic Assu!"ions#- Defciency state seldom occurs

alone- Anatomic lesion is an indicator o

chronic nutritional disorder- Children are more vulnerable to

nutritional insults

T$!e o% Nu"rien"s#1. Macronutrients needed in large

amounts and primarily unction assources o energy. (Carbohydrates!ats "roteins#

$. Micronutrients needed in minuteamounts and unction mainly ascoactors in many chemicalprocesses. (%itamins Minerals

&race elements#

Food Securi"$#- Access by all people at all times to

'!!)C)*+& oods in terms o,uality ,uantity and diversity oran active and healthy lie ithoutris o loss o such access.

- & diensions# Availability supply o ood Access household level

re/ecting purchasing poer asell as transer program0 oodshared e,ually ithin thehousehold

tiliation re/ect the act thateven hen the household hasaccess to ood it does notnecessarily achieve nutritionalsecurity

Food Insecuri"$#- 2imited or uncertain availability o

nutritionally ade,uate and saeoods

- Due to lac o resources to assureade,uate production importationand distribution o ood

- May lead to an3iety that ood maysoon become inade,uate

- More prevalent in developing

countries (145#- &36 mae the mother complete a 7-8day ood diary appropriate dietaryadvice and or supplementnutritional counseling

'un(er- &he uneasy sensation that results

rom lac o ood- Di9cult to defne bec concepts

di:er rom each individual- 'A6 45 o poor children ;1$yo0

$15 at ris o hunger-


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B. )mbalance disproportion amongess nutrients ith or ithoutabsolute defciency o any nutrient

E!ideio)o($#$1(lobal# ;8yo- 118M undereight- 1E4M stunted- $M severe acute malnutrition

-Fighest in Asia and Arica)n the "hilippines6$11 "revalence decreased over the last$ decades but the burden remains high-8 yo6

- 7$5 undereight- 775 stunted- $.$5 overeight or height

Acu"e Ma)nu"ri"ion

- Deterioration o nutritional statusover a short period o timecharacteried by asting ornutritional edema

A. Moderate Acute Malnutrition (MAM#- GFH or G2H bet. ; -$ and ; -7- M) bet. ; -$ and ; -7. 'evere Acute Malnutriton ('AM#- MAC ;11.8cm- GFH or G2H ; -7- M) ; -7- ilateral pitting edema- Marasmic-Iashioror

Chronic Ma)nu"ri"ion

- >ccurs sloly and involvesreduction in linear groth stunting

- "roportionally normal but aresmaller and shorter than theirpeers

- Measured using the indicatorlength-or-age ;$ yo and height-or-age thereater

- Critical indo o opportunity orintervention e3ist pregnancy untilbeore 14mos o age ater hichstunting may become irreversible

CAUSES# "?)MA?J MA2+&?)&)>+

1. 2o income and purchasingpoer o amilies (totally nosource#

$. )gnorance and erroneousood habits (cultural oodpractices#

7. 'carcity o ood supply (inthe presence o naturaldisasters#

B. >verpopulation '*C>+DA?J MA2+&?)&)>+

(ith access to ood supply#1. )nectious diseases

gastroenteritis

parasitism

respiratory diseases

2oss o appetite Kfrst to maniest

$. Metabolic diseases (patientsstarved during illnesses#

diabetes

thyroid diseases

)n cases o diarrhea Kstart early eedingnever starve thepatient#

7. )atrogenic diseases starvation during

diarrhea

BATC' *+,&?A+' &*AM6 Magbitang Magalas Maluto Mercado Mi@ares esana Dacanay Contreras

With all your heart, you must trust the Lord and not your own judgment. Always let him lead you, and he will clear theroad for you to follow. Proverbs !"#$

