ENVIRONMENTAL

AND
NUTRITIONAL PATHOLOGY

EDGARDO B. PERALTA, M.D.

Lecturer
ENVIRONMENT

OUTDOOR
INDOOR
OCCUPATION
AIR
FOOD
WATER
EXPOSURE
 ENVIRONMENTAL DISEASES
CONDITIONS DUE TO
EXPOSURE TO
CHEMICAL/PHYSICAL
AGENTS IN THE AMBIENT,
WORKPLACE, &
PERSONAL
ENVIRONMENT,
INCLUDING DISEASES OF
NUTRITIONAL ORIGIN
CLIMATE CHANGE

MAIN AGENTS OF
GREENHOUSE
EFFECT: INCREASES
OF CARBON
DIOXIDE, METHANE,
& OZONE
WARMING OF THE EARTH
GLOBAL CHANGES IN CLIMATE CHANGE ARE
PREDICTED TO CAUSE THE GLOBAL TEMPT TO RISE
2 TO 5 DEGREES C BY THE YEAR 2100.
Climate Change-
Increased Incidence of
CVS, CEREBROVASCULAR, &
RESP DISEASES

GASTROENTERITIS

INFECTIOUS DISEASES
DENGUE FEVER
MALARIA

VECTOR-BORNE DISEASES

MALNUTRITION
 REGULATORY AGENCIES:
EPA/DENR PESTICIDES, TOXIC
CHEMICALS, WATER AND AIR
POLLUTANTS, & HAZARDOUS
WASTE
FDA/BFAD DRUGS, MEDICAL
DEVICES, FOOD ADDITIVES, AND
COSMETICS
OSHA/DOLE SAFE CONDITIONS
FOR EMPLOYEES
CPSC/DTI ALL OTHER
PRODUCTS SOLD FOR HOMES,
SCHOOLS, OR RECREATION

OCCUPATIONAL HEALTH RISKS:

INDUSTRIAL & AGRICULTURAL
EXPOSURES
ENVIRONMENTAL POLLUTION
-OUTDOOR AIR POLLUTION

1.SULFUR DIOXIDE
2.CARBON MONOXIDE
3.OZONE
4.NITROGEN DIOXIDE
5.LEAD
6.PARTICULATE MATTER
 UV RADIATION +
OZONE OXYGEN
(STRATOSPHERE) =
OZONE (O3),
WHICH
ACCUMULATES IN
THE OZONE LAYER.
 OZONE THAT
GROUND-LEVEL ACCUMULATES IN
THE LOWER
OZONE ATMOSPHERE IS
ONE OF THE MOST
PERNICIOUS AIR
POLLUTANTS.
OZONE
EVEN LOW LEVELS
OF OZONE MAY BE
DETRIMENTAL TO
THE LUNG
FUNCTION OF
NORMAL
INDIVIDUALS WHEN
COMBINED WITH
OTHER AIR
POLLUTANTS.
SOOT FINE OR ULTRAFINE
PARTICLES < 10 um
MOST HARMFUL
READILY INHALED
INTO THE ALVEOLI
DIESEL
 CARBON SOURCES:
MONOXIDE (CO) 1.AUTOMOTIVE
ENGINES
2.FOSSIL FUELS
3.WOOD & CHARCOAL
BURNING
4.CIGARETTE SMOKE
 LETHAL COMA
WITHIN 5 MINS
CARBON
MONOXIDE SYSTEMIC
ASPHYXIANT
 CARBON HEMOGLOBIN HAS
MONOXIDE 200-FOLD GREATER
AFFINITY FOR CO
THAN FOR OXYGEN, &
THE RESULTANT
CARBOXYHEMOGLOBIN
DOES NOT CARRY
OXYGEN.
INDOOR AIR COMMONEST
POLLUTION OFFENDER-
TOBACCO SMOKE
ADDITIONAL
OFFENDERS:
CO
NITROGEN DIOXIDE
ASBESTOS
VOLATILE
SUBSTANCES WITH
AROMATIC
HYDROCARBONS
INDOOR AIR PREDISPOSES TO
POLLUTION LUNG INFECTIONS
WOOD SMOKE
MAY CONTAIN FAR
MORE DANGEROUS
CARCINOGENIC
POLYCYCLIC
HYDROCARBONS
INDOOR AIR MICROBIOLOGIC
POLLUTION AGENTS CAUSING
BIOAEROSOLS LEGIONNAIRES DSE
VIRAL PNEUMONIA
COMMON COLD

