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PEM-a ppt

Dr Swati Prashant, MD paediatrics www.paediatrics4all.com drprashntw@gmail.com Index Medical College, Indore,MP,India. PEM-a ppt. Macronutrients. They are necessary for 1)Tissue growth 2) Tissue repair 3)Physical activities 4)Basal metabolic activities of the body.

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PEM-a ppt

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  1. Dr Swati Prashant, MD paediatrics www.paediatrics4all.com drprashntw@gmail.com Index Medical College, Indore,MP,India PEM-a ppt

  2. Macronutrients They are necessary for 1)Tissue growth 2) Tissue repair 3)Physical activities 4)Basal metabolic activities of the body.

  3. Macronut. Cont. Energy (calories ) is received from 1)Carbohydrates 2)Fats 3)Proteins. They are abundant in our body hence called macronutrients.

  4. Proteins • It is 2nd most abundant substance in our body next to water. • Contains 20 different Amino Acids. • Essential and non essential. • 1 gm. Of proteins = 4 kcal. • Diet should contain at least 10% of proteins. • Functions--

  5. Proteins--- • Functions--- • 1)Tissue synthesis • 2)Essential in forming digestive juices ,enzymes , hormones ,plasma proteins ,Hb. ,Vitamins etc . • Powerful buffer. • Source of energy . • Sources---Meat ,eggs ,pulses , cereals ,vegetables.

  6. FATS • They are concentrated source of energy . • Provide insulation • Act as carriers of fat soluble vitamins . • Essential Fatty acids help preventing infection ,myocardial problems ,renal HT. skin disorders etc . • Fats should not exceed >30 % of total diet. • 1 gm fat= 9 kcal.

  7. Carbohydrates • They provide ready to use energy for use. • Helps digestion and assimilation of food. • Protect proteins from being used for energy. • 1 gm =4kcal. • Richest source is grains ,legumes, potatos,fruits etc. • Excess carbs. Converted to glycogen or fats.

  8. Classification OF PEM • 1)IAP class.--- • Grade 1—wt is71-80% of exp. • Grade 2—61-70% • Grade 3---51-60 % • Grade 4---<50 % • If odema is +nt it is eg.PEM GRADE 3 K . • 2 )WHO class. Uses the term stunting and wasting ,which considers weight for height and height for age.

  9. kwashiorkar

  10. Marasmus

  11. Kwashiorkar baby

  12. PEM contd. • Causes--- • 1)poverty • 2)LBW • 3)Infections • 4)Overpopulation • 5)Faulty feeding habits • Social factors---repeated pregnancy ,inadequate spacing, food fads ,broken homes , natural disasters.

  13. The major contributing factors • Diarrhea 20% • ARI 20% • Perinatal causes 18% • Measles 07% • Malaria 05% 55% of the total have malnutrition

  14. Anthropometry • Weight----weight for age, weight for height. • Height for age. • MAC • Chest circum. • Head circum. • Kanawati index • Rao’s index.

  15. MARASMIC BABY

  16. MARASMUS • The term marasmus is derived from the Greek marasmos, which means wasting. • Marasmus involves inadequate intake of protein and calories and is characterized by emaciation. • Marasmus represents the end result of starvation where both proteins and calories are deficient.

  17. MARASMUS/2 • Marasmus represents an adaptive response to starvation, whereas kwashiorkor represents a maladaptive response to starvation • In Marasmus the body utilizes all fat stores before using muscles.

  18. EPIDEMIOLOGY & ETIOLOGY • Seen most commonly in the first year of life due to lack of breast feeding and the use of dilute animal milk. • Poverty or famine and diarrhoea are the usual precipitating factors • Ignorance & poor maternal nutrition are also contributory

  19. MARASMUS • It is caused by qualitative defect in the diet, lack of energy. • Weight for height and age is decreased. • MAC is<12.5 cm. • Chest cir. <head cir. • Height is the last to be affected.

  20. C/F OF Marasmus • Gross WASTING of muscle and subcut. Tissue (emaciated ,monkey look.) • NO ODEMA, • Body wt.< 60 % of expected for age . • Height is STUNTED . • HAIR SPARSE ,THIN , COLOUR CHANGES. • Monkey face ,Oral Ulcers with VIT. Defic. • Irritable ,with a voracious appetite .