*with dotted line: for

example, youngest will be

fed first before the others


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Pro"ein Ener($ Ma)nu"ri"ion PEM/

or Se0ere Acu"e Ma)nu"ri"ionSAM/- Defciencies o protein and energy- Mild moderate severe orms- roth ailure frst clinical

indication- Almost alays accompanied by

defciencieso other nutrients

Marasus In%an"i)e a"ro!h$1

Inani"ion1 Cache2ia/- severely asted- undereight- lo in both protein and calories

(balanced starvation#

34ashior5or Pro"ein

a)nu"ri"ion1 Nu"ri"iona) EdeaS$ndroe/

- Diet very lo in protein but ithcalories

- *dema is the cardinal sign

Mild, 2g/dlGross , 1.5 g/dl- !lay-paint rash or enamel

dermatoses(pathognomonic# i e3tensive poorprognosis

rading o Iashioror6radin( In0o)0een"

accd( "ose0eri"$ o%

edea

In0o)0een"as "o

se0eri"$ o%dera"oses

L Mild oth eet Discolorationor a erough

patchesLLModerate

oth eet plusloer legshands or loerarms

Multiplepatches onthe armslegs

LLL'evere

eneraliededema incboth eetlegs handsarms and ace

!laing rasin fssures




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Pre0en"ion#1. "roper education correct aulty amily ood habits

(has to becorrected#

encourage breasteeding promote ade,uate supplementary

eeding

(tell the mother the proper time# emphasie home ood

production(additionalincome#

motivate amily planning good physical hygiene



KWASHIORKOR

KWASHIORKOR

MARASMUS

Ma"erna) and 7ir"h ou"coe

N Maternal supplementation obalanced energy and protein

N Maternal iodine supplements

N Maternal deorming inpregnancy

N )ntermittent preventativetreatment or malaria

N )nsecticide treated bednetsMa"erna) and 7ir"h ou"coe

N )ron olate supplementation

N Maternal supplements omultiple micronutrients

N Maternal iodine throughiodiation o salt

N Maternal calciumsupplementation

N )nterventions to reduce tobaccoconsumption or indoor airpollution


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environmental condition(handashing veryimportant#

$. )mmuniation strengthen


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Adolescence (gain appetite# small mouth and nose double-

chin

adiposity in mammary regions pendulous abdomen ith hite orpurple striae disproportionately small e3ternal

genitalia (boys# &all stature advanced bone age

early puberty Acanthosis nigricans ( hypertrophic

hyperpigmentation o the sincommonly seen on the posteriornec and in sin creases# K seen atthe bac o the nec0 reduce the

eight and that ill disappear

La7ora"or$ Findin(s#&hose that evaluate C%' disease rissanddiabetes ris ("lasma lipid profles !'insulin levels FbA1c# test or sleepapnea

Pre0en"ion# breasteeding (loo lighter and

thinner than thoseinants in mil or ormula ed# delay in introduction o solid oods

(increasesugar in mil ormula#

counseling mothers to give oodonly

in response to hunger not as apacifer reorientation o amily lie toards

localorie ood promotion o physical e3ercise

Trea"en"#1. Diet therapy - caloric re,uirement depends onage

and gender

- energy balance should beemphasied$. *3ercise therapy - schools should provide specialprograms - bris al ($8 calhr#

- regular physical e3ercise atschool and at home

should be planned

- limit and monitor &% vieing time7. "sychological therapy ( ith severeor e3tremeobesity0 re,uires certain

intervention or their apnea# - emotional support - parental counseling - psychiatric reerral ther orms o therapy - asting - intestinal by-pass operation - gastric stapling (haardous should not beadvocated#

Pic54ic5ian S$ndroe- rare complication- severe cardiorespiratory distress

ith hypoventilation- CM6 polycythemia

o hypo3emiao cyanosiso somnolence

- eight reduction is e3tremelyimportant

TABLE 88-9 -- An"ici!a"or$ 6uidance# Es"a7)ishin(

'ea)"h$ Ea"in( 'a7i"s in Chi)drenDo not punish a child during mealtimes ith regard to eating.

&he emotional atmosphere o a meal is very important.