ALLERGENS
PET DANDER
DUST MITES
FUNGI
MOLDS
METALS AS ENVIRONMENTAL
POLLUTANTS
LEAD
MERCURY
ARSENIC
CADMIUM
 SOURCES OF
LEAD EXPOSURE
CONTAMINATED AIR
& FOOD AND
WATER
TOYS WITH LEAD
MINING
FOUNDRIES
BATTERIES
SPRAY PAINTING
FLAKING OLD PAINT
 EFFECTS OF LOW
LEAD POISONING INTELLECTUAL
CAPACITY
BEHAVIORAL
PROBLEMS
(HYPERACTIVITY)
POOR
ORGANIZATIONAL
SKILLS
LEAD POISONING (ABSORBED)
LEAD POISONING:
DEFINITIVE DIAGNOSIS

-DETECTION OF
ELEVATED BLOOD
LEVELS OF LEAD &
FREE (OR ZINC-
BOUND) RED CELL
PROTOPHORPHYRINS
LEAD POISONING LEAD COLIC
(GIT)- EXTREMELY
SEVERE, POORLY
LOCALIZED
ABDOMINAL PAIN
KIDNEYS- PROXIMAL
TUBULAR DAMAGE
WITH
INTRANUCLEAR
LEAD INCLUSIONS
SATURNINE
GOUT
 USES
MERCURY PIGMENT IN CAVE
PAINTINGS
COSMETIC
REMEDY FOR
SYPHILIS
COMPONENT OF
DIURETICS

MOT OF
POISONING:
INHALATION
 MERCURY TREMOR
POISONING GINGIVITIS
MAIN SOURCES OF
EXPOSURE: BIZARRE BEHAVIOR
1.contaminated fish
(methyl mercury)-
swordfish, shark,
bluefish
2.Dental amalgams
3.Gold mining
 SOURCES
ARSENIC 1.SOILS & WATER
2.WOOD
PRESERVERS,
HERBICIDES
3.ARSENIC TRIOXIDE
(USED IN THE
TREATMENT OF
RELAPSING ACUTE
PROMYELOCYTIC
LEUKEMIA)
BANGLADESH
ARSENIC
POISONING
DUE TO WATER
CONTAMINATED BY
ARSENIC
 ARSENIC SEVERE
DISTURBANCES OF
POISONING
GIT
INGESTION OF LARGE CARDIOVASCULAR
QUANTITIES CENTRAL NERVOUS
SYSTEM

OFTEN FATAL

NEUROLOGIC
EFFECTS- 2 TO 3 WKS
AFTER EXPOSURE
(SENSORIMOTOR
NEUROPATHY)
 OCCUPATIONAL &
CADMIUM ENVIRONMENTAL
POLLUTANT
GENERATED BY
MINING
ELECTROPLATING
PRODUCTION OF
NICKEL-CADMIUM
BATTERIES
(DISPOSED OF AS
HOUSEHOLD
WASTE)
OCCUPATIONAL HEALTH RISKS
WORK-RELATED ACCIDENTS ARE THE
BIGGEST PROBLEM IN DEVELOPING
COUNTRIES
IRRITATION OF THE RESPIRATORY MUCOSA
FORMALDEHYDE/ AMMONIA FUMES

