Child Malnutrition in Families With Substance Abuse Usage

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Malnutrition in children in resource-limited countries

Malnutrition is a clinical state caused past an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute astringent malnutrition are ARE Number Needed to Treat marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema Edema Edema is a status in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into two types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema ). Malnutrition is nigh always associated with an underlying disease procedure, which tin exist classified into 4 categories: decreased nutrient intake, decreased assimilation Absorption Absorption involves the uptake of food molecules and their transfer from the lumen of the GI tract beyond the enterocytes and into the interstitial space, where they tin can be taken upward in the venous or lymphatic circulation. Digestion and Absorption of micronutrients and macronutrients, increased food loss, and increased free energy expenditure Free energy expenditure Free energy expenditure is the sum of internal heat produced and external work. Energy Homeostasis . The clinical presentation of marasmus varies based on severity, duration of caloric restriction, and vitamin/mineral deficiencies. The clinical presentation of kwashiorkor includes peripheral pitting edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical weather. Information technology tin exist categorized into ii types, namely, peripheral (in the extremities) and internal (in an organ or body crenel). Edema , muscle cloudburst, and abdominal distention. Anthropometry is essential in the diagnosis of malnutrition. The 3-pace approach to treat malnutrition includes resuscitation, rehabilitation, and relapse prevention.

• September 29, 2021
• 6:19 am

Table of Contents

Overview

Definition

Malnutrition is a clinical state with an imbalance, a deficiency, or an excess of a wide range of nutrients and energy.

• Marasmus:
  • Inadequate caloric/nutrient intake
  • Low weight-to-height ratio (< three standard deviations of the mean Hateful Mean is the sum of all measurements in a data fix divided by the number of measurements in that data ready. Measures of Central Tendency and Dispersion for age)
  • Muscle wasting and reduced adipose tissue Adipose tissue Adipose tissue is a specialized blazon of connective tissue that has both structural and highly circuitous metabolic functions, including free energy storage, glucose homeostasis, and a multitude of endocrine capabilities. There are three types of adipose tissue, white adipose tissue, brown adipose tissue, and beige or "brite" adipose tissue, which is a transitional grade. Adipose Tissue
• Kwashiorkor:
  • Protein deficiency
  • Unremarkably sufficient calories (compensated diet)
  • Classic finding: edema Edema Edema is a condition in which backlog serous fluid accumulates in the torso cavity or interstitial infinite of connective tissues. Edema is a symptom observed in several medical weather. It can be categorized into ii types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema due to lack of intravascular colloid Colloid Colloid solutions include large proteins or cells that exercise not readily cantankerous capillary membranes. They remain in the ecf and do not distribute into the icf (similar to crystalloids). Intravenous Fluids pressure

Two forms of severe acute malnutrition: edematous (kwashiorkor) and nonedematous (marasmus) malnutrition

Image: "Clinical picture" by Department of Nutrition, Practice and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark. License: CC Past 4.0

Epidemiology

• Global prevalence Prevalence The full number of cases of a given disease in a specified population at a designated time. Information technology is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency for acute malnutrition:
  • Moderate malnutrition: 32.vii million children
  • Severe wasting: xiv.iii million children < 5 years of age
• Primarily in resource-limited regions (eastward.g., South Asia and sub-Saharan Africa)

Etiology

Malnutrition is oftentimes associated with underlying affliction and tin can be conceptually categorized into four broad etiological categories:

• Decreased intake:
  • Lack of availability
  • Lack of admission (e.m., difficulty physically reaching food and chewing food)
• Decreased absorption Absorption Absorption involves the uptake of nutrient molecules and their transfer from the lumen of the GI tract beyond the enterocytes and into the interstitial space, where they can be taken upward in the venous or lymphatic apportionment. Digestion and Assimilation of micronutrients/macronutrients ( malabsorption Malabsorption General term for a group of malnutrition syndromes caused past failure of normal abdominal absorption of nutrients. Malabsorption and Maldigestion ):
  • Chronic diarrhea Diarrhea Diarrhea is defined as ≥ three watery or loose stools in a 24-hour menstruum. There are a multitude of etiologies, which tin can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.1000., watery, bloody, steatorrheic, mucoid) can assist guide further diagnostic evaluation. Diarrhea
  • Lack of small bowel area
• Increased loss and/or a alter in energy requirements:
  • Pregnancy Pregnancy The status during which female mammals conduct their developing young (embryos or fetuses) in utero before birth, get-go from fertilization to birth. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care
  • Enterocutaneous fistula Fistula Abnormal communication most usually seen betwixt two internal organs, or between an internal organ and the surface of the body. Anal Fistula
• Increased energy expenditure Energy expenditure Free energy expenditure is the sum of internal rut produced and external work. Energy Homeostasis :
  • Hypermetabolic states ( hyperthyroidism Hyperthyroidism Hypersecretion of thyroid hormones from the thyroid gland. Elevated levels of thyroid hormones increment basal metabolic rate. Thyrotoxicosis and Hyperthyroidism )
  • Specific pathological states (e.1000., all-encompassing burns Burns A burn is a blazon of injury to the skin and deeper tissues acquired by exposure to heat, electricity, chemicals, friction, or radiation. Burns are classified according to their depth as superficial (1st-caste), partial-thickness (2nd-degree), full-thickness (3rd-degree), and 4th-degree burns. Burns , cardiac dysfunction, and caput injury)