)nteractions during meals should be pleasant and happy.

Do not use oods as reards.

"arents siblings and peers should model healthy eating

tasting ne oods and eating a ell-balanced meal.

Children should be e3posed to a ide range o oods tastes

and te3tures.

!oods should be o:ered multiple times. ?epeated e3posure toinitially dislied oods ill brea don resistance.

>:ering a range o oods ith lo energy density helps children

balance energy intae.




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?estricting access to oods ill increase rather than decrease a

childTs preerence or that ood.

!orcing a child to eat a certain ood ill decrease his or her

preerence or that ood. ChildrenTs ariness o ne oods is

normal and should be e3pected.

Children tend to be more aare o satiety than adults so allo

children to respond to satiety and let that dictate servings. Do

not orce children to


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- cyanosis dyspnea systolicmurmur pulmonary edema andrales

A!honic 7eri-7eri- 8-E months insidious onset- hoarseness dysphonia or aphonia

Pseudoenin(ea) 7eri-7eri

- 4-1 months- apathy drosiness- signs o meningeal irritation

Dia(nosis#- t3tic test ith parenteral thiamine- increase levels o blood lactic and

pyruvic acid ater an oral glucosetest

Pre0en"ion#

?DA6 inants - .B mg older children - .P to 1.$ mg adults - 1. to 1.7 mgTrea"en"#Children - 1 mg daily or several eesAdults - 8 mg daily or several ees

Vi"ain B*Ri7o


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Trea"en"#- $-1 mg )M- 1 mg ".>

Vi"ain C Scur0$/ de:cienc$

- P-$B months (pea#- improper cooing practices

C)inica) Mani%es"a"ions# painul immobile legs

(pseudoparalysis# gums bluish purple sollen depression o sternum (scorbutic

beads# irritability tachypnea )&

disturbances slo ound healing

'curvy - ormation o collagen andchondroitin sulate is impaired

deective tooth dentin loosening othe teeth hemorrhage

ollicular hypereratosis 'icca 'yndrome o '@ogren -

Verostomia Ieratocon@unctivitis sicca enlarged

salivary glandsDia(nosis#

- clinical picture- history o poor %it. C intae- V-ray fndings o long bones6


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- 1$ ) moderate to severericets

- Artifcial and natural lights

- )nantile &etany may occasionallyaccompany ricets seen inpatients ith steatorrhea icalcium increase ; 7-B mgdl

'$!er0i"ainosis D

- 'ymptoms develop ater 1 7months o large intae Fypotonia anore3ia

constipation polydipsiapolyuria pallor

Fypercalcemia hypercalciuria %omiting Fypertension

retinopathy Corneal cloudingT2# vitamin D and calcium intae

Me(a)o7)as"ic Aneia

- defciency o either olic acid orvitamin 1$ or both

- $ E monthsE"io)o($#

- Dietary lac- Deective Absorption- "resence o olic antagonists

(methotre3ate and anti-epileptic

drugs#- "ure goatUs milC)inica) Mani%es"a"ions#

"allor irritability !&& "ersistent respiratory inection )ntermittent ever and diarrhea

Dia(nosis#- Macrocytic type- Fypersegmentation o the

neutrophilsTrea"en"#

- !olic Acid $-8 mgday 3 $-7 ees

- Ascorbic acid $ mg

Fo)ic Acid

- !olate defciency beore becomingpregnant or during pregnancyresults in serious dysmorphic

e:ects in the etus ( neural tubedeects#

- B ug beore conception or all

child bearing age- %itamin C needed or olic acidconversion

Vi"ain E a)!ha "oco!hero) /

- !at soluble anti o3idant- )nvolve in nucleic acid metabolism- Malabsorption states- "remature inants