LUNG CANCER
ASBESTOS, ARSENIC, URANIUM MINING

LEUKEMIA
CHRONIC EXPOSURE TO BENZENE
 ORGANIC ACUTE EXPOSURE
DIZZINESS &
SOLVENTS CONFUSION
CHLOROFORM CNS DEPRESSION
COMA
CARBON LOWER LEVELS
TETRACHLORIDE TOXIC FOR THE
LIVER & KIDNEYS
RISK OF LEUKEMIA
RUBBER WORKERS
EXPOSED TO
BENZENE & 1,3-
BUTADIENE
HUMAN DISEASES ASSOCIATED
WITH OCCUPATIONAL
EXPOSURE TO BENZENE:
LEUKEMIA
 POLYCYCLIC RELEASED DURING
HYDROCARBONS THE COMBUSTION
OF FOSSIL FUELS,
WHEN COAL & GAS
ARE BURNED AT
HIGH
TEMPERATURES
(STEEL FOUNDRIES)
IN TAR, SOOT,
CHIMNEY SWEEPS
 * DIOXIN EXPOSURE
-INTENTIONAL DIOXIN
* Seveso, Italy (1976) EXPOSURE OF A FUTURE
PRESIDENT OF UKRAINE
 NONPESTICIDE SOURCES
DIOXIN
ORGANOCHLORINES PCB (POLYCHLORINATED
BIPHENYLS)

USED AS PESTICIDES
DDT
LINDANE
ALDRIN
DIELDRIN

MOST ARE ENDOCRINE

DISRUPTORS WITH ANTI-
ESTROGENIC OR WITH
ANDROGENIC ACTIVITY
PNEUMOCONIOSES
ASBESTOS THE INCREASED
EXPOSURE RISK OF CANCER AS
A RESULT OF
ASBESTOS
EXPOSURE EXTENDS
TO THE FAMILY
MEMBERS OF
ASBESTOS WORKERS
& TO OTHER
INDIVIDUALS
EXPOSED OUTSIDE
THE WORKPLACE.
HUMAN DISEASES
ASSOCIATED WITH
OCCUPATIONAL
EXPOSURE:

LIVER
ANGIOSARCOMA
SMOKING
DELAYING THE AGE AT WHICH SMOKING IS
INITIATED REDUCES THE FUTURE RISK OF
LUNG & OTHER TYPES OF CANCER
CESSATION OF SMOKING GREATLY REDUCES,
WITHIN 5 YEARS THE
OVERALL MORTALITY
RISK OF DEATH FROM CARDIOVASCULAR
DISEASES
POTENTIALLY NOXIOUS
CHEMICALS IN TOBACCO SMOKE
DISEASES:
1.EMPHYSEMA
2.CHRONIC BRONCHITIS
3.COPD
4.LUNG CANCER
5.ATHEROSCLEROSIS, MI
6.CANCERS-LIP, MOUTH,
PHARYNX, ESOPHAGUS,
PANCREAS, BLADDER,
KIDNEY, & CERVIX
SMOKING
MULTIPLIES THE RISK OF OTHER
CARCINOGENIC INFLUENCES (ASBESTOS
WORKERS & URANIUM WORKERS- SMOKING
INCREASES THE RISK OF LUNG CANCER 10-
FOLD)
THE RISK OF DEVELOPING LUNG CANCER IS
RELATED TO THE
INTENSITY OF EXPOSURE (PACK YEARS)
CIGARETTES SMOKED PER DAY
MATERNAL INCREASES THE
SMOKING RISK OF
SPONTANEOUS
ABORTIONS
PRETERM BIRTHS
INTRAUTERINE
GROWTH
RETARDATION
 PASSIVE THE RELATIVE RISK
SMOKING OF LUNG CANCER IN
NONSMOKERS
EXPOSED TO
ENVIRONMENTAL
SMOKE IS ABOUT 1.3
TIMES HIGHER THAN
THAT OF
NONSMOKERS WHO
ARE NOT EXPOSED
TO SMOKE.
 EXCESSIVE
ALCOHOL AMOUNTS OF
ALCOHOL CAUSES
SERIOUS PHYSICAL
& PHYSIOLOGICAL
DAMAGE.
<10% OF ETHANOL
INGESTED IS
EXCRETED
UNCHANGED IN THE
URINE, SWEAT, AND
BREATH.
 CHRONIC
ALCOHOLICS CAN
RATE OF TOLERATE TO LEVELS
UP TO 700 mg/dL
METABOLISM
-AFFECTS THE BLOOD EFFECTS OF
ALCOHOL LEVEL ALCOHOL ALSO VARY
BY
AGE
SEX
BODY FAT
ACUTE
ADVERSE EFFECTS OF ALCOHOL
CNS- STIMULATION & DISORDERED
CORTICAL, MOTOR, &
INTELLECTUAL
BEHAVIOR
-DEPRESSANT
-RESPIRATORY ARREST