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Clinical Presentation

Pathological changes caused by malnutrition

• Basal metabolic charge per unit ↓ by 30%
• ↓ Protein synthesis Synthesis Polymerase Chain Reaction (PCR)
• Sodium Sodium A member of the alkali group of metals. Information technology has the atomic symbol na, diminutive number 11, and atomic weight 23. Hyponatremia - potassium Potassium An element in the brine group of metals with an atomic symbol thousand, diminutive number xix, and diminutive weight 39. 10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte that plays a significant role in the regulation of fluid volume and maintenance of the h2o-electrolyte rest. Hyperkalemia pump dysfunction → increased intracellular sodium
• Endocrine:
  • ↓ Insulin Insulin Insulin is a peptide hormone that is produced past the beta cells of the pancreas. Insulin plays a role in metabolic functions such as glucose uptake, glycolysis, glycogenesis, lipogenesis, and poly peptide synthesis. Exogenous insulin may exist needed for individuals with diabetes mellitus, in whom at that place is a deficiency in endogenous insulin or increased insulin resistance. Insulin product
  • ↓ Insulin Insulin Insulin is a peptide hormone that is produced by the beta cells of the pancreas. Insulin plays a role in metabolic functions such equally glucose uptake, glycolysis, glycogenesis, lipogenesis, and protein synthesis. Exogenous insulin may be needed for individuals with diabetes mellitus, in whom there is a deficiency in endogenous insulin or increased insulin resistance. Insulin -like growth factor (IGF) production
  • ↑ Cortisol production

Clinical presentation of marasmus

Clinical presentation varies based on severity, duration of caloric brake, and presence of vitamin/mineral deficiencies.

Individuals present with:

• Failure to thrive Failure to Thrive Failure to thrive (FTT), or faltering growth, describes suboptimal weight gain and growth in children. The majority of cases are due to inadequate caloric intake; all the same, genetic, infectious, and oncological etiologies are also mutual. Failure to Thrive :
  • Low weight for height
  • Decreased mid-upper arm Arm The arm, or "upper arm" in mutual usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (inductive and posterior). Arm circumference (MUAC)
• Loss of adipose tissue Adipose tissue Adipose tissue is a specialized type of connective tissue that has both structural and highly complex metabolic functions, including free energy storage, glucose homeostasis, and a multitude of endocrine capabilities. In that location are three types of adipose tissue, white adipose tissue, brown adipose tissue, and biscuit or "brite" adipose tissue, which is a transitional form. Adipose Tissue :
  • Begins in the groin Groin The external junctural region between the lower office of the abdomen and the thigh. Male Genitourinary Test or axilla Axilla The axilla is a pyramid-shaped space located between the upper thorax and the arm. The axilla has a base, an apex, and 4 walls (inductive, medial, lateral, posterior). The base of operations of the pyramid is made up of the axillary skin. The apex is the axillary inlet, located between the 1st rib, superior edge of the scapula, and clavicle. Axilla and Brachial Plexus → buttocks, face, and thigh Thigh The thigh is the region of the lower limb plant betwixt the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into iii fascial compartments. Thigh
  • Full general appearance: shrunken and wasted
• Signs unique to infants:
  • Sunken fontanelle Fontanelle Any of six membrane-covered openings betwixt the cranial sutures in the incompletely ossified skull of the fetus or newborn baby. The fontanelles commonly close erstwhile after birth. Skull ( dehydration Dehydration The status that results from excessive loss of h2o from a living organism. Volume Depletion and Dehydration )
  • Irritability
  • Apathy Apathy Lack of emotion or emotional expression; a disorder of motivation that persists over time. Wernicke Encephalopathy and Korsakoff Syndrome /torpor
• Symptoms of marasmus associated with vitamin/mineral deficiencies:
  • Vitamin A deficiency Vitamin A Deficiency A nutritional status produced by a deficiency of vitamin A in the diet, characterized by night incomprehension and other ocular manifestations such equally dryness of the conjunctiva and after of the cornea (xerophthalmia). Vitamin a deficiency is a very mutual problem worldwide, especially in developing countries as a consequence of famine or shortages of vitamin a-rich foods. In the United States information technology is found amongst the urban poor, the elderly, alcoholics, and patients with malabsorption. Fatty-soluble Vitamins and their Deficiencies : dry eyes and Bitot spots
  • Iron Iron A metallic chemical element with atomic symbol iron, diminutive number 26, and atomic weight 55. 85. It is an essential constituent of hemoglobins; cytochromes; and fe-binding proteins. Information technology plays a role in cellular redox reactions and in the transport of oxygen. Trace Elements deficiency and anemia Anemia Anemia is a condition in which individuals have depression Hb levels, which can arise from diverse causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of jiff, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview : spoon nail (koilonychia)
  • Hypocalcemia Hypocalcemia Hypocalcemia, a serum calcium < eight.5 mg/dL, can event from various conditions. The causes may include hypoparathyroidism, drugs, disorders leading to vitamin D deficiency, and more. Calcium levels are regulated and affected by dissimilar elements such as dietary intake, parathyroid hormone (PTH), vitamin D, pH, and albumin. Presentation can range from an asymptomatic (mild deficiency) to a life-threatening status (acute, pregnant deficiency). Hypocalcemia : hyperreflexia
    • Chvostek'southward sign: twitching of the facial muscles in response to tapping over the surface area of the facial nerve Facial nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the inductive two-thirds of the tongue and for touch from the external ear. Overview of the 12 Cranial Nerves .
    • Trousseau'south sign: carpopedal spasm caused by inflating the blood-pressure gage to a level above systolic pressure for 3 minutes
• Calcium and vitamin D deficiency Vitamin D Deficiency A nutritional status produced past a deficiency of vitamin D in the nutrition, insufficient production of vitamin D in the skin, inadequate absorption of vitamin D from the nutrition, or aberrant conversion of vitamin D to its bioactive metabolites. It is manifested clinically every bit rickets in children and osteomalacia in adults. Fat-soluble Vitamins and their Deficiencies : bone Bone Os is a meaty type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and fundamental bone marrow. The 2 primary types of bone are meaty and spongy. Construction of Bones deformities including rickets Rickets Disorders acquired by break of bone mineralization manifesting as osteomalacia in adults and characteristic deformities in infancy and babyhood due to disturbances in normal bone formation. The mineralization process may be interrupted by disruption of vitamin d; phosphorus; or calcium homeostasis, resulting from dietary deficiencies, or acquired, or inherited metabolic, or hormonal disturbances. Osteomalacia and Rickets and/or osteomalacia Osteomalacia Disorder caused by an interruption of the mineralization of organic os matrix leading to os softening, bone pain, and weakness. It is the adult course of rickets resulting from disruption of vitamin d; phosphorus; or calcium homeostasis. Osteomalacia and Rickets
• Long-standing marasmus:
  • Stunted growth
  • Symptoms of anemia Anemia Anemia is a condition in which individuals accept low Hb levels, which tin arise from various causes. Anemia is accompanied past a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and rickets Rickets Disorders acquired by interruption of os mineralization manifesting every bit osteomalacia in adults and characteristic deformities in infancy and childhood due to disturbances in normal bone formation. The mineralization procedure may be interrupted by disruption of vitamin d; phosphorus; or calcium homeostasis, resulting from dietary deficiencies, or acquired, or inherited metabolic, or hormonal disturbances. Osteomalacia and Rickets
  • Harm of cardiovascular function → hypotension Hypotension Hypotension is divers as low blood pressure level, specifically < ninety/60 mm Hg, and is about commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the crusade. Hypotension , hypothermia Hypothermia Hypothermia tin can be divers every bit a driblet in the core body temperature below 35°C (95°F) and is classified into mild, moderate, severe, and profound forms based on the caste of temperature subtract. Hypothermia , and bradycardia

Bitot spots resulting from vitamin A deficiency

Image: "Bitot spots" past Professor of Ophthalmology, Higher of Medicine, University of Ibadan, Nigeria. License: CC BY 2.0

Clinical presentation of kwashiorkor

Individuals present with:

• Peripheral pitting edema Edema Edema is a condition in which excess serous fluid accumulates in the torso crenel or interstitial infinite of connective tissues. Edema is a symptom observed in several medical conditions. It can exist categorized into two types, namely, peripheral (in the extremities) and internal (in an organ or trunk crenel). Edema :
  • Gravity-dependent edema Edema Edema is a condition in which excess serous fluid accumulates in the body crenel or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It tin can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or trunk crenel). Edema : begins in the lower extremities and moves cranially
  • Symmetrical
• Significant musculus cloudburst
• Abdominal distention (with or without dilatation of the bowel loop and hepatomegaly)
• Circular face with prominent cheeks Cheeks The part of the face that is below the eye and to the side of the nose and oral fissure. Melasma
• Skin changes:
  • Dryness
  • Thinning
  • Peels easily
  • Confluent areas of scaling and hyperpigmentation Hyperpigmentation Excessive pigmentation of the skin, commonly as a effect of increased epidermal or dermal melanin pigmentation, hypermelanosis. Hyperpigmentation tin can exist localized or generalized. The condition may arise from exposure to calorie-free, chemicals or other substances, or from a primary metabolic imbalance. Malassezia Fungi
  • Lesions and dermatitis Dermatitis Any inflammation of the skin. IPEX Syndrome in the perineum, groin Groin The external junctural region betwixt the lower function of the abdomen and the thigh. Male Genitourinary Test , limbs, ears, and armpits
• Hair changes:
  • Dryness
  • Hypopigmentation Hypopigmentation A condition caused by a deficiency or a loss of melanin pigmentation in the epidermis, as well known as hypomelanosis. Hypopigmentation tin be localized or generalized, and may issue from genetic defects, trauma, inflammation, or infections. Malassezia Fungi
  • Falls out/hands plucked
• Growth retardation
• Fat retention in the subcutaneous peel Skin The peel, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily equanimous of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily equanimous of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin is accompanied by loose peel Skin The skin, also referred to every bit the integumentary organisation, is the largest organ of the body. The pare is primarily equanimous of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Part of the Pare folds in the inner inguinal skin Skin The skin, besides referred to as the integumentary system, is the largest organ of the trunk. The peel is primarily equanimous of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily equanimous of keratinocytes that undergo rapid turnover, while the dermis contains dumbo layers of connective tissue. Structure and Office of the Skin .

