儿科：小儿营养不良(英文)

Etiology
Secondary:Disease factor
Inadequate digestion & absorption of food
Abnormality of alimentary canal Malabsorption syndrome
Infection
Tuberculosis Parasitosis
Classification Guidelines for Pediatric Undernutrition
Nutrition Status Wasting Stunting Mild malnutrition Moderate malnutrition Kwashiorkor Marasmus (severe wasting) Weight/Age Normal or low <5th percentile Normal or low Normal or low Normal or low Low Height/Age Normal <5th percentile Normal Normal Normal or low Normal or low Weight/Height % IBW <5th percentile Normal <5th percentile <5th percentile Normal (edema) <5th percentile <85-90% Normal 81-90% 70-80% Normal <70%
Definit来自百度文库on
PEM, a macronutrient deficiency, not a micronutrient deficiency Mainly occur in the children ≦3 years old
Classification
Marasmus
Severe inadequacy of energy and nutrients， characterized by severe wasting
2. Circulation System
Systole weaken、blood pressure drop down、pulse extenuate etc
3. Urinary System
Kidney concentrate function Urinary volume Urine specific gravity
Chronic wasting disease
Diabetes Hyperthyroidism
Etiology Congenital deficiency
Prematurity Low birth weight infant Intrauterine malnourishment IUM ） malnourishment（IUM Congenital metabolic diseases
Clinical manifestations Kwashiorkor Ocuurs in children aged 1-3yr It is classically described as being caused by inadequate protein intake (fed on relatively high starch diet . Clinical manifestation Wasting, edema, sparse hair and pigmented skin, monilial stomatitis and hepatomegaly.
Nutritional status of children under 6 years
Normal (eutrophy)
Overweight/Obese
Protein-Energy Malnutrition
Definition
A state of deficiency resulting from inadequate intake of protein and/or energy relative to physiological needs leading to progressive changes in body composition and function The child with PEM usually has growth failure which manifests shorter in height or lighter in weight than expected for a child of his age, or may be thinner than expected for height
Clinical manifestations
Poor growth
Growth failure always occurs The child will be found to be shorter /lighter than normal
Clinical manifestations
Wasting Weight (anthropometric measurements) Loss of muscle mass and subcutaneous fat stores Abdomen trunk hips limbs face
The muscles are always extremely wasted (marked atrophy) The ribs are prominent The limbs are very emaciated The face has a characteristic simian (monkey -like) appearance There is little if any subcutaneous fat left The skin hangs in wrinkles, especially around the buttocks and thighs
Diagnosis History
Insufficient food supply Improper feeding Chronic wasting disease
Symptoms & Signs
Gross loss of weight Growth retardation Wasting of subcutaneous fat and muscle
Pathophysiology
Metabolism abnormality
1. Protein metabolism disorder hypoalbuminemic 2. Glucose metabolism disorder hypoglycemia
Pathophysiology Metabolism abnormality
Clinical manifestations
Temperature (hypothermia ) Skin and Hair changes : dry and thin, sparse Circulation System (bradycardia) Gastrointestinal System bowel sounds tend to be hypoactive diarrhea Urinary System Nervous System muscle tone apathetic and weak, weak
4. Nervous System
Decrease of DNA and RNA in the brain Delay of motor/language/cognition/socialemotional development
Impaired immunity
Reduce of nonspecific immunity ( deficit of anatomic-mucociliary barrier ) Impaired adaptive immune responses(involve antigen-specific T lymphocytes and B lymphocytes) Patients are likely to be stricken by various kinds of infection。
Classification
Marasmus-edema
Intermediate forms
Etiology
Primary: Long-term inadequate food intake
1.Insufficient food supply ：poverty-stricken 2.Improper feeding
inappropriate weaning practices staple diets that are often of low energy density insufficient artificial feeding
3. social and behavioral factors
monophagia Picky Eating Anorexia Nervosa
Protein-Energy Malnutrition
Department of Pediatrics Zhejiang University School of Medicine
JIE SHAO
Introduction
There is more than one-third of the world's under-five population is malnourished. In China:serious PEM is rare,but mild or moderate PEM are still common
Classification
Edema (Kwashiorkor)
hypoalbuminemic, edematous malnutrition and presents with pitting edema that starts in the lower extremities and ascends with increasing severity.
Clinical manifestations
Complications Nutritional anemia ( IDA) Trace nutritional element deficiency
Vitamin A and zinc deficiencies
Infection Spontaneous hypoglycemia
Diagnosis laboratory examination
The level of plasma-albumin IGF-1 Cholesterin potassium/ magnesium Calcium,phosphate and Vit D levels sensitive Necessary Amino Acids diagnostic change
Hypocalcemia
Pathophysiology
Body systems’ dysfunction
1. Gastrointestinal System
Bowel movement , quantity and activity of enzyme
Dysbacteriosis、Infection、Diarrhea etc
3. Fat metabolism disorder
Serum cholesterol
Fat consume too much
Adipose infiltration in liver
Pathophysiology 4. Water-electrolyte metabolism disorder
Hypotonic dehydration Metabolic acidosis sodium pump’s functional disturbance ATP decrease extracellular fluid hypotension Hypokalemia