FATTY CHANGE, LIVER

ACUTE GASTRITIS & ULCERATION

CHRONIC ALCOHOLISM
SHORTENED LIVER
SPAN
DAMAGE TO THE
LIVER
GIT
CNS
CARDIOVASCULAR
SYSTEM
PANCREAS
CHRONIC ALCOHOLISM
CIRRHOSIS HPN
INC RISK FOR DEVT OF CORONARY HEART DSE
HEPATOCELLULAR
CARCINOMA PANCREATITIS
ESOPHAGEAL VARICES FETAL ALCOHOL
SYNDROME
GASTRITIS
INC CANCER INCIDENCE
GASTRIC ULCER
MALNUTRITION &
THIAMINE DEFICIENCY NUTRITIONAL
DEFICIENCIES (EMPTY
CALORIES)
INJURY BY THERAPEUTIC DRUGS
ADVERSE DRUG REACTIONS (ADRs)
-UNTOWARD EFFECTS
-10% ARE FATAL
 HORMONAL MOST COMMON TYPE:
ESTROGEN WITH
REPLACEMENT PROGESTERONE
THERAPY USED IN
POSTMENOPAUSAL
WOMEN TO
PREVENT/SLOW THE
PROGRESSION OF
OSTEOPOROSIS
REDUCE THE
LIKELIHOOD OF
MYOCARDIAL
INFARCTION
ORAL CONTRACEPTIVES
ASSOC WITH
THROMBOEMBOLISM
MI
ENDOMETRIAL &
OVARIAN CANCERS
HEPATIC ADENOMA
ANABOLIC SYNTHETIC
STEROIDS VERSIONS OF
TESTOSTERONE
USED AT DOSES
THAT ARE 10 TO 100
TIMES HIGHER
THAN THERAPEUTIC
INDICATIONS
 TOXICITY:
ACETAMINOPHEN NAUSEA, VOMITING
DIARRHEA
SHOCK
JAUNDICE
LIVER FAILURE
(SERIOUS OVERDOSE)

TREATMENT OF
OVERDOSES
WITHIN 12 HRS: N-
ACETYLCYSTEINE
 ASPIRIN
(ACETYLSALICYLIC CAUSES OF
OVERDOSE
ACID)
ACCIDENTAL
INGESTION
EXCESSIVE USE OF
OINTMENTS WITH
OIL OF
WINTERGREEN
(METHYL
SALICYLATE)
 ACUTE ALKALOSISMETABOLIC
SALICYLATE ACIDOSIS
OVERDOSAGE NAUSEACOMA
INGESTION MAY BE
FATAL:
2 TO 4 gm IN CHILDREN
10 TO 30 gm BY ADULTS
 3 GRAMS OR > DAILY
FOR LONG PERIODS OF
CHRONIC ASPIRIN TIME FOR TREATMENT
OF CHRONIC PAIN OR
TOXICITY INFLAMMATORY
(SALICYLISM) CONDITIONS
HEADACHES, DIZZINESS
TINNITUS, HEARING
IMPAIRMENT
MENTAL CONFUSION,
DROWSINESS
NAUSEA, VOMITING,
DIARRHEA
SALICYLISM
CONVULSIONS PETECHIAL
HEMORRHAGES- SKIN &
COMA INTERNAL VISCERA
ACUTE EROSIVE BLEEDING FROM
GASTRITIS GASTRIC ULCERATION
GIT BLEEDING ANALGESIC
NEPHROPATHY
GASTRIC ULCERATION
TUBULOINTERSTITIAL
BLEEDING TENDENCY NEPHRITIS WITH RENAL
PAPILLARY NECROSIS
 DRUG ABUSE
DRUG ABUSE, ADDICTION,
AND OVERDOSE ARE
SERIOUS PUBLIC HEALTH
PROBLEMS
RISK FACTORS: FAMILY
HISTORY, MALE SEX,
PSYCHIATRIC DISORDERS,
ETHANOL ABUSE, EASY
ACCESS TO DRUGS, AND
PEER PRESSURE
 INTENSE EUPHORIA &
STIMULATION
COCAINE PROFOUND PSYCHOLOGIC
WITHDRAWAL
CRYSTALLIZATION YIELDS
NUGGETS OF CRACK
MORE POTENT
 COCAINE HYPERPYREXIA,
-ACUTE OVERDOSAGE SEIZURES

