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Protein-Energy Malnutrition (PEM) : The Third Affiliated Hospital of Zhengzhou University Wangdiao

Protein-energy malnutrition (PEM), also known as kwashiorkor or marasmus, is caused by inadequate dietary intake or diseases in children under 3 years old. It results in metabolic disorders of protein, fat, carbohydrates, fluids and electrolytes. Clinically, it manifests as failure to thrive, dermatitis, edema, and susceptibility to infections. Diagnosis involves assessing weight, height, serum albumin and providing adequate nutrition is the primary treatment. Prevention focuses on breastfeeding education, nutrition monitoring, and preventing infectious diseases.

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204 views15 pages

Protein-Energy Malnutrition (PEM) : The Third Affiliated Hospital of Zhengzhou University Wangdiao

Protein-energy malnutrition (PEM), also known as kwashiorkor or marasmus, is caused by inadequate dietary intake or diseases in children under 3 years old. It results in metabolic disorders of protein, fat, carbohydrates, fluids and electrolytes. Clinically, it manifests as failure to thrive, dermatitis, edema, and susceptibility to infections. Diagnosis involves assessing weight, height, serum albumin and providing adequate nutrition is the primary treatment. Prevention focuses on breastfeeding education, nutrition monitoring, and preventing infectious diseases.

Uploaded by

api-19916399
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Protein-energy Malnutrition

(PEM)

The Third Affiliated Hospital of


Zhengzhou University
Wangdiao
Definition
 PEM is a kind of malnutrition caused by
inadequate dietary intake or some diseases,
occurs commonly in children under 3 years
of age.

Kwashiorkor

Marasmus
Etiology
 The Primary PEM
Inadequate food intake
Inadequate food absorption

 The Secondary causes


Increased nutrient needs
Disorder in nutrient absorption
Increased body metabolism
Certain metabolic abnormality
Pathophysiology
 Metabolic disorder
 Protein metabolism
anabolism & catabolism ; hypoalbuminemia
 Fat metabolism
mobilized fat store, acetone body ;
metabolic acidosis; fatty liver
 Carbohydrate: low hepatin, hypoglycemia
 Fluid & electrolyte disorders
hypernatremia; edema; potassium disorder;
acid-base disturbances
Pathophysiology
 Disorders of Organ & Tissue function
 Failure to thrive
 Lower digested function ： diarrhea
 Central nerve system: apathy or irritability
 Cardiovascular system ： pulse slow, Low BP
 Low renal function: urine amount decrease
 Low immunologic function: easy to be infected
Clinical Manifestations
 Marasmus
• Failure to gain weight
• Weight loss and listlessness
• skin become wrinkled and loose
• Subcutaneous fat disappear (sequence :abdomen→trunk →
buttocks → extremities →face)
• Muscle: atrophy, hypotonia
• Constipation, a starvation diarrhea
• Pulse slow
• Irritability
Clinical Manifestations
 Edematous PEM (Kwashiorkor)
• Lethargy, apathy, or irritability
• Inadequate growth
• Increased susceptibility to infection
• Vomiting, diarrhea, anorexia
• Flabby subcutaneous tissue
• Edema
• Liver enlargement
• Dermatitis
• Hair sparse and thin
Complications of Malnutrition
• Nutritional deficiency anemia
• Deficiencies of vitamins and minerals
• Infections
• Infantile diarrhea
• Hypotonic dehydration
Physical Measurement
WHO Z-
 underweight
score
chronic or acute malnutrition system
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
Laboratory Examination
 Serum 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
Principles of Treatment
 To treat the primary disease
 To provide adequate nutrients intakes
 To supply energy and protein
 To keep the Fluid & electrolyte balance
 To supply multi-vitamins

To provide the accelerant for protein synthesize

 Supporting therapy
Management of malnutrition
• Provision of Optimum Nutrition and Energy
 The mild : 60~80kcal/kg/day→--→
 The moderate to severe : 45~60kcal/kg/day→
-- →-- →140kcal/kg/day

• Supplement of Vitamin and Minerals

• Establish Appropriate Diet Habit


Prevention
 promoting the skills for breast-feeding

and the introduction of supplementary


 Food Nutrition education
 Growth monitoring
 Prevention and treatment of infectious
diseases

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