Protein Calorie Malnutrition

Subject: Community Health Nursing II

Overview

A variety of medical conditions are categorized as protein-calorie malnutrition, which is most frequently observed in infants and young children and is typically linked to infection. In line with WHO Protein and calorie malnutrition types Marasmus 1. Kwashiorkor 2. Marasmic kwashiorkor 3. 1. Energy deficiency is the primary cause of marasmus. The child doesn't consume enough nutritious food or carbohydrates. These youngsters are frequently compared to "little old men." Marasmus can happen at any age, but it most frequently affects children between the ages of 9 months and 3 years. Children with marasmus often cry a lot, are lethargic, have very thin arms, legs, and hands, and have exposed ribs that make them appear older. Marasmus management includes regular checkups, a healthy supply of a well-balanced diet, treatment of disease, daily weight, etc. Kwashiorkor 2. sometimes referred to as dietary edema and infantile pellagra. Protein malnutrition is a condition brought on by a lack of protein. Symptoms include being overweight, having a moon-like look, losing 80% of one's body weight for one's age, having edema in the lower limbs, being weak and hypotonic, having an enlarged abdomen, etc. Marasmic 3. Kwashiorkor: Youngster The combined signs and symptoms of marasmus and kwashior are known as marasmic kwashiorkor. A child is severely underweight if their weight is under 60% of what is normal for their age. Symptoms and signs: Weight that is less than 60% of the allowed weight, frequent sobbing, an enlarged abdomen, and edema.Management of mild to moderate protein-energy malnutrition includes educating parents about nutrition, providing nourishing meals as needed, identifying the underlying causes and treating them, regular checkups, and anthropometry measurements. Treatment for severe protein-energy malnutrition includes admitting the child to the hospital, keeping the child warm with warm clothing and blankets, and treating hypoglycemia with 1-2 ml or 5-10 ml/kg of 50 dextrose solution intravenously (IV). If dehydration develops, it should be treated, and additional vitamins and minerals should be added, and weight should be taken every day. preventative action 1. A measure for expectant and nursing mothers ( education, disturb of supplement ). 2. Support for breastfeeding 3. Efforts to enhance family nutrition. 4. Family preparation

A variety of clinical conditions that result from a concomitant shortage of protein and calories in varied proportions are referred to as protein-calorie malnutrition. These conditions are most frequently found in infants and young children, and they are typically accompanied by infection. - WHO

One of the biggest issues is it. It is a pathological disorder with a protein and calorie shortage and an infection-related association.

Types of protein calorie malnutrition:

Marasmus:

The main cause of marasmus is energy deficiency. The child doesn't consume enough nutritious food or carbohydrates. As a result, the youngster loses muscle mass as the muscle protein is consumed for energy. These youngsters are frequently compared to "little old men."

Marasmus can happen at any age, but it most frequently affects children between the ages of 9 months and 3 years. However, the first year of life is when the incidence is at its highest.

Sign and symptoms:

  • The youngster has extremely thin limbs and legs, hands that appear to be too big for their bodies, exposed ribs, and a "little old person's" countenance from the loss of the fat from beneath the skin.
  • The child is passive and weeps frequently.
  • Less than 60% of the normal weight for their age, the youngster is externally underweight.
  • The youngster is always crying and agitated.
  • Diarrhea that has persisted for a while may occasionally be the cause of the visit to the health professional.

Management of marasmus

  • Routine examination and anthropometry measurements
  • Provide the nourishing food if necessary.
  • Treat them if they are ill if they are.
  • Determine the underlying causes and address them.
  • Give the parents information on nutrition.
  • Everyday weigh yourself.
  • Additional vitamins and minerals.

Kwashiorkor

Dr. Cicely Williams coined the phrase "kwashiorkor" in 1935, which translates to "sickness of the misplaced kid." When the disease was first discovered, it was also known as infantile pellagra and nutritional edema because the cause of the condition was not entirely understood. When it was discovered that kwashiorkor was caused by a protein deficiency in the diet, the phrase protein-energy malnutrition was later used; however, when it was discovered how crucial a calorie deficit was in the etiology of this disorder, the name was altered to "protein calorie malnutrition."