LETHAL
ARRHYTHMIAS
MYOCARDIAL
ISCHEMIA
CORONARY ARTERY
VASOCONSTRICTION
RESPIRATORY ARREST
CHRONIC COCAINE USE
-NASAL SEPTUM PERFORATION
(SNORTERS)
 EUPHORIA
HEROIN EFFECTS HALLUCINATIONS
SOMNOLENCE
SEDATION
NEUROLOGIC,
RENAL, & AUDITORY
TOXICITY
 HEROIN SUDDEN DEATH DUE TO
PROFOUND
-ADVERSE EFFECTS RESPIRATORY
DEPRESSION
ARRHYTHMIA
CARDIAC ARREST

SEVERE PULMONARY
EDEMA
SEPTIC EMBOLISM
INFECTIONS IN THE
SKIN & SUBCUTANEOUS
TISSUE, HEART VALVES,
LIVER, & LUNGS
 HEROIN
-ADVERSE EFFECTS

VIRAL HEPATITIS
CUTANEOUS LESIONS-
MOST FREQUENT
TELLTALE SIGN
RENAL PROBLEMS
METHAMPHETAMINE
FEELING OF EUPHORIA Amphetamines
FF BY A CRASH
LONG-TERM USE:
VIOLENT BEHAVIORS,
CONFUSION, PSYCHOTIC
FEATURES: PARANOIA &
HALLUCINATIONS

MDMA OR ECSTASY
-TAKEN ORALLY
 MARIJUANA
MARIJUANA, MARY JANE,
DAMO
THC-
TETRAHYDROCANNABINOL-
active ingredient
POTENTIAL USES
TREAT NAUSEA IN CANCER
CHEMOTHERAPY
DECREASE PAIN IN SOME
CHRONIC CONDITIONS
 MARIJUANA
DISTORTS SENSORY PERCEPTION
IMPAIRS MOTOR COORDINATION
COGNITIVE & PSYCHOMOTOR IMPAIRMENTS
INABILITY TO JUDGE TIME, SPEED, &
DISTANCE
ANGINA IF WITH CORONARY HEART DISEASE
CHRONIC EFFECTS: LARYNGITIS,
PHARYNGITIS, BRONCHITIS, COUGH,
HOARSENESS, ASTHMA-LIKE SYMPTOMS,
AIRWAY OBSTRUCTION
CARCINOGENIC
 TOLUENE
-EFFECTS OF
GLUE SNIFFING

COGNITIVE
ABNORMALITIES
BRAIN DAMAGE
MILD TO SEVERE
DEMENTIA
INJURY BY MECHANICAL
PHYSICAL TRAUMA
AGENTS THERMAL INJURY
ELECTRICAL INJURY
INJURY PRODUCED
BY IONIZING
RADIATION
THERMAL INJURY
EXCESSIVE HEAT &
EXCESSIVE COLD
ARE IMPORTANT
CAUSES OF INJURY.

BURNS- MOST
COMMON CAUSE OF
THERMAL INJURY
THERMAL BURNS CLINICAL
-FIRE OR SCALDING SIGNIFICANCE
DEPENDS ON
DEPTH OF BURNS
% OF BODY
SURFACE
INTERNAL INJURIES
FR INHALATION OF
HOT & TOXIC
FUMES
PROMPTNESS &
EFFICACY OF
THERAPY
CAUSE OF DEATH SHOCK
IN SEPSIS
BURNS
RESPIRATORY
INSUFFICIENCY
 GENERALIZED EDEMA
BURNS PULMONARY EDEMA
HYPERMETABOLIC
STATE
CANDIDA, S. AUREUS
PNEUMONIA, SEPTIC
SHOCK WITH RENAL
FAILURE &/ACUTE
RESP DISTRESS
SYNDROME
 BURNS

