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Nutrition 7 - Kwashiorkor & Marasmus

Terms in this set (15)

Define the origins of "Kwashiorkor" term?
"The displaced child"
The disease that a child gets when mom has a new baby (and first baby gets displaced from the breast)
Define Marasmus
Severe wasting
< 70% or <3SD weight/height
No obvious pathology
Looks very skinny
Define Kwashiorkor
Severe malnutrition with the presence of edema
Multiple pathologies
Looks pudgy
What are the pathologies seen in Kwashiorkor?
Pitting edema (may mask weight-loss)
Dermatosis (lighter hair color - pluckable, depigmentations)
Hypoalbuminemia (Fatty liver - up to 50% wet wt.)
Abnormal plasma AA (reduced EAA)
K+ deficiency (apathy and anorexia)
Infections (cytokines)
Child is not happy
What do doctors tend to due wrong with Kwashiorkor?
High protein diets tube-fed on admission --> fatal (25%)
This is because protein is stressful on the body (processing requires co-factors)
What are the steps used to treat severe malnutrition? (short steps)
1. Resuscitate (treat the emergent issues) (stabilization)
2. Repair (fix damaged cellular machinery)
3. Catch-up (rehabilitation)
What are the ten steps for routine treatment of malnutrition?
1. Hypoglycemia (days 1-2)
2. Hypothermia (days 1-2)
3. Dehydration (days 1-2)
4. Electrolytes (continuous)
5. Infection (days 1-7)
6. Micro nutrients (continuous - but NO iron for week 1)
7. Cautious feeding (days 1-7)
8. Catch up feeding (days 7 on)
9. Sensory stimulation (continuous)
10. Prepare for follow-up (days 7 on)
What do you do during stabilization during week 1 of treatment of malnutrition?
- Treat infections with broad-spectrum antibiotics
- Dehydration (rehydration solution for malnutrition - ReSoMal)
- Vitamin and mineral supplementation (A, multi, folic acid, Zn, Cu, NO IRON)
- Electrolyte supplementation with low protein (K, Mg - 4-6.5% protein:energy)
- Edema is cured, appetite returns
What do you provide during rehabilitation (weeks 2-6) of treatment for malnutrition?
Feed large amounts of energy-dense, milk-based feed
Full cream milk + sugar + oil, 10% protein energy (50% fat energy) with IRON
This allows for catch-up growth
What is the impact of oxidative stress on kwashiorkor?
Noxious insult (i.e. infection)
--> free radial production (superoxide anion)
--> inadequate protection (defiecienceis of E, A, O, Se, Zn, Mn, Cu, sulpher AA)
--> Iron-catalysed chain reactions (apparent iron overload)
--> Inadequate repair (deficiency of EFA)
--> Damage, edema, fatty liver, skin lesions, bleached hair
What damage does oxidative stress cause?
Damage to membranes and proteins disrupting transport and ionic balance resulting in K+ loss
What damage is seen in the kidney?
Impaired function giving edema
What damage is seen in the liver?
Impaired protein synthesis
Impaired albumin, apoB100 secretion
Damaged mitochondrial function (i.e. decreased ATP generation and fatty infiltration)
What damage is seen in the skin?
Changes similar to sunburn (free radicals from ionising radiation in sunlight)
What damage is seen in the hair?
Bleaching as with peroxide whiteners
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