  21. C/F cont. • Skin elalstic , dry ,scaly ,prone for infections. • ABDOMEN DISTENDED. • RS—Pneumonia • CVS—decreasd CO ,decreased BP. • Metabolic ---decreased sugar ,calcium pl. pr. • Renal---GFR decrased . • Immunity---decreased cell mediated immunity.

  22. MARASMUS C/F CON. • Fluid and electrolyte imbalance. • Learning disabilities • GIT---Lactose malabsorption, rectal prolapse. • Anemia is always + nt .

  23. Kwashiorkar

  24. ETIOLOGY • Kwashiorkor can occur in infancy but its maximal incidence is in the 2nd yr of life following abrupt weaning. • Kwashiorkor is not only dietary in origin. Infective, psycho-socical, and cultural factors are also operative.

  25. KWASHIORKOR • Cecilly Williams, a British nurse, had introduced the word Kwashiorkor to the medical literature in 1933. The word is taken from the Ga language in Ghana & used to describe the sickness of weaning.

  26. ETIOLOGY (2) • Kwashiorkor is an example of lack of physiological adaptation to unbalanced deficiency where the body utilized proteins and conserve S/C fat. • One theory says Kwash is a result of liver insult with hypoproteinemia and oedema. Food toxins like aflatoxins have been suggested as precipitating factors.

  27. CONSTANT FEATURES OF KWASH • OEDEMA • PSYCHOMOTOR CHANGES • GROWTH RETARDATION • MUSCLE WASTING

  28. USUALLY PRESENT SIGNS • MOON FACE • HAIR CHANGES (Flag sign ) • SKIN DEPIGMENTATION • ANAEMIA

  29. OCCASIONALLY PRESENT SIGNS • HEPATOMEGALY • FLAKY PAINT DERMATITIS • CARDIOMYOPATHY & FAILURE • DEHYDRATION (Diarrh. & Vomiting) • SIGNS OF VITAMIN DEFICIENCIES • SIGNS OF INFECTIONS

  30. Complications of PEMand criterias of admission • Odema , • Severe dehydration ,diarrhoea • hypothermia • Septic shock • Systemic infections • Jaundice • Bleeding • Age<1 YR

  31. Poor prognostic factors • 1)Sr. Albumin <1 gm/ dl. • 2)Sr. Bil. >6mg / dl. • 3)Sr. Sodium-<120 • Mortality---20 %

  32. Management of PEM • Investigations and Treatment • CBC, MP ,Blood group, Total proteins,Urine • Sr.electrolytes , • Stool test • Blood glucose ,calcium. • MT • R/o HIV and other immunity disorders. • X-RAY chest.

  33. Treatment • SHIELDED • Symptomatic-----for temp. ,fluids , antipyretics , skin care. • T/t of Infections. • T/t of Electrolyte imbalance ,ORS ,fluid corr. • Glucose , calcium ,vit D . OTER VITAMINS. • T/t of worms ,TB , dirrhea , pneumonia.

  34. T/t contd. • T/t of Anemia ---start after 1 wk • Iron ---3 mg /kg • Folic acid---1 mg /d • B12 ---100micr gm./d • Vit A—50,000 IU---2 LACS • Vit K---2.5 mg stat • Mgso4—2 ml 50% • Zinc—20 mg /d • Blood transfusion.

  35. T/t cont. • DIET---- • 1)Freq. small feeds • 2)dried skimmed milk +sugar+oil initially. • 3) Diet should give initially 80 kcal/kg /d of energy, and 0.7 gm /kg /d of Proteins. • 4)kcal ^ to 150 to200kcal /kg /d • 5)proteins increased to2-3gms/kg /d. • 6)fluids 100ml /kg /d.

  36. DIET co. Different prep. Should include wheat , rice ,pulses, sugar jaggery ,oil ,ghee fruits veg. Dairy products. Rate of weight gain should be 10 -20 gms. /kg/d. Immunisation , and further diet plan on discharge.

  37. THANK YOU

  38. Thank you all • OUR other websites • Paediatrics4all.com • Pharmacology4students.com • Psm4students.com • Microbiology4students.com • Anatomy4students.com • biochemistry4students.com

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