C)inica) Mani%es"a"ions# Creatinuria ceroid deposition in

smooth muscle

Anemia or Iashioror Femolytic anemia retinopathy inpremature inants

)ncreased platelet adhesivenessDia(nosis#

'evere1. alpha - tochopherol 6 lipid ratio o

; .4mgg and or$. erytrocyte hemolysis in

hydrogenpero3ide o more than 15 (should bedone 7 days ater an oral vit *.#Trea"en" and Pre0en"ion#

- "remature6 18-$8) per day- .E mgg o unsaturated at in thediet

- Figher dose in children ith biliaryatresia

Iron De:cienc$ Aneia IDA/

- most common orm o anemia- pea6 P-$B months

IncidenceW- 71.45 (1SS4# O 7$.B5 ($7# P

mos to 8 years- 87.5 - 1 yr old children

- 7B.45 - $ yr old children- $B.45 - 7 yr old children- 14.45 - B yr old children- 1B.5 - 8 yr old children

E"io)o($#- )nade,uate supply o iron- )nade,uate intae




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- )mpaired absorption- lood loss

C)inica) Mani%es"a"ions#

)rritabilityloss o appetite F3 o repeated respiratoryinections

"allor o sin and mucousmembranes

&achycardia systolic murmurcardiomegaly

Dia(nosis#- *3amination o peripheral blood- hypochromic microcytic- ?ed cell indices decrease MCFC

MC%- Determination o transerrin

saturation- belo 185 and serum iron ; 8mgdl

Pre0en"ion#- )nants6 1-18 mg elemental iron

dailyTrea"en" Ora) %errous SO8/#

- )nant6 P mggG P 4 ees- >lder children6 1 $ mg (total

daily iron#- &ransusions6 'everely anemic

inantchild F level B- 8 gdl orless

- &reat underlying actors

Pernicious Aneia

- due to %itamin 1$defciency- serum %itamin 1$level is belo

4 pgml

>inc De:cienc$

- Can reduce chi)d or"a)i"$- No 7ioar5er s"andard "ha" is

4ide)$ used as cu"o? "o de:ne!u7)ic hea)"h concern

- I!or"an" in (roe"h and

iuni"$- Co%ac"or in nuerouse"a7o)ic !a"h4a$s

- 6ro4"h %ai)ure1 diarrhea1d4ar:s and h$!o(onadis

- Lon( "er hi(h dose in"er%ere4i"h co!!er e"a7o)is1anore2ia1 0oi"in(

Nu"ri"iona) Assessen"- "rimary step in the evaluation o

children hose groth di:ers romthe norm

- *ssential in the management ochildren ith acute or chronicdisease

Me"hods o% Assessen" a. Assessment by history b. Clinical assessment c. se o roth Charts d. Anthropometric )ndicators e. 2aboratory assessment

Assessen" 7$ his"or$

- medical history- dietary history (motherUs child#- eight and height changes- change in psychic reaction

C)inica) Assessen"

- careul e3amination- observation- evidence o specifc defciencies

Use o% (ro4"h char"s

- roth charts are derived romlongitudinal studies o a selectedell-defned healthy populationand rom cross-sectional data onlarge numbers o children hoparticipated in national surveys

- Data are presented as "ercentile- 'erial measurements are easier to

interpret than singlemeasurements

An"hro!oe"ric Indica"ors

- eight- length- triceps sinold thicness- head circumerence- mid-upper arm circumerence (MAC#




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La7ora"or$ assessen"s

- hematologic and protein status- determination o body composition

to defne e3cesses and defciencieso specifc nutrients

6oe@ c)assi:ca"ion

Gelcome classifcation

;a"er)o4 c)assi:ca"ion

Couni"$ Nu"ri"ion

Main 6oa)

- &o promote the nutritional health o

children- asic Core o +utrition in Community

'ea)"h Pro(ras#1. Assessment o childUs nutritional

status and needs$. +utrition Counseling7. +utrition *ducationB. &reatment o nutrition-related

conditions8. !ollo-up and reerral

Nutrition and growth of children aectsnot only their survival but also theiruality of life.!



Pedia Exam 2 Malnutrition Anchores 071415

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