PSEUDOMONAS AERUGINOSA
 BURN
SURVIVORS
HYPERTROPHIC
SCARS
AT THE SITE OF
THE ORIGINAL
BURN
AT DONOR GRAFT
SITES

ITCHING
FULL-THICKNESS
BURNS

WHITE OR CHARRED
DRY
ANESTHETIC (DUE
TO DESTRUCTION
OF NERVE ENDINGS)
PARTIAL-THICKNESS
BURNS
PINK OR MOTTLED
BLISTERS
PAINFUL
HYPERTHERMIA DUE TO LOSS OF
-HEAT CRAMPS ELECTROLYTES VIA
SWEATING
CRAMPING OF
VOLUNTARY
MUSCLES WITH
VIGOROUS
EXERCISE
(HALLMARK)
HYPERTHERMIA ASSOCIATED WITH
-HEAT STROKE HIGH AMBIENT
TEMPERATURES
HIGH HUMIDITY
EXERTION

LEADS TO MULTI-
ORGAN DYSFUNCTION
THAT CAN BE RAPIDLY
FATAL
HYPERTHERMIA
-HEAT STROKE

HYPERKALEMIA
TACHYCARDIA

ARRHYTHMIAS
NECROSIS OF
MUSCLES
(RHABDOMYOLYSIS)
& MYOCARDIUM
 FREQUENTLY IN
HYPOTHERMIA HOMELESS PERSONS
CAUSES
HIGH HUMIDITY
WET CLOTHING
DILATION OF
SUPERFICIAL
BLOOD VESSELS
FROM ALCOHOL
INGESTION
 90 DEGREES
HYPOTHERMIA FAHRENHEIT
LOSS OF
CONSCIOUSNESS
BRADYCARDIA
ATRIAL FIBRILLATION
AT LOWER CORE
TEMPERATURES
ELECTRICAL INJURIES
LIGHTNING MARKS
LINEAR ARBORIZING
BURNS
 ELECTRICAL INJURIES

TRANSMITTED INTERNALLY
EXPLODE SOLID ORGANS,
FRACTURE BONES, CHAR
AREAS OF ORGANS
LESS INTENSE VOLTAGE
HEMORRHAGES,
INFARCTIONS, OR RUPTURES
 ALPHA PARTICLES
INJURY
INDUCE HEAVY
PRODUCED BY DAMAGE
IONIZING
X-RAYS & GAMMA
RADIATION RAYS
LESS DAMAGE PER
UNIT TISSUE
EFFECTS OF IONIZING RADIATION
CARCINOGENESIS- INC INCIDENCE OF
SKIN
LUNG
LEUKEMIA
OSTEOSARCOMA
IN OCCUPATIONAL OR ACCIDENTAL
EXPOSURE

CHILDRENS EXPOSURE: BREAST,

THYROID, GIT TUMORS
EFFECTS OF RADIATION THERAPY
- SHRINK TUMOR MASS
- RELIEVE PAIN OR COMPRESSION OF
ADJACENT TISSUES
- NEUTROPHIL & PLATELET
DEPRESSION
- STERILITY
- 2O MALIGNANCY
- DELAYED RADIATION INJURY
 SOLAR RADIATION: UV,
ULTRAVIOLET VISIBLE, & INFRARED
RADIATION RADIATION
UV MAY BE UVA, UVB, &
UVC
OZONE-COMPLETELY
ABSORBS ALL UVC;
PARTIALLY, UVB
WINDOW GLASSES-
ABSORBS UBV, TRANSMIT
UVA
SUNBLOCKS-ABSORBS
UVB & UVA-VARIABLE
DEGREES
 ULTRAVIOLET RADIATION
REPEATED
EXPOSURES
PREMATURE AGING
(WRINKLING-
SOLAR ELASTOSIS,
IRREGULAR
PIGMENTATION)
CANCER
CHANGES IN ATMOSPHERIC
PRESSURE

