Protein Disease (III)

Reinita Arlin Puspita 03008202

MARASMUS

Protein Energy Malnutrition

What am I going to present ?

1. 2.

Introduction Explanation :
1. 2. 3. 4. 5. 6.

Epidemiology Symptoms Diagnosis Complications Therapy Prevention

3.

Conclusion

Background


Marasmus is a serious worldwide problem that involves more than 50 million children younger than 3 years. According to the World Health Organization (WHO), 49% of the 10.4 million deaths occurring in children younger than 5 years in developing countries are associated with PEM.

Background


Nearly 30% of humans currently experience one or more of the multiple forms of malnutrition. Close to 50 million children younger than 5 years have PEM, and half of the children who die younger than 5 years are undernourished. Approximately 80% of these malnourished children live in Asia, 15% in Africa, and 5% in Latin America.

Background


Five million children younger than 5 years die every year of malnutrition. Approximately 70 million present with wasting, and 230 million present with some stunting. Fifty percent of the children in Asia are malnourished, 30% are malnourished in Africa, and 20% are malnourished in Latin America.

Introduction


A severe form of protein and energy malnutrition that usually occurs in famine or semi-starvation conditions. In developing countries (over populated regions of world), marasmus is widespread in children under three years of age

Introduction
Greek word ``marasmos' = wasting Severe deprivation of food over a long period Suffering from an inadequate energy and protein intake PEM Most common in infants 6 to 18 months of age. A result of a chronic gross deficiency of calories and an accompanying lack of protein and other nutrients.

    

Introduction
A form of malnutrition caused by a severe deficiency of both protein and calories

Epidemiology
   

Age Sex Social class Seasonal variation PEM may be related to epidemics of diarrheal diseases

Symptoms
    

 

Very low body weight for age (<60% wt for age) failure to gain weight Old mans face Loss of subcutaneous fat Muscles are flabby and relaxed (gross wasting) Brain and skeletal growth continues resulting in a long skinny body & a large head in proportion to weight Total diet deficiency malabsorption Edema (-) hepatic enlargement (-)

Symptoms
         

Slow, chronic Weak heart Brittle hair, skin problems Anxiety, apathy Eyes become sunken Skin appears loose Infant is not active Cry is weak and shrill Dehydration Diarrhoea

Symptoms
  

Mental retardation and learning disabilities. Distributed metabolism which leads to dropping in body temperature. Increased susceptibility to infections due to deficiency of immunoglobulin.

Clinical History


Marasmus is typically observed in infants who are breastfeeding when the amount of milk is markedly reduced or, more frequently, in those who are artificially fed.

Physical Examination
Body temperature Anemia Edema Dehydration Hypovolemic shock Tachypnea Abdominal manifestations Ocular manifestations Dermal manifestations ENT findings Hypothermia as well as fever Pale mucosa (-) Thirst, shrunken eyes Weak radial pulse, cold extremities, decreased consciousness Pneumonia, heart failure Distension, decreased or metallic bowel sounds, large or small liver, blood or mucus in the stools Corneal lesions associated with vitamin A deficiency Evidence of infection, purpura Otitis, rhinitis

Diagnosis


   

height and weight less than 80% of standard for the patients age and sex, and belownormal arm circumference and triceps skinfold serum albumin level urinary creatinine (24-hour) level skin tests with standard antigens moderate anemia.

Differential Diagnoses
 

No differential diagnosis for marasmus are noted. Edema (+), reflect a KW component of the malnutrition or an underlying cardiac or renal insufficiency. additional laboratory tests radiographic tests

Differences between Kwarshiorkor

Differences between Kwashiorkor

Differences between Kwarshiorkhor

Laboratory Studies (adapted from the WHO)

Blood glucose Examination of blood smears Hemoglobin Urine examination and culture

Hypoglycemia Parasites (Expensive) < 40 g/L >10 leukocytes/highpower field Stool examination by microscopy Parasites and blood (dysentery) Albumin <35 Electrolytes Hyponatremia

Laboratory Studies


Imaging Studies Radiological examinations ex : Thoracic radiography Other Tests Skin test Procedures Lumbar puncture Urine catheterization or vesical puncture

Complications
      

Tongue abnormality Short stature Hypopigmentation Immune deficiency Red cell production reduced Mental and physical retardation DEATH

Treatment


Prevent and treat the following:

Hypoglycemia Hypothermia Dehydration Electrolyte imbalance Infection Micronutrient deficiencies Initial stabilization Catch-up growth Provide loving care and stimulation Prepare for follow-up after discharge

Provide special feeds for the following:

The guidelines highlight 10 steps for routine management of children with malnutrition (HBO)

Treatment
  

Treatment consists of keeping the child warm and giving a high-energy, protein-rich diet. Correct the electrolyte imbalance followed by a gradual feeding program Treatment does not limit only in supplementing dietary needs but also includes treatment for impending infections and diseases. Nutritional management of the acute phase of severe marasmus (week 1) Rehabilitation phase (weeks 2-6)

 

Follow up


Child

Appropriate weight for height (-1 standard deviation [SD]) Eating well and gaining weight Infections properly treated Immunization started Able to look after the child Able to prepare appropriate food Able to provide home treatment for diarrhea Able to recognize the signs that mean she must seek medical assistance

Mother

Health care worker - Able to ensure the follow-up care of the child

Prevention
  

Maintain nutritional status of infants and children at highest possible level Reducing risk and effects of infection Nutritional health education
y Nutritional rehabilitation along with mothers' education and family planning are primary essentials. y Mothers be encouraged breast-feeding and to keep contact with the maternity and child health clinics.

Prevention

Educational programs for girls Sanitation programs Nutritional programs Programs that integrate breastfeeding promotion, diarrhea and infection therapy, and improvement of the nutritional status of mothers and pregnant women

Prevention
y Teaching parents :
y y y y the causes of malnutrition how to prevent its recurrence correct feeding how to treat diarrhea and other infections.

y They have much to learn and need considerable care from the medical staff.

Prognosis
y Except for complications mentioned above, prognosis of even severe marasmus is good if treatment and follow-up care are correctly applied. Persistent marasmus can cause permanent mental handicap and impaired growth.

Conclusion
y Marasmus, and malnutrition in general, represents multiple deficiencies, and multiple etiologies. Therefore, epidemiological, public health, and therapeutic approaches must be comprehensive. y Nutritional rehabilitation along with education and family planning are primary y essentials. mothers'

Thank You