Sign and symptoms

  • Has a moon face and a chubby, clubby appearance, yet closer inspection reveals muscular atrophy over the buttocks and thighs.
  • The youngster weighs less than 80% of what is typical for his or her age, while this can occasionally happen when there is significant edema.
  • Edema starts out moderate on the lower limbs before spreading later.
  • The infant is unable to stand or walk and appears feeble and hypotonic.
  • In addition to cracking lips, discomfort in the mouth corner, and smoothness of the tongue, hair becomes thin, dull, and breaks easily.
  • Children typically cry intermittently, are uninterested in anything depressing, and refuse to eat.

Marasmic kwashiorkor

The combined signs and symptoms of marasmus and kwashiorkor are known as marasmic kwashiorkor. The child's weight is dangerously below 60% of what is normal for his or her age.

Sign and symptoms

  • A combination of the marasmus and kwashiorkor signs and symptoms.
  • Less than 60% of the allowed weight in weight.
  • Frequently sobs.
  • Has some edema and perhaps an enlarged abdomen.

Management of mild to moderate PEM

  • Instructing parents in nutrition
  • The provision of nourishing nourishment as required.
  • Treat them if they are ill, if necessary.
  • Identify the contributing elements and address them.
  • Routine examination and anthropometry measurements

Management of severe PEM

  • The hospital should take the youngster in.
  • Warm the room, the child's clothing, and the blanket to keep the child warm.
  • If hypoglycemia is evident, administer 1-2 ml of 50 dextrose solution per kg of body weight through IV as soon as the patient is admitted, or 5–10 ml.
  • If signs of dehydration occur, treat them.
  • Supplement of additional minerals and vitamins.
  • Everyday weigh yourself.
  • Parents should receive nutritional instruction.

Preventive measure

  • Women who are pregnant or nursing should take this measure ( education, disturb of supplement ).
  • Encouraging breastfeeding
  • Measures to enhance family nutrition.
  • Birth spacing and family planning.
  • Diarrhea and infection should be treated quickly.
  • Healthy children who are afflicted are dewormed

REFERENCE

  • Ambika Rai, Kabita Dahal. Community Health Nursing II. Kathmandu: Makalu Publication House, 2012 (reprint).
  • Basavan Thappa Bt, 2005, Community Health Nursing, JAYPEE BROTHERS medical Publisher (P) Ltd, New Delhi
  • Dr.Suwal S.N. & Tuitui R. (2063) A Textbook of Community Health Nursing, 1st edition, Vidyarthi Prakashan (P). Ltd. Kamalpokhari, Kathmandu
  • Endres J.B & Rockwell R.E. (1985), 2nd edition, Food, Nutrition & the Young Child, Times Mirror/ Mosby College Publishing, Toronto, USA
  • J.F MC Kenzie, RR Pinger & J.E. Kotecki, 2004, An introduction to community health, 5th edition, Jones & Bartlett
  • MedicineNet. 1996. 2017 http://www.medicinenet.com/script/main/art.asp?articlekey=5085
  • Medscape. 1994. 2017 http://emedicine.medscape.com/article/1104623-overview
Things to remember
  • Protein-calorie malnutrition is defined as a range of pathological condition arising out of coincident lack of protein and energy in varying proportion most frequently seen in infant and young children and usually associated with infection- According to WHO
  • Types of protein calorie malnutrition
  • 1. Marasmus
  • 2. Kwashiorkor
  • 3. Marasmic kwashiorkor

 

