儿童营养性疾病-2006.ppt

Nutritional Disease
Chapter 4
Protein-energy Malnutrition
(PEM)
Definition
PEM is a kind of malnutrition caused by inadequate dietary intake or some diseases, monly in children under 3 years of age.
Kwashiorkor
Marasmus
Etiology
The Primary PEM
Inadequate food intake
Children under 3 yrs
The Secondary causes
Increased nutrient needs
Disorder in nutrient absorption
Increased body metabolism
Pathophysiology
Metabolism disorder
Protein metabolism
anabolism & catabolism ; hypoalbuminemia
Fat metabolism
mobilized fat store, acetone body ;
metabolism acidosis; fatty liver
Carbohydrate: low hepatin, hypoglycemia
Fluid & electrolyte disorders
hypernatremia; edema; potassium disorder;
acid-base disturbances
Pathophysiology
Disorders an & Tissue function
Failure to thrive
Lower digested function:diarrhea
Central nerve system: apathy, or irritability
Cardiovascular system:pulse slow, Low BP
lower renal function: urine amount decrease
low immunologic function: easy to be infected
Clinical manifestations
History:Feeding history
Nonedematous PEM
(marasmus)
Edematous PEM (Kwashiorkor)
WHO Z-score
system
underweight chronic or acute malnutrition X-3SD≤W/A<X-2SD moderate W/A<X-3SD severe
stunting long-term chronic malnutrition X-3SD≤H/A<X-2SD moderate H/A<X-3SD severe
wasting recent acute malnutrition X-3SD≤W/H<X-2SD moderate W/H<X-3SD severe
Physical measurement
Laboratory examination
plasma albumin concentration
Normal: >35g/L; Diagnose:< 25g/L
Serum Pre-albumin concentration
Normal: 150~296mg/L;
Mild deficiency: 100~150mg/L;
Moderate:50~100mg/L; Severe:<50mg/L
Urine hydroxy-proling concentration
Diagnosis
History
Clinical manifestations
Anthropometric indicators
Laboratory examination