儿科：小儿营养不良(英文)课件

Protein-EnergyMalnutrition

DepartmentofPediatricsZhejiangUniversitySchoolofMedicine

JIESHAOIntroduction

Thereismorethanone-thirdoftheworld'sunder-fivepopulationismalnourished.InChina:seriousPEMisrare,butmildormoderate

PEMarestillcommonNutritionalstatusofchildrenunder6years

Normal(eutrophy)Overweight/Obese

Protein-EnergyMalnutritionDefinitionPEM,amacronutrientdeficiency,notamicronutrientdeficiencyMainlyoccurinthechildren≦3yearsoldClassificationMarasmus

Severeinadequacyofenergyandnutrients，characterizedbyseverewastingClassificationEdema

(Kwashiorkor)hypoalbuminemic,edematousmalnutritionandpresentswithpittingedemathatstartsinthelowerextremitiesandascendswithincreasingseverity.ClassificationMarasmus-edemaIntermediateformsEtiologySecondary:DiseasefactorInadequatedigestion&absorptionoffood

AbnormalityofalimentarycanalMalabsorptionsyndromeInfection

TuberculosisParasitosisChronicwastingdisease

DiabetesHyperthyroidismPathophysiology1.Proteinmetabolismdisorderhypoalbuminemic2.GlucosemetabolismdisorderhypoglycemiaMetabolismabnormality

Pathophysiology

4.Water-electrolytemetabolismdisordersodiumpump’sfunctionaldisturbanceATPdecreaseextracellularfluidhypotensionHypotonicdehydrationMetabolicacidosisHypocalcemiaHypokalemiaPathophysiologyBodysystems’dysfunction

1.GastrointestinalSystem

Bowelmovement,quantityandactivityofenzymeDysbacteriosis、Infection、Diarrheaetc

2.CirculationSystem

Systoleweaken、bloodpressuredropdown、pulseextenuateetc

3.UrinarySystem

KidneyconcentratefunctionUrinaryvolumeUrinespecificgravity

4.NervousSystem

DecreaseofDNAandRNAinthebrainDelayofmotor/language/cognition/social-emotionaldevelopment

Impairedimmunity

Reduceof

nonspecificimmunity(deficitofanatomic-mucociliarybarrier)Impairedadaptiveimmuneresponses(involveantigen-specificTlymphocytesandBlymphocytes)Patientsarelikelytobestrickenbyvariouskindsofinfection。ClinicalmanifestationsPoorgrowth

GrowthfailurealwaysoccursThechildwillbefoundtobeshorter/lighterthannormalClinicalmanifestations

Temperature(hypothermia)SkinandHairchanges:dryandthin,sparseCirculationSystem

(bradycardia)GastrointestinalSystem

bowelsoundstendtobehypoactivediarrheaUrinarySystemNervousSystem

apatheticandweak,weakmuscletone

ClinicalmanifestationsKwashiorkor

Ocuursinchildrenaged1-3yr

Itisclassicallydescribedasbeingcausedbyinadequateproteinintake(fedonrelativelyhighstarchdiet.ClinicalmanifestationWasting,edema,sparsehairandpigmentedskin,monilialstomatitisandhepatomegaly.ComplicationsNutritionalanemia(IDA)Tracenutritionalelementdeficiency

VitaminAandzincdeficienciesInfectionSpontaneoushypoglycemia

DiagnosisHistory

InsufficientfoodsupplyImproperfeedingChronicwastingdisease

Symptoms&Signs

GrosslossofweightGrowthretardationWastingofsubcutaneousfatandmuscleClassificationGuidelinesforPediatricUndernutritionNutritionStatusWeight/AgeHeight/AgeWeight/Height%IBWWastingNormalorlowNormal<5thpercentile<85-90%Stunting<5thpercentile<5thpercentileNormalNormalMildmalnutritionNormalorlowNormal<5thpercentile81-90%ModeratemalnutritionNormalorlowNormal<5thpercentile70-80%KwashiorkorNormalorlowNormalorlowNormal(edema)NormalMarasmus(severewasting)LowNormalorlow<5thpercentile<70%Nutritionstatus

Underweight①Insufficientweightgainrelativetoage/genderweight②Moderate:

mean-3SD=weight<mean-2SD

Severe:

weight<mean-3SD③

Impliesslow/acute

malnutrition<TypingandgraduationStunting①Insufficientheightgainrelativetoage/sexheight②Moderate:

mean-3SD=Height<mean-2SD

Severe:

Height<mean-3SD③Implieslong-termmalnutrition<TreatmentEtiologytherapy

primarydiseaseDiettherapy1.Thegastrointestinaltractmaynottoleratearapidincreaseinintake.2.NutritionalrehabilitationshouldbeinitiatedandadvancedslowlytominimizethecomplicationsTreatment

Caloriesaregivenintheformofcarbohydrates,sugars,andfatsCaloricintakecanbeincreased10%to20%perdayMild:250~344kJ(60~80kcal)

/kg/d

Mid-Severe:from167~251kJ(40~60kcal)

/kg/d

to

628.0~711kJ(150~170kcal)/kg/dProtein:from1.5~2.0g/kgto3.0~4.5g/kgTreatmentSupplyvitaminandmineralsupplementsareessential(VitA5000IU,iron1~3mg,Zinc1mg)DrugtherapyPepsin,Pancreatin&VitaminBNandrolonePhenpropionatepromotethesynthesizeofproteinInsulinZincsupplementationChinesetraditionalmedicineComplicationtherapyrestoreandmaintainfluidandelectrolytebalancepreventandtreatspontaneoushypoglycemiabloodinfusion(<10ml/kg)ifsevereanaemiaIntensivecareEnoughsleepProperexerciseGooddiethabitTreatmentBeforetherapyAftertherapyPreventionProperfeedingencourage