A child with kwashiorkor: Ascites Ascites Ascites is the pathologic accumulation of fluid inside the peritoneal cavity that occurs due to an osmotic and/or hydrostatic pressure imbalance secondary to portal hypertension (cirrhosis, heart failure) or non-portal hypertension (hypoalbuminemia, malignancy, infection). Ascites atomic number 82 to protruding abdomen.

Image: "Kwashiorkor" by Av TKnoxB/Flickr. License: CC Past 2.0

Diagnosis

Malnutrition

Accurate anthropometry is essential in malnutrition diagnosis:

• Vertical-length precision: 0.5 cm
• Weight precision: 100 grand
• MUAC precision: 2 mm or less

Laboratory tests to consider:

• Hemoglobin and CBC
• Claret smear Blood smear Myeloperoxidase Deficiency
• Blood glucose Glucose A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its gratuitous land. Information technology is used therapeutically in fluid and food replacement. Lactose Intolerance
• Serum albumin Albumin Serum albumin from humans. It is an essential carrier of both endogenous substances, such as fat acids and bilirubin, and of xenobiotics in the claret. Liver Function Tests
• Stool microscopy and culture (ova and eggs included)
• Urine Urine Liquid by-product of excretion produced in the kidneys, temporarily stored in the bladder until discharge through the urethra. Bowen Disease and Erythroplasia of Queyrat microscopy and culture
• HIV testing HIV testing Diagnosis of HIV infections past assaying bodily fluids or tissues for the presence of HIV antibodies; HIV antigens; or the viral RNA of HIV. HIV Infection and AIDS
• Fe Iron A metallic chemical element with atomic symbol fe, atomic number 26, and atomic weight 55. 85. It is an essential elective of hemoglobins; cytochromes; and iron-binding proteins. It plays a role in cellular redox reactions and in the transport of oxygen. Trace Elements studies
• Folic acid level
• Vitamin B₁₂ level

Marasmus

Diagnosis made if:

• MUAC < 115 mm OR
• Weight-for-summit Z score > 3 standard deviations below the mean Mean Mean is the sum of all measurements in a information set divided by the number of measurements in that data gear up. Measures of Central Trend and Dispersion
• Investigate pitting edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical atmospheric condition. It can be categorized into ii types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema to dominion out kwashiorkor.

Kwashiorkor

• Depression MUAC
• Symmetrical pitting edema Edema Edema is a condition in which excess serous fluid accumulates in the body crenel or interstitial space of connective tissues. Edema is a symptom observed in several medical weather. It tin be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema
• Other diagnostic criteria for kwashiorkor:
  • Hair hypopigmentation
  • Cheilosis
  • Dermatitis

Management

Stepwise arroyo

Divided into 3 primary phases:

1. Resuscitation and stabilization of the individual (approximately one week):
   • Goals:
     • Treatment and prevention of dehydration Dehydration The condition that results from excessive loss of h2o from a living organism. Volume Depletion and Dehydration and correction of electrolyte imbalances:
       • The sodium in normal saline Normal saline A crystalloid solution that contains 9. 0g of sodium chloride per liter of water. It has a variety of uses, including: equally a contact lens solution, in ophthalmic solutions and nasal lavage, in wound irrigation, and for fluid therapy. Intravenous Fluids solution is as well high and the potassium Potassium An chemical element in the alkali grouping of metals with an atomic symbol grand, atomic number 19, and atomic weight 39. 10. It is the chief cation in the intracellular fluid of musculus and other cells. Potassium ion is a strong electrolyte that plays a meaning role in the regulation of fluid book and maintenance of the water-electrolyte remainder. Hyperkalemia is also depression.
       • ReSoMal (REhydration SOlution for MALnutrition) is a customized solution administered orally or through a nasogastric tube, which contains the exact amount of electrolytes Electrolytes Electrolytes are mineral salts that dissolve in h2o and dissociate into charged particles chosen ions, which tin exist either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for various bones life-sustaining functions. Electrolytes , minerals Minerals Electrolytes , water, and sugar needed.
     • Handling and prevention of infection:
       • Individuals may not nowadays with an overt response to sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, information technology is called severe sepsis. When sepsis is accompanied past hypotension despite acceptable fluid infusion, it is chosen septic daze. Sepsis and Septic Shock .
       • Give antibiotics to individuals with suspected infection.
     • Handling and prevention of hypothermia Hypothermia Hypothermia tin exist defined equally a drop in the core trunk temperature below 35°C (95°F) and is classified into mild, moderate, severe, and profound forms based on the caste of temperature subtract. Hypothermia
   • Prevention of refeeding syndrome Refeeding syndrome A status of metabolic imbalance that is caused by complications of initially feeding a severely malnourished patient likewise aggressively. Usually occurring within the outset 5 days of refeeding, this syndrome is characterized by h2o-electrolyte imbalance; glucose intolerance; cardiac arrhythmias; and diarrhea. Failure to Thrive :
     • Nutrition should be delivered at a dull rate with a caloric intake betwixt 60% and lxxx% of age-specific needs.
     • Hypoglycemia Hypoglycemia Hypoglycemia is an emergency status defined as a serum glucose level ≤ seventy mg/dL (≤ 3.9 mmol/Fifty) in diabetic patients. In nondiabetic patients, there is no specific or defined limit for normal serum glucose levels, and hypoglycemia is defined mainly past its clinical features. Hypoglycemia is a risk of refeeding syndrome Refeeding syndrome A condition of metabolic imbalance that is caused by complications of initially feeding a severely malnourished patient too aggressively. Ordinarily occurring inside the first five days of refeeding, this syndrome is characterized by h2o-electrolyte imbalance; glucose intolerance; cardiac arrhythmias; and diarrhea. Failure to Thrive : Recommend continuous nasogastric feeds or small meals at night to avert hypoglycemia.
     • Administer thiamine and oral phosphate Phosphate Inorganic salts of phosphoric acrid. Electrolytes to prevent hypophosphatemia Hypophosphatemia A status of an abnormally low level of phosphates in the blood. Bartter Syndrome .
2. Nutritional rehabilitation (2–6 weeks):
   • Caloric intake can exist increased to 120%–140% of age-specific requirements.
   • Administrate needed vaccinations.
   • Encourage increased motor activeness.
   • Mother/child bonding is beneficial to opposite developmental filibuster and provide sensory stimulation and emotional back up.
3. Follow-upwards and prevention of recurrence:
   • Educate the caregiver (especially for breastfeeding Breastfeeding Breastfeeding is often the primary source of nutrition for the newborn. During pregnancy, hormonal stimulation causes the number and size of mammary glands in the breast to significantly increase. After delivery, prolactin stimulates milk production, while oxytocin stimulates milk expulsion through the lactiferous ducts, where it is sucked out through the nipple by the infant. Breastfeeding considerations and supplemental feeding).
   • Infectious disease control and a continuous supply of adequate nutrition and clean drinking water are ARE Number Needed to Treat crucial.

Primal considerations:

• Fluid imbalance is a significant upshot in kwashiorkor:
  • Rehydrate vigilantly.
  • Ambitious rehydration may cause acute middle failure and astringent hypovolemia, resulting in shock Stupor Shock is a life-threatening condition associated with dumb apportionment that results in tissue hypoxia. The unlike types of stupor are based on the underlying crusade: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock and death.
• If an baby is < half dozen months of age, a MUAC < 110 mm is highly associated with mortality Bloodshed All deaths reported in a given population. Measures of Health Status .

Complications

Refeeding syndrome

• Intracellular/extracellular electrolytes Electrolytes Electrolytes are mineral salts that dissolve in water and dissociate into charged particles chosen ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for diverse bones life-sustaining functions. Electrolytes and fluid levels are ARE Number Needed to Treat abnormal in malnourished individuals.
• Feeding and hydration performed too rapidly cause unexpected shifts in fluids and electrolytes Electrolytes Electrolytes are mineral salts that dissolve in h2o and dissociate into charged particles called ions, which tin can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in different concentrations. Electrolytes are essential for diverse basic life-sustaining functions. Electrolytes .
• Hallmarks of refeeding syndrome Refeeding syndrome A condition of metabolic imbalance that is caused by complications of initially feeding a severely malnourished patient also aggressively. Ordinarily occurring within the outset 5 days of refeeding, this syndrome is characterized by h2o-electrolyte imbalance; glucose intolerance; cardiac arrhythmias; and diarrhea. Failure to Thrive :
  • Edema
  • Seizures Seizures A seizure is abnormal electrical activity of the neurons in the cognitive cortex that can manifest in numerous ways depending on the region of the brain affected. Seizures consist of a sudden imbalance that occurs between the excitatory and inhibitory signals in cortical neurons, creating a net excitation. The 2 major classes of seizures are focal and generalized. Seizures
  • Rhabdomyolysis Rhabdomyolysis Rhabdomyolysis is characterized by muscle necrosis and the release of toxic intracellular contents, particularly myoglobin, into the circulation. Rhabdomyolysis
  • Hypophosphatemia
  • Hypokalemia Hypokalemia Hypokalemia is defined as plasma potassium (K+) concentration < three.five mEq/L. Homeostatic mechanisms maintain plasma concentration between three.5-five.2 mEq/L despite marked variation in dietary intake. Hypokalemia tin be due to renal losses, GI losses, transcellular shifts, or poor dietary intake. Hypokalemia