HIGH-ALTITUDE ILLNESS

>4000M LOW O2
PRESSURE MENTAL
OBTUNDATION, INC
CAPILLARY
PERMEABILITY
PULMONARY EDEMA
BLAST INJURY

VIOLENT INC IN
PRESSURE EITHER IN
ATMOSPHERE (AIR
BLAST) OR
WATER (IMMERSION
BLAST)

COLLAPSE THE
THORAX OR
COMPRESS
ABDOMEN
RUPTURE OF
INTERNAL ORGANS
 DECOMPRESSION (CAISSON)
DISEASE
DEEP-SEA DIVERS &
UNDERWATER WORKERS;
ASCENT
 COMMON CAUSES OF
UNDERNUTRITION IN U.S.
1. IGNORANCE & POVERTY HOMELESS, AGED, CHILDREN
OF THE POOR

2. CHRONIC ALCOHOLISM VITAMIN DEF.

3. ACUTE & CHRONIC ILLNESSES INCREASED BMR

4. SELF IMPOSED DIETARY RESTRICTION ANOREXIA

NERVOSA, BULIMIA NERVOSA
PROTEIN-ENERGY MALNUTRITION
RANGE OF CLINICAL SYNDROMES WITH
INADEQUATE DIETARY INTAKE OF PROTEIN &
CALORIES TO MEET BODY NEEDS
2 PROTEIN COMPARTMENTS
SOMATIC-SKELETAL MUSCLE, MORE IN
MARASMUS
VISCERAL-LIVER, MORE IN KWASHIORKOR
PROTEIN-ENERGY MALNUTRITION
DIAGNOSIS
COMPARE WEIGHT FOR HEIGHT IN PERCENTILE
EVALUATION OF FAT STORES
MUSCLE MASS
SERUM PROTEINS
CHILD WITH WEIGHT <80% OF NORMAL
MALNOURISHED
 SEVERE REDUCTION IN CALORIC INTAKE
GREATER THAN 60% REDUCTION IN BODY
WT ADJUSTED FOR HEIGHT & SEX
CATABOLISM & DEPLETION OF SOMATIC
PROTEIN COMPARTMENT MARASMUS
GROWTH RETARDATION & LOSS OF MUSCLE
MASS
VISCERAL PROTEIN ARE DEPLETED ONLY
MARGINALLY-SERUM ALBUMIN N OR
SLIGHTLY DECREASED
EXTREMITIES ARE EMACIATED, ANEMIA,
MULTIVITAMIN DEFICIENCY, IMMUNE
DEFICIENCY-T CELL MEDIATED IMMUNITY
INFECTIONS
 KWASHIORKOR
PROTEIN DEPRIVATION>REDUCTION IN TOTAL
CALORIES
MOST COMMON FORM SEEN IN AFRICAN CHILDREN-
WEANED TOO EARLY & FED EXCLUSIVELY CHO DIET
SEEN IN PROTEIN-LOSING ENTEROPATHIES,
NEPHROTIC SYNDROME, OR AFTER EXTENSIVE
BURNS
MORE SEVERE FORM OF MALNUTRITION
SEVERE LOSS OF VISCERAL PROTEIN
HYPOALBUMINEMIAEDEMA
WEIGHT-60-80% OF NORMAL
 KWASHIORKOR
SKIN LESIONS FLAKY PAINT
DERMATITIS

HAIR CHANGES-FLAG SIGN

ENLARGED FATTY LIVER

TENDENCY TO DEVELOP EARLY

APATHY, LISTLESSNESS & LOSS
OF APPETITE

DEFECTS IN IMMUNITY & 2O

INFECTIONS
FUNCTIONS
MAINTAIN NORMAL
VISION IN REDUCED
LIGHT
DIFFERENTIATION OF
SPECIALIZED
EPITHELIAL CELLS-
MUCUS SECRETING
ENHANCING
IMMUNITY TO
INFECTIONS IMPORTANT DIETARY
SOURCES:LIVER, FISH, EGGS,
MILK, BUTTER, YELLOW &
GREEN LEAFY VEGETABLES-
CARROTS, SQUASH, SPINACH
VITAMIN A
DEFICIENCY
NIGHT BLINDNESS-
ONE OF THE
EARLIEST
MANIFESTATION

