Malnutrition.pptx

Malnutrition.pptx

• 1.
  Malnutrition 7th semester mbbs NischalShrestha 3/21/2019 @Nischal Shrestha 1
• 2.
  • WHO definesmalnutrition as “ the cellular imbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance and specific functions “ 3/21/2019 @Nischal Shrestha 2
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  • Malnutrition Undernutrition overnutrition Proteinenergy malnutrition (PEM) > kwashiorkor: cause by inadequate protein intake > Marasmus: d.t inadequate protein & calorie ( energy) 3/21/2019 @Nischal Shrestha 3
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  e.g. A childpresents with diarrhea for 3 days e.g. a child presents with chronic malabsorption Weight for age (WFA) low Low Height for age (HFA) normal Low Weight for height (WFH) low Normal (since both quantities decrease) WFA denotes undernutrition HFA is specific for chronic undernutrition cases WFH is specific for acute undernutrition cases 3/21/2019 @Nischal Shrestha 4
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  Gomez ‘ Classification WFA (we know if child is undernourished, normal or overnourished) Waterlow Classification (cut off criteria is -2 SD) WFH HFA Drop in ratio (k/a wasting) indicates acute malnutrition Drop in ratio (k/a stunting)= chronic malnutrition 3/21/2019 @Nischal Shrestha 5
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  3/21/2019 @Nischal Shrestha 6
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  • Marasmus very lean, thin wasting • Kwashiorker (more severe undernutrition)  edema +nt  no such drop in WFA or normal WFA ( negative Gomez classification inspite of severely malnourished) So malnutrition with edema is classified under Wellcome Trust classification 3/21/2019 @Nischal Shrestha 7
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  Standard deviation • aquantity expressing by how much the members of a group differ from the mean value for the group. Z-score or standard score (Obtained) 3/21/2019 @Nischal Shrestha 8
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  Z score For example:if the z-score of weight for height for a child is -3, it means that he/she has a weight which is lesser than mean by a factor of almost 3 times of SD. -2 or more No acute malnutrition -3 to -2 Moderate < -3 Severe 3/21/2019 @Nischal Shrestha 9
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  MUAC Tape No malnutrition Moderate malnutrition Severeacute malnutrition 3/21/2019 @Nischal Shrestha 10
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  Ready-to-Use Therapeutic Food(RUTF) • High energy, fortified ready to eat (w/o cooking) food suitable for treatment of severely malnourished children (> 6 months of age). • ( At least half of the proteins contained in the product should come from milk products.) • There are four basic ingredients in RUTF: - Sugar - Dried Skimmed Milk - Oil - Vitamin and Mineral Supplement (CMV) If child > 6 month can not finish RUTF, then condition is considered to be a complicated severe acute malnutrition. 3/21/2019 @Nischal Shrestha 11
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  RUTF sachet For child< 6 months of age, if there is breast feeding problem  complicated severe acute malnutrition 3/21/2019 @Nischal Shrestha 12
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  Classification of nutritionalstatus acc to IMCI  Oedema of both feet OR  WFH less than -3 z-scores OR MUAC < 11.5 cm AND any of the following: - Medical complication +nt - Not able to finish RUTF or - Breastfeeding problem (pink ) complicated severe acute malnutrition  WFH less than -3 z-score OR MUAC less than 11.5 cm AND  Able to finish RUTF (yellow) Uncomplicated severe acute malnutrition  WFH between -3 and -2 z-scores OR  MUAC 11.5 – 12.5 cm (yellow) Moderate acute malnutrition  WFH -2 z-score or more OR  MUAC 12.5 cm or more (green) No acute malnutrition 3/21/2019 @Nischal Shrestha 13
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  Medical complications • Anygeneral danger signs • Pneumonia with chest indrawing 3/21/2019 @Nischal Shrestha 14
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  t/t strategy (stabilization+ rehabilitation) A) Stabilization 1) Blood sugar level 2)Temperature 3) Immune status 4) Hydration status 5) Electrolyte status 6) Micronutrient ORS+ zinc antibiotics Keep child warm. 1°F/hour increase by Kangaroo method Incase of deficiency, 10 % glucose 5-10 ml/kg i.v. Fe, vitamin & other micronutrients 3/21/2019 @Nischal Shrestha 15
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  B) Rehabilitation i) Feedto rebuild wasted tissue : 150-220 kcal/kg/day ii) Follow up ,care and examination 3/21/2019 @Nischal Shrestha 16