Cardiac and pulmonary implications

• Cardiac muscle Cardiac musculus The muscle tissue of the heart. It is composed of striated, involuntary muscle cells connected to form the contractile pump to generate blood flow. Types of Muscle Tissue mass Mass Iii-dimensional lesion that occupies a space within the chest Breast Imaging reduction → cardiac output Cardiac output The volume of blood passing through the centre per unit of time. It is usually expressed as liters (volume) per infinitesimal so as not to be dislocated with stroke book (volume per beat). Cardiac Mechanics decreases → decrease in renal perfusion and glomerular filtration rate Glomerular filtration charge per unit The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. Kidney Function Tests
• Weakened diaphragmatic and respiratory muscle function → reduction in cough pressure and decreased secretion Secretion Coagulation Studies expectoration → delayed respiratory tract infection recovery

Gastrointestinal consequences

• Pancreatic insufficiency
• Altered abdominal permeability, villous architecture, and intestinal blood catamenia Blood flow Blood flow refers to the motility of a sure volume of blood through the vasculature over a given unit of time (east.g., mL per minute). Vascular Resistance, Flow, and Hateful Arterial Pressure :
  • Ion and fluid secretions occur in the small-scale and large bowel.
  • The colon Colon The large intestines constitute the last portion of the digestive organisation. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal culvert. The primary function of the colon is to remove water and meaty the stool prior to expulsion from the body via the rectum and anal culvert. Colon, Cecum, and Appendix loses the ability to reabsorb water and electrolytes Electrolytes Electrolytes are mineral salts that deliquesce in h2o and dissociate into charged particles called ions, which can be either be positively (cations) or negatively (anions) charged. Electrolytes are distributed in the extracellular and intracellular compartments in unlike concentrations. Electrolytes are essential for various bones life-sustaining functions. Electrolytes .
• Leads to diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour menstruation. There are a multitude of etiologies, which can exist classified based on the underlying machinery of affliction. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) tin can help guide further diagnostic evaluation. Diarrhea → high bloodshed rate Mortality rate Calculated as the ratio of the total number of people who die due to all causes over a specific fourth dimension menses to the total number of people in the selected population. Measures of Health Status in severely malnourished
• Individuals may develop ileus Ileus A condition caused past the lack of intestinal peristalsis or intestinal motion without any mechanical obstacle. This interference of the flow of intestinal contents often leads to intestinal obstruction. Ileus may be classified into postoperative, inflammatory, metabolic, neurogenic, and drug-induced. Small-scale Bowel Obstruction , lactase Lactase An enzyme which catalyzes the hydrolysis of lactose to d-galactose and d-glucose. Defects in the enzyme cause lactose intolerance. Digestion and Absorption of Carbohydrates deficiency, or bacterial overgrowth, which may progress to septicemia and death.

Immunity and wound healing Wound healing Wound healing is a physiological process involving tissue repair in response to injury. Information technology involves a complex interaction of various prison cell types, cytokines, and inflammatory mediators. Wound healing stages include hemostasis, inflammation, granulation, and remodeling. Wound Healing

• Impaired cell-mediated immunity Cell-mediated immunity Manifestations of the immune response which are mediated past antigen-sensitized T-lymphocytes via lymphokines or direct cytotoxicity. This takes identify in the absence of circulating antibody or where antibody plays a subordinate role. Squamous Cell Carcinoma and altered cytokine, complement, and phagocyte office → increased gamble of infection
• Delayed wound healing Wound healing Wound healing is a physiological procedure involving tissue repair in response to injury. It involves a complex interaction of various prison cell types, cytokines, and inflammatory mediators. Wound healing stages include hemostasis, inflammation, granulation, and remodeling. Wound Healing is observed in malnourished surgical individuals.

