HNF

123 Review Material

Summary of Clinical signs indicating or suggesting malnutrition
Nutrient
Body
Clinical Signs
Deficiency/Disorder
Parts/System
Kwashiorkor, Thiamin
Edema
Marasmus, Protein Energy Subcutaneous
Decrease in
Malnutrition (PEM)
subcutaneous fat
Iron
Nails
Koilonychia
Vitamin C
Musculo-skeletal Epiphyseal enlargement
Parietal bossing
Epiphyseal enlargement
Vitamin D
Skeletal
Beading of ribs
Bowlegs
PEM and Kwashiorkor
Muscles
Muscle wasting
Kwashiorkor
Kwashiorkor, PEM

Gastrointestinal

Thiamin

Nervous system

Niacin, Vitamin B12

Thiamin
Anemia (Iron, Folic Acid)
Thiamin

Cardio-vascular

Night blindness
Photophobia
Conjunctival xerosis
Bitots spot

Vitamin A
Eyes
Anemia
Riboflavin, Pyridoxine
deficiency
Hyperlipidemia

Hepatomegaly
Psychomotor changes
Mental confusion and
irritability
Absent reflexes
Sensory changes
Motor changes
Dementia
Cardiac enlargement
Tachycardia

Characteristics
Apparent over the ankles and feet, may extend to other areas of extremities
Most obvious in buttocks
Nails become spoon shaped
Enlarged epiphyseal ends of bones, visible at wrist and ankles
Softening of occipital and parietal bones
Broadening of bone on the wrist (end of radius)
Rosary effect
Abnormal out-curving of the legs, resulting in a gap between the knees on standing
Absence of muscles and fat on buttocks causing skin to fold. Bones all over the
body become prominent
Enlarged liver
Apathy, Listlessness

No reflexes on knee and ankle
Calf tenderness; tingling and burning sensation on hands and feet
Foot drop and impaired ability to squat


Increase in the heart rate above normal

Corneal xerosis
Keratomalacia
Pale conjunctiva
Red and fissures

Difficulty in seeing at night matang manok

Highly sensitive to light
Dry, thick, pigmentation with lack of luster and transparency of the eye ball
Dry, grayish, silvery or chalky, white foamy plaques, often triangular or irregularly
circular in shape usually confined to the regions lateral to the cornea
Cornea is hazy or opaque, with bluish milky appearance
Softening of the cornea which can lead to perforation or iris prolapse
Pallor of mucosa
Eyelid corners red and with fissures

Cornea Arcus
Xanthelasma

White ring surrounding the eye

Small yellowish lumps surrounding the eye

Nutrient
Deficiency/Disorder
Riboflavin

Body
Parts/System
Lips

Iron

Riboflavin
B-complex
Niacin
Flourine
Simple sugar
Vitamin C
Iodine
Starvation, Bulimia
Kwashiorkor
Niacin, Tryptophan
Vitamin C

Tongue

Teeth
Gums
Thyroid
Parotid

Skin

Vitamin A

Hair
Kwashiorkor

Face
Riboflavin

Clinical Signs
Angular stomatitis
Angular scars
Cheilosis
Atrophic papillae (may
also be due to riboflavin,
niacin deficiency)
Magenta tongue
Atrophic papillae
Edema of tongue
Scarlet raw
Fluorosis
Caries or missing teeth
Spongy, bleeding
Thyroid enlargement
Parotid enlargement
Flaky paint dermatosis

Characteristics
Pink lesions at the angles of the mouth
Pink or white scars at the angles of the mouth
Vertical fissuring, later complicated by swelling and ulceration of the lips
Filiform papillae disappear, the tongue is extremely smooth

The tongue is purplish red in color

Indentions are made by pressure of teeth along the edges of the tongue
Tongue is bright red in color, normal size, slightly atrophic and very painful
Diffuse white patches or mottled enamel
Cavities on teeth or teeth that have been pulled out due to cavities
Purplish or red swelling of gum which easily bleed with slight pressure
The gland is palpable or visibly enlarged
Cheeks are swollen
Bilateral hyper pigmented patches which desquamate; resembles a second degree
burn
Pelagrous dermatosis
Symmetrical skin lesions, clearly demarcated, hyperpigmented
Petechiae
Small hemorrhagic spots on skin or mucous membranes
Xerosis (may also be due Generalized dryness
to climate, dirt,
congenital abnormality)
Follicular hyperkeratosis Hyperkeratosis surrounding the mouth or hair follicles
Lacks natural luster
Dull and dry
Thin and sparse
Hair is thin, fine silky texture and sparse
Dyspigmentation
Distinct lightening of color
Flag sign
Alternating bands of light and dark color of the hair
Easy pluckability
A small clump of hair can be easily pulled out using moderate force, without pain
Diffuse depigmentation Lightening of color
Moon face
Uncommon rounded prominence of the cheeks whick protrude over the level of
the nasolabial folds
Nasolabial dyssebacea
Dry greasy lesions