RISK FACTORS: Nutritional - Prolonged and severe reduction of intake, Inadequate body reserves, Concurrent deficiencies of the other nutrients, Anorexia nervosa, Underlying illnesses
. Fever, infection, trauma, burns and other
RISK FACTORS
. Nutritional
. Prolonged and severe reduction of intake
. Inadequate body reserves
. Concurrent defi ciencies of the other nutrients
. Anorexia nervosa
. Underlying illnesses
. Fever, infection, trauma, burns and other hypercatabolic states
. Malabsorptive and maldigestive states
. Protein-losing enteropathy, nephrotic syndrome, enteric fistulas
. Metabolic disorders: Diabetes, hyperthyroidism
. Physiologic states in which requirements are increased
. Pregnancy and lactation
. Growth and development during infancy, childhood and adolescence
GENERAL MEASURES
β’ Fluid and electrolyte balance should be restored and maintained
β’ In severe kwashiorkor, IV or SC infusion of amino acids
β’ Low-lactose formulas have been helpful in some cases with diarrhea due to disaccharidases deficiency
β’ Diarrhea due to other causes should be identified and treated
β’ Supplementary vitamins and micronutrients as well as multiple antioxidants
β’ Mild anemia usually responds to oral protein, iron and folic acid supplements. Blood transfusion may be
necessary in severe cases (Hb < 6 g/dL). Use oral iron with caution in kwashiorkor.
ACTIVITY As tolerated
DIET
β’ Sufficient milk for infants and children to supply 2-5 g/kg/day protein. Lactic-acid fortifi ed milk can be given.
β’ Adequate calories should be supplied by adding sugar and cereal to the milk diet (150-250 kcal/day)
β’ Gradual supplementation with high-energy foods such as candies, cake, puddings, meats, eggs and fruit
juices
β’ Small, frequent feedings around the clock better tolerated in the early stages
β’ Prepared nutritional supplements available commercially are convenient
PATIENT EDUCATION
β’ Emphasis on nutrition education with the help of a dietitian
β’ Need for a balanced food intake
β’ Educate about the composition of nutritional products to ensure balanced intake
β’ Awareness about risk factors and need for timely nutritional supplements
DRUG(S) OF CHOICE
β’ Antibiotics may be indicated to treat infections
β’ Multivitamin-multimineral supplementation is required
PATIENT MONITORING
Initially periodic follow-up to ensure good nutritional status
PREVENTION/AVOIDANCE
β’ Emphasis on nutritional education and continuous nutritional care
β’ Routine record of height and weight
β’ Observe and record the patientβs food intake
β’ Early recognition of increased nutritional needs during stress and infections
β’ Frequent interactions between physician, nurse and dietitian to assess nutritional needs
β’ Avoidance of risk factors when possible
POSSIBLE COMPLICATIONS
Death in the first few days of treatment is usually due to electrolyte imbalance, infection, hypothermia or
circulatory failure. Stupor, jaundice, petechiae and low serum sodium are ominous signs.
EXPECTED COURSE/PROGNOSIS
β’ Mortality varies between 15-40%
β’ Recovery is more rapid in kwashiorkor than in marasmus. Disappearance of apathy, edema and anorexia
are favorable signs.
β’ In adequately treated cases, liver recovers fully without subsequent cirrhosis, but GI malabsorption and pancreatic deficiency may remain
β’ Compromised cell-mediated immunity returns to normalcy with recovery
β’ Behavioral and mental retardation is marked in the severely malnourished child. It is related to the duration of malnutrition and to the age of onset. Relatively mild degree of mental retardation persists into school age.