文档介绍：Protein-energy Malnutrition
(PEM)
Definition
PEM is manifested primarily by inadequate dietary intakes of protein and energy.
PEM is almost always panied by deficiencies of other nutrient.
PEM can be divided as primary PEM and secondary PEM.
Causes of Primary PEM
Inadequate food intake
Inadequate infant and child feeding practices
Secondary causes
Increased nutrient needs
Decreased nutrient absorption
Increased nutrient losses
Causes
Pathophysiology of PEM
Disorder of metabolism
Protein: Protein catabolism、hypoalbuminemia
Fat: mobilized fat store, emaciation, fatty infiltration, fatty liver
Carbohydrate: low hepatin, hypoglycemia
Water、minerals:dehydration,low serum Ca concentration
1、Failure to thrive
2、lower digested function:diarrhea
3、Central nerve system: apathy, or irritability
4、Cardiovascular system:pulse slow, Low BP
5、lower renal function: urine amount decrease
6、low immunologic function: easy to infect
Disorder ans and tissues
Clinical manifestations
Nonedematous PEM (marasmus)
Failure to gain weight
Irritability
Weight loss and listlessness
skin e wrinkled and loose
Subcutaneous fat disappear
Muscle: atrophy, hypotonia
Pulse slow
Constipation, a starvation diarrhea
Vague manifestations
Lethargy, apathy, or irritability
Inadequate growth
Increased susceptibility to infectious
Vomiting, diarrhea, anorexia
Flabby subcutaneous tissue
Edema
Liver enlargement
Dermatitis
Hair sparse and thin
Edematous PEM (Kwashiorkor)
Laboratory examination
Serum albumin concentration
bined protein
Pre-albumin
transferrin
IGF-I
Diagnosis
History
Clinical manifestations
Laboratory examination
Anthropometric indicators
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