SQUAMOUS
METAPLASIA:
RESPIRATORY & UT

IMMUNE DEFICIENCY
 DEFICIENCY STATES
XEROPHTHALMIA-DRY EYE
XEROSIS-DRYNESS OF CONJUCTIVAE-
METAPLASIA OF LACRIMAL & MUCUS-
SECRETING EPITHELIUM
BITOTS SPOT-BUILD UP OF KERATIN
DEBRIS IN SMALL OPAQUE PLAQUES
KERATOMALACIA-SOFTENING &
DESTRUCTION OF CORNEA
 VITAMIN A TOXICITY
ACUTE-HEADACHE, VOMITING,
STUPOR, PAPILLEDEMA
CHRONIC-WT LOSS, NAUSEA,
VOMITING, DRYNESS OF MUCOSA OF
THE LIPS, BONE & JOINT PAIN,
HEPATOMEGALY
TERATOGENIC IN PREGNANT
STIMULATE OSTEOCLAST
FORMATION OSTEOPOROSIS
FRACTURES
 VITAMIN D
MAINTENANCE OF NORMAL PLASMA LEVELS OF CALCIUM &
PHOSPHORUS

2 POSSIBLE SOURCES: ENDOGENOUS SYNTHESIS IN SKIN-

80%, DIET-20%

DEEP SEA FISH, PLANTS & GRAINS

FUNCTIONS: STIMULATES INTESTINAL ABSORPTION OF

CALCIUM & PHOSPHORUS, COLLABORATES WITH PTH IN
MOBILIZATION OF CALCIUM FROM BONE, STIMULATES PTH
DEPENDENT REABSORPTION OF CALCIUM IN THE DISTAL
RENAL TUBULES
 VITAMIN D
DEFICIENCY STATES
RICKETS-CHILDREN
OSTEOMALACIA-ADULTS
HYPOCALCEMIC TETANY
VITAMIN D DEFICIENCY
CRANIOTABES, FRONTAL
BOSSING, & SQUARED
APPEARANCE TO THE HEAD
PIGEON BREAST DEFORMITY
HARRISONS GROOVE
LUMBAR LORDOSIS AND BOWING
OF LEGS
RACHITIC ROSARY
OSTEOPENIA LOSS OF
SKELETAL MASS
THIAMINE DEFICIENCY
POLYNEUROPATHY DRY BERI-
BERI TOE, FOOT, & WRIST
DROP

CARDIOVASCULAR SYNDROME
WET BERI-BERI PERIPHERAL
VASODILATATION HIGH-
OUTPUT FAILURE EDEMA

WERNICKE-KORSAKOFF
SYNDROME (ENCEPHALOPATHY
PSYCHOSIS)
NIACIN DEFICIENCY (PELLAGRA)
DERMATITIS
BILATERAL,
SYMMETRIC
ROUGHENING OF SKIN
SCALING
FISSURES
DIARRHEA ATROPHY OF
COLUMNAR EPITHELIUM
OF GIT
DEMENTIA
 ASCORBIC ACID
ANTIOXIDANT
DEFICIENCY:
SCURVY
HEMORRHAGES
HEALING DEFECTS IN BOTH
CHILDREN & ADULTS
 ZINC DEFICIENCY
ESSENTIAL FEATURES
1. GROWTH RETARDATION
2. IMPAIRED WOUND HEALING
3. HYPOGONADISM
4. ALTERED IMMUNE FUNCTION
5. IMPAIRED NIGHT VISION
6. DEPRESSED MENTAL FUNCTION
7. INCREASED INCIDENCE OF CONGENITAL
MALFORMATIONS IN ZINC DEFICIENT MOTHER
ZINC DEFICIENCY
CAUSED BY TOTAL
PARENTERAL NUTRITION
UNSUPPLEMENTED BY
ZINC OR GENETIC
SYNDROME THAT
INTERFERES WITH
ABSORPTION
 Obesity

CENTRAL OR VISCERAL
OBESITY
SKINFOLD MEASUREMENTS
MEDICAL COMPLICATIONS OF
OBESITY