Protein Disease (III)

8/6/2019 Protein Disease (III)

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Protein Disease (III)

Reinita Arlin Puspita

03008202


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M A R A S M U S

Protein Energy Malnutrition


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What am I going to present ?

1. Introduction

2. Explanation :1. Epidemiology

2. Symptoms

3. Diagnosis

4. Complications

5. Therapy

6. Prevention

3. Conclusion


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Background

Marasmus is a serious worldwide problem

that involves more than 50 million childrenyounger than 3 years. According to the World

Health Organization (WHO), 49% of the 10.4

million deaths occurring in children younger

than 5 years in developing countries areassociated with PEM.


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Background

Nearly 30% ofhumans currently experience

one or more of the multiple forms ofmalnutrition.Close to 50 million children

younger than 5 years have PEM, and half of

the children who die younger than 5 years

are undernourished. Approximately 80% ofthese malnourished children live in Asia,

15% in Africa, and 5% in Latin America.


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Background

Five million children younger than 5 years die

every year of malnutrition. Approximately 70million present with wasting, and 230 million

present with some stunting.Fifty percent of

the children in Asia are malnourished, 30%

are malnourished in Africa, and 20% aremalnourished in Latin America.


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Introduction

A severe form ofprotein and energy

malnutrition that usually occurs in famine orsemi-starvation conditions.In developing

countries (over populated regions of world),

marasmus is widespread in children under

three years of age


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Introduction

Greek word ``marasmos' = wasting Severe deprivation of food over a long period

Suffering from an inadequate energy and protein

intake PEM

Most common in infants 6 to 18 months of age. A result of a chronic gross deficiency of calories and

an accompanying lack of protein and other nutrients.


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Introduction

A form of malnutritioncaused by

a severe deficiency of both protein and calories


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Epidemiology

Age

Sex Social class

Seasonal variation

PEM may be related toepidemics of diarrheal

diseases


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Symptoms

Very low body weight for age (


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Symptoms

Slow, chronic

Weak heart

Brittle hair, skin problems

Anxiety, apathy

Eyes become sunken

Skin appears loose

Infant is not active Cry is weak and shrill

Dehydration

Diarrhoea


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Symptoms

Mental retardation and learning disabilities.

Distributed metabolism which leads todropping in body temperature.

Increased susceptibility to infections due to

deficiency of immunoglobulin.


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Clinical History

Marasmus is typically observed in infants

who are breastfeeding when the amount ofmilk is markedly reduced or, more frequently,

in those who are artificially fed.


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Physical Examination

Body temperature Hypothermia as well as fever

Anemia Pale mucosa

Edema (-)Dehydration Thirst, shrunken eyes

Hypovolemic shock Weak radial pulse, cold extremities,decreased consciousness

Tachypnea Pneumonia, heart failure

Abdominal manifestations Distension, decreased or metallicbowel sounds, large or small liver,

blood or mucus in the stoolsOcular manifestations Corneal lesions associated with

vitamin A deficiency

Dermal manifestations Evidence of infection, purpura

ENT findings Otitis, rhinitis


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Diagnosis

height and weightless than 80% of standard

for the patients age and sex, and below-normal arm circumference and tricepsskinfold

serum albumin level

urinary creatinine (24-hour) level skin tests with standard antigens

moderate anemia.


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Differential Diagnoses

No differential diagnosis for marasmus are

noted. Edema (+), reflect a KW component of the

malnutrition or an underlying cardiac or renal

insufficiency.

additional laboratory tests

radiographic tests


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Differences between Kwarshiorkor


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Differences between Kwashiorkor


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Differences between Kwarshiorkhor


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Laboratory Studies (adapted from the WHO)

Blood glucose Hypoglycemia

Examination of blood smears Parasites (Expensive)

Hemoglobin < 40 g/L

Urine examination and culture >10 leukocytes/high-

power field

Stool examination by microscopy Parasites and blood

(dysentery)

Albumin


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Laboratory Studies

Imaging Studies

Radiological examinations

ex : Thoracic radiography

Other Tests

Skin test

Procedures

Lumbar puncture

Urine catheterization or vesical puncture


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Complications

Tongue abnormality

Short stature

Hypopigmentation

Immune deficiency

Red cell production

reduced

Mental and physical

retardation

DEATH


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Treatment

Prevent and treat the following: Hypoglycemia

Hypothermia Dehydration

Electrolyte imbalance

Infection

Micronutrient deficiencies

Provide special feeds for the following:

Initial stabilization Catch-up growth

Provide loving care and stimulation

Prepare for follow-up after discharge

Th

e guidelinesh

igh

ligh

t 10 steps for routine management of ch

ildren with

malnutrition (HB

O)


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Treatment

Treatment consists of keeping the child warm andgiving a high-energy, protein-rich diet.

Correct the electrolyte imbalance followed by agradual feeding program

Treatment does not limit only in supplementingdietary needs but also includes treatment forimpending infections and diseases.

Nutritional management of the acute phase ofsevere marasmus (week 1)

Rehabilitation phase (weeks 2-6)


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Follow up

Child Appropriate weight forheight (-1 standard deviation [SD])

Eating well and gaining weight Infections properly treated

Immunization started

Mother Able to look after the child

Able to prepare appropriate food

Able to provide home treatment for diarrhea Able to recognize the signs that mean she must seek medical

assistance

Health care worker - Able to ensure the follow-up care of thechild


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Prevention

Maintain nutritional status of infants and children at

highest possible level

Reducing risk and effects of infection

Nutritional health education

y Nutritional rehabilitation along with mothers' education and

family planning are primary essentials.

y Mothers be encouraged breast-feeding and to keep contactwith the maternity and child health clinics.


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Prevention

Educational programs for girls

Sanitation programs Nutritional programs

Programs that integrate breastfeeding promotion,

diarrhea and infection therapy, and improvement

of the nutritional status of mothers and pregnant

women


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Prevention

y Teaching parents :

y the causes of malnutritiony how to prevent its recurrence

y correct feeding

y how to treat diarrhea and other infections.

y They have much to learn and needconsiderable care from the medical staff.


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Prognosis

y Except for complications mentioned above,

prognosis of even severe marasmus is goodif treatment and follow-up care are correctly

applied.

Persistent marasmus can cause permanentmental handicap and impaired growth.


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Conclusion

y Marasmus, and malnutrition in general, represents

multiple deficiencies, and multiple etiologies.

Therefore, epidemiological, public health, and

therapeutic approaches must be comprehensive.

y Nutritional rehabilitation along with mothers'

education and family planning are primary

y essentials.


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Thank You

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Protein Disease (III)