MOONDRAGON ARTICLES
Pediatric Malnutrition
by Karina Luise Glaser from Medstudents' Homepage
Malnutrition may be due to inadequate food absorption or inadequate food intake (inadequate supply, increased requirements).
The diagnosis of malnutrition is not always apparent as in severe cases. It depends on an accurate dietary history, evaluation of height, weight, head circumference and past rates of growth, measurement of midarm circumference and skinfold thickness and other tests.
Acute nutritional disturbances: water and electrolytes.
Chronic malnutrition: deficits of more than a single nutrient. There is usually associated immunologic insufficiency (white blood cell count below 1500/mm3 and anergy to skin test antigens).
Marasmus (Infantile Atrophy, Inanition, Athrepsia)
In most cases, marasmus is due to inadequate caloric intake, but may also be due to metabolic abnormalities or congenital malformations.
Clinically, there is failure to gain weight followed by weight loss and finally emaciation. Fat is loss last from the cheeks. The abdomen may be flat or distended. There is muscle atrophy and hypotonia. The basal metabolic rate is reduced. The infant may be constipated or have the "starvation type" of diarrhea with mucus.
Protein Malnutrition (Protein-Calorie Malnutrition, Kwashiorkor)
The main characteristic is insufficient protein intake; there may be impaired absorption (chronic diarrhea), abnormal losses (nephrosis, burns) or impaired synthesis (chronic liver disease).
Kwashiorkor is a serious problem in underdeveloped countries, affecting children from infancy to about 5 years of age.
The symptoms vary from lethargy, apathy, irritability to inadequate growth, loss of muscular mass, secondary immunodeficiency and edema. Renal function is decreased, the liver and the heart may enlarge. Dermatitis is common; the hair is sparse, thin and dyspigmentated. Infections, vomiting and diarrhea are common. There are signs of vitamin and mineral deficiencies; delayed bone growth. Mental changes may occur, followed by stupor, coma and death.
Laboratory data:
- low albumin concentration
- low plasma glucose
- ketonuria
- low plasma amino acids
- decresed K+, Mg++
- low cholesterol
The treatment is based on management of the associated conditions (infections, dehydration, anemia, diarrhea) and institution of adequate diet. Mental and physical retardation may be permanent.
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