  • Marasmus is primarily and energy malnutrition.
  •  These children are often described as looking like "little old men."
  • Marasmus can occur at any age but is more common between the age of 9 months to 3 years of age.
  • Signs and symptoms of marasmus are the children has very thin arms, legs and hands look large, visible ribs seems like old persons, cries frequently, inactive e.t.c.
  • Management of Marasmus: Regular check up, proper supply of nutritious and balanced diet, treatment of illness, daily weighing e.t.c
  •  Kwashiorkor is also known as infantile pellagra and nutritional edema.
  • It is protein energy malnutrition which is caused due to the deficiency of protein in Kwashiorkor.
  • Signs and symptoms of kwashiorkor are at, clubby appearance with the moon like face, weight loss 80% of the expected age, edema in the lower limbs, weak and hypotonic and distended abdomen e.t.c.
  • Marasmic kwashiorkor is the combination of the sign and symptoms of marasmus and kwashiorkor.
  • Signs and Symptoms: 
  • Weight less than 60% of the excepted weight, Cries frequently, and distended abdomen, edema.
Questions and Answers
  • The term "protein calorie malnutrition" refers to a variety of clinical conditions caused by a simultaneous shortage of both protein and energy in variable proportions. These conditions are most frequently found in infants and young children, and they are typically accompanied by infections. - WHO
  • The main cause of marasmus is energy deficiency, which occurs when a kid does not consume enough nutritious foods or carbs. These youngsters are frequently compared to "little old men."
  • Kwashiorkor, a protein energy malnutrition brought on by a lack of protein, is a condition.
  • Sometimes referred to as dietary edema and infantile pellagra.
  • Marasmic Kwashiorkor is the result of combining the marasmus sign and symptoms with kwashiorkor. The youngster is significantly underweight, weighing less than 60% of what is normal for his or her age.

 Signs and symptoms of marasmus are as below:

  1. The child has very thin arms and legs, the hand looks too large for the body, the ribs are visible, and looking like "little old person's " expression due to the loss of pads of fst from under the skin.
  2. The child cries often and is not active.
  3. The child has externally underweight for their age, less than 60% of the expected weight for the age.
  4. The child is crying all the time and irritable.
  5. Sometimes the reason for coming to the health worker may be diarrhea for a prolonged period.

 

 

 

Management of marasmus: 

  1. Regular check up and anthropometry measurement.
  2. Supply the nutritious food, if needed.
  3. If there is any illness, treat them.
  4. Find out the causative factors and treat them.
  5. Give nutrition education to the parents.
  6. Take weight daily.
  7. Supplement of other vitamin andminerals.

Sign and symptoms of kwashiorkor are:

1. Has a fat ,clubby appearance with a moon face but on a closer look wasting of muscle is observed over the buttocks and thighs

 2. The child's weight is less than 80% of the expected for the age sometimes in the presence of servere oedema,the weight may be within the normal range

 3. Oedema is mild in the beginning on the lower limbs buy generalized later on.

 4. The child appears weak and hypotonic who is unable to stand and walk

5. Hait become thin,dull and break easily, cracking of lips, soreness of the vorner of mouth and smoothness of tge tongue.

6. Children are usually unhappy not interested in anything sad with intermittent crying and refuse to take food.

7. May present with mild to severe anemia and cold and pale extremities due to poor circulation.

8. The abdomen is usually distended and the liver may be enlarged.

Sign and symptoms of kwashiorkor marasmic are:

1. Combination of the sign and symptoms of marasmus and kwashiorkor.

2. Weight less than 60% of the excepted weight.

3. Cries frequently.

4. Has some oedema with possibly a distended abdomen.

Management of mild to moderate PEM

_ give nutritional education to parents.

_ supply the nutritious food , as per needed.

_ if there is any illness, treat them.

_ find out the causative factors and treat them.

_ regular check up and anthropometry measurement.

 

Management of severe PEM

_ admit the child in hospital.

_ keep the child warm by warming the room, clothing, covering with a warm blanket.

_ if hypoglycemia is present give 1-2 ml per kg body weight of 50 dextrose solution IV immediately at the time of admission or 5-10 ml/kg dextrose solution IV.

_ if dehydration appears, correct it.

_ supplement of other vitamins and minerals.

_ take weight daily.

_ give the nutritional education to parents.

 

 

Preventive measure for protein energy malnutrition are as follows:

  1. Measure directed to pregnant and lactating women ( education, distrubwof supplement ).
  2. Promotion of breat feeding.
  3. Measures to improve family diet.
  4. Family planning and spacing of birth.
  5. Early diagnosis and treatment of infection and diarrhea.
  6.  Dewarming of healthy infested children

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