Psychosocial impact

• Apathy Aloofness Lack of emotion or emotional expression; a disorder of motivation that persists over time. Wernicke Encephalopathy and Korsakoff Syndrome
• Depression
• Neglect of cocky
• Anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling equally with anxiety disorders. Generalized Anxiety Disorder

Differential Diagnosis

• Human immunodeficiency Immunodeficiency Chédiak-Higashi Syndrome virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The nomenclature of viruses is circuitous and based on many factors, including blazon and structure of the nucleoid and capsid, the presence of an envelope, the replication bike, and the host range. Virology: Overview (HIV): a single-stranded RNA RNA A polynucleotide consisting essentially of chains with a repeating courage of phosphate and ribose units to which nitrogenous bases are fastened. RNA is unique amid biological macromolecules in that it can encode genetic data, serve as an abundant structural component of cells, and also possesses catalytic activity. RNA Types and Structure virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses tin can exist either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including blazon and structure of the nucleoid and capsid, the presence of an envelope, the replication bike, and the host range. Virology: Overview transmitted sexually or through claret-to-blood contact. The virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded past a protein capsid. Viruses tin can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication bicycle, and the host range. Virology: Overview attacks CD4 T lymphocyte cells, macrophages Macrophages The relatively long-lived phagocytic cell of mammalian tissues that are derived from blood monocytes. Principal types are peritoneal macrophages; alveolar macrophages; histiocytes; kupffer cells of the liver; and osteoclasts. They may further differentiate within chronic inflammatory lesions to epithelioid cells or may fuse to form foreign body giant cells or langhans giant cells. Cells of the Innate Immune Organization , and dendritic cells Dendritic cells Specialized cells of the hematopoietic arrangement that accept co-operative-similar extensions. They are establish throughout the lymphatic system, and in non-lymphoid tissues such equally skin and the epithelia of the intestinal, respiratory, and reproductive tracts. They trap and process antigens, and present them to T-cells, thereby stimulating cell-mediated immunity. They are unlike from the non-hematopoietic follicular dendritic cells, which have a like morphology and immune system function, but with respect to humoral immunity (antibody product). Construction and Function of the Pare leading to immunodeficiency Immunodeficiency Chédiak-Higashi Syndrome . The presentation is marked by constitutional symptoms, such as lymphadenopathy Lymphadenopathy Lymphadenopathy is lymph node enlargement (> ane cm) and is beneficial and self-limited in nigh patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such every bit the use of certain medications. Generalized lymphadenopathy ofttimes indicates underlying systemic affliction. Lymphadenopathy and fever Fever Fever is divers as a measured body temperature of at to the lowest degree 38°C (100.4°F). Fever is acquired past circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever . Immediate treatment with combination antiretroviral therapy Antiretroviral therapy Antiretroviral therapy (Fine art) targets the replication bike of the human immunodeficiency virus (HIV) and is classified based on the viral enzyme or machinery that is inhibited. The goal of therapy is to suppress viral replication to attain the upshot of undetected viral load. Anti-HIV Drugs is recommended.
• Inflammatory bowel illness: a chronic pathological condition of the bowels divided into Crohn's affliction and ulcerative colitis Ulcerative colitis Ulcerative colitis (UC) is an idiopathic inflammatory condition that involves the mucosal surface of the colon. It is a blazon of inflammatory bowel illness (IBD), forth with Crohn's disease (CD). The rectum is always involved, and inflammation may extend proximally through the colon. Ulcerative Colitis . Crohn'due south disease (CD) is a chronic, recurrent condition causing patchy, transmural inflammation Inflammation Inflammation is a circuitous gear up of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the procedure of wound healing. The v cardinal signs of inflammation are hurting, heat, redness, swelling, and loss of role. Inflammation involving whatever part of the GI tract. Ulcerative colitis colitis Inflammation of the colon section of the big intestine, usually with symptoms such every bit diarrhea (often with blood and fungus), abdominal hurting, and fever. Pseudomembranous Colitis ( UC UC Ulcerative colitis (UC) is an idiopathic inflammatory condition that involves the mucosal surface of the colon. It is a type of inflammatory bowel disease (IBD), along with Crohn'south illness (CD). The rectum is e'er involved, and inflammation may extend proximally through the colon. Ulcerative Colitis ) is an idiopathic inflammatory condition involving the mucosal surface of the colon Colon The large intestines found the last portion of the digestive organization. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove h2o and compact the stool prior to expulsion from the torso via the rectum and anal canal. Colon, Cecum, and Appendix . Extraintestinal manifestations of CD include calcium Calcium A bones element found in near all tissues. It is a member of the alkaline metal earth family of metals with the diminutive symbol ca, atomic number twenty, and atomic weight 40. Calcium is the well-nigh arable mineral in the body and combines with phosphorus to class calcium phosphate in the bones and teeth. It is essential for the normal performance of fretfulness and muscles and plays a role in blood coagulation (equally cistron Four) and in many enzymatic processes. Electrolytes oxalate renal stones, gallstones, erythema nodosum Erythema nodosum Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type Four (delayed-type) hypersensitivity reaction. Information technology normally manifests in young women every bit tender, erythematous nodules on the shins. Erythema Nodosum , and arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis . Extraintestinal manifestations of UC UC Ulcerative colitis (UC) is an idiopathic inflammatory condition that involves the mucosal surface of the colon. It is a blazon of inflammatory bowel disease (IBD), forth with Crohn's disease (CD). The rectum is always involved, and inflammation may extend proximally through the colon. Ulcerative Colitis include primary sclerosing cholangitis Primary Sclerosing Cholangitis Primary sclerosing cholangitis (PSC) is an inflammatory disease that causes fibrosis and strictures of the bile ducts. The exact etiology is unknown, merely in that location is a potent association with IBD. Patients typically present with an insidious onset of fatigue, pruritus, and jaundice, which can progress to cirrhosis and complications related to biliary obstruction. Primary Sclerosing Cholangitis , eye inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the primary cellular mediators in the trunk's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of part. Inflammation , oral ulcerations, and erythema nodosum Erythema nodosum Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type 4 (delayed-type) hypersensitivity reaction. Information technology unremarkably manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum .
• Nephrotic syndrome Nephrotic syndrome Nephrotic syndrome is characterized by severe proteinuria, hypoalbuminemia, and peripheral edema. In dissimilarity, the nephritic syndromes present with hematuria, variable loss of renal function, and hypertension, although at that place is sometimes overlap of > 1 glomerular disease in the same individual. Nephrotic Syndrome : a broad category of glomerular diseases characterized by severe proteinuria Proteinuria The presence of proteins in the urine, an indicator of kidney diseases. Nephrotic Syndrome in Children , hypoalbuminemia Hypoalbuminemia A condition in which albumin level in blood (serum albumin) is below the normal range. Hypoalbuminemia may be due to decreased hepatic albumin synthesis, increased albumin catabolism, altered albumin distribution, or albumin loss through the urine (albuminuria). Nephrotic Syndrome in Children , edema Edema Edema is a status in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or torso cavity). Edema , and hyperlipidemia. The clinical presentation of nephrotic syndrome includes edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical weather condition. Information technology tin can be categorized into two types, namely, peripheral (in the extremities) and internal (in an organ or body crenel). Edema (peripheral and periorbital), frothy urine (lipiduria from hyperlipidemia), hypoalbuminemia Hypoalbuminemia A status in which albumin level in claret (serum albumin) is below the normal range. Hypoalbuminemia may be due to decreased hepatic albumin synthesis, increased albumin catabolism, altered albumin distribution, or albumin loss through the urine (albuminuria). Nephrotic Syndrome in Children , and variable Variable Variables stand for information about something that tin change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that information. As a result, a variable can be qualitative or quantitative, and may exist further classified into subgroups. Types of Variables degrees of renal dysfunction. Direction varies with etiology and ordinarily involves glucocorticoids Glucocorticoids Glucocorticoids are a class within the corticosteroid family unit. Glucocorticoids are chemically and functionally similar to endogenous cortisol. There are a wide array of indications, which primarily do good from the antiinflammatory and immunosuppressive effects of this class of drugs. Glucocorticoids .
• Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The ii about common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis : persistent inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the primary cellular mediators in the trunk'southward defense confronting pathogenic organisms. Inflammation is also seen as a response to tissue injury in the procedure of wound healing. The 5 key signs of inflammation are pain, heat, redness, swelling, and loss of role. Inflammation , fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans , and irreversible cell damage to the pancreas Pancreas The pancreas lies mostly posterior to the stomach and extends beyond the posterior abdominal wall from the duodenum on the right to the spleen on the left. This organ has both exocrine and endocrine tissue. Pancreas secondary to multiple etiologies (e.g., tumour, infection, and alcoholism Alcoholism A principal, chronic affliction with genetic, psychosocial, and environmental factors influencing its evolution and manifestations. The disease is often progressive and fatal. Information technology is characterized by dumb control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. Wernicke Encephalopathy and Korsakoff Syndrome ), resulting in a loss of endocrine and exocrine gland part. Individuals ofttimes present with recurrent epigastric intestinal pain Pain An unpleasant sensation induced by baneful stimuli which are detected by nerve endings of nociceptive neurons. Physiology of Pain , nausea, and features of malabsorption Malabsorption General term for a grouping of malnutrition syndromes caused by failure of normal intestinal absorption of nutrients. Malabsorption and Maldigestion syndrome (e.k., diarrhea Diarrhea Diarrhea is divers equally ≥ 3 watery or loose stools in a 24-hour period. In that location are a multitude of etiologies, which tin be classified based on the underlying mechanism of disease. The duration of symptoms (astute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide farther diagnostic evaluation. Diarrhea , steatorrhea Steatorrhea A condition that is characterized past chronic fatty diarrhea, a consequence of abnormal digestion and/or abdominal absorption of fats. Diarrhea , and weight loss Weight loss Decrease in existing body weight. Bariatric Surgery ). Therapy focuses on alcohol cessation, nutrition changes, hurting management Hurting Direction Pain is divers as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is a subjective experience. Acute hurting lasts < three months and typically has a specific, identifiable cause. Pain Management , and treatment of pancreatic insufficiency.

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