Protein Energy Malnutrition PEM

 

Protein Energy Malnutrition
PEM

 

 

Protein energy malnutrition

Definition:

   It is a range of pathological conditions arising from coincidental lack of proteins and calories, in varying proportions, occurring most frequently in infants and young children.

•       PEM takes several forms

 

MARASMUS

•       Marasmus is severe PEM characterized by body weight less than 60% of the average for age.

•       It is mainly caused by inadequate but more or less balanced diet deficient in both proteins and calories.

Clinical manifestations

•         Growth failure:

    Weight is less than 60% of the expected average for age.

•         Loss of subcutaneous fat:

    old face appearance.

•         Muscle wasting:

•         General: anxious look, irritable and have good appetite.

•         Associated infections:

    UTI and Otitis Media

•         Micronutrient deficiency:

    Iron deficiency anemia and vitamin A and D deficiencies may be present.

Complications:

•       Complication of diarrhea as dehydration and electrolyte disturbances.

•       Infections: infection in Marasmus may have silent course with no fever.

•       Hypoglycemia.

•       Hypothermia.

•       Mental sub normality.

Prognosis

•       Death rate: 1 – 2% of those who is severely that will need admission.

•       Death occurs due to dehydration or infections.

KWASHIORKOR

•         Kwashiorkor is a sever form of PEM characterized by under weight between 60 – 80% of the expected average for age and edema

 

•         It occurs mainly due to provision of inadequate, unbalanced diet, deficient mainly in proteins and consist mainly of carbohydrates

 

•         It usually develops in the weaning and post-weaning period (The weanling dilemma)

Clinical manifestations

•          Under weight, weight between 60 –80% of the average for age.

 

•          Edema. It is evident on the feet, lower parts of legs and dorsum of the hands. The cheeks become bulky, pale waxy in appearance.

 

•          Subcutaneous fat is preserved.

 

•          There is generalized muscle wasting.

 

•          General: Miserable look, apathetic and not interested in the surroundings. There is anorexia and general weakness .

 

•          MOON FACE.

 

•          Hair changes: Hair is sparse, brittle and depigmented.

.

•          SKIN DEPIGMENTATION.

 

•          ANAEMIA

 

Complications:

•       Complications of diarrhea as dehydration and electrolyte disturbances.

•       Infections.

•       Hypothermia.

•       Hypoglycemia

•       Heart failure 

Marasmic Kwashiorkor Management

Initial Phase:

•     Involves resuscitation, treatment of infection and correction of disordered metabolism. (electrolyte imbalance, specific deficiencies, hypoglycemia, hypothermia, dehydration, heart failure and shock)

 

•    Bacterial infection must treated with broad spectrum antibiotics.

 

•     supplements of vitamin A and folic acid are also recommended.

 

•     Iron is contraindicated because of its potential toxicity and aggravation of infection

•     Rehabilitation Phase

•     Increased appetite and improvement of major abnormalities including loss of edema.

•     The principles of management change to include feeding to appetite, stimulating emotional and physical development and preparing for home

•     At this stage, the formula feed is changed to one that provides more energy and protein for growth

•     supplementary iron is necessary during this phase for new hemoglobin synthesis.

 Follow-Up Phase commences

•     Home management, when the child has reached –1 SD weight-for-length or height, equivalent to 90% of WHO reference

•     Ideally, the child is recalled or visited at increasing intervals for up to 3 years to ensure that recurrence of malnutrition is prevented and that healthy physical and mental development is promoted, supported and achieved.