PROTEIN ENERGY MALNUTRITION (PEM) AND ITS CLASSIFICATION

  PROTEIN ENERGY MALNUTRITION (PEM)

What is protein energy malnutrition ?A range of pathological conditions due to simultaneous deficiency of protein and calories and commonly associate with infective and or parasite infestation or we can also define it another word e.g.

It is under nutrition, or pathological states generally or specific that result from total or relative lack of one or more essential nutrients 

P.E.M with the help of table

S.No	Age Group	Usually b/w 6 months and 3 Years
1	Marasmus	6 months  to 15 months
2	Kwashiorkor	From 1 to 3 years
3	PEM (45)	From 1 to 2 years
4	PEM (69)	From 1 3 years

Causes if we count it causes, there are a lot of causes of  P.E.M

Main Etiological Factors

1.Nutritional imbalance/ or due to some deficiency.

2.Non- fulfillment of requirement of necessary nutrients' for rapid growth in early

childhood.

3.It may b due to some Infection like bacterial or due to some  or parasitic.

4.Cultured factors (type of food consumed & weaning products)

5.Psychological factors due to deprivation of the child from breast feeding.

Beside these factors there are some cptobutories factors which may lead to protein energy malnutrition these are below

CONTRIBUTORY/PRECIPITATING ETIOLOGICALFACTOORS.

1. HOUSE- HOLD FACTORS

a. Erroneous/wrong weaning by ignorant mothers.

b. Early wearing due to 2nd pregnancy

c. Poor sanitation food contamination

d. Wrong distribution of food among family members.

e. Poor M.C.H. care due to careless parents.

2.FACTORS OUTSIDE HOUSE- HOLD

1.Shortage of protein foods in community.

2.High cost of protein foods.

3.Poor environmental sanitation

4.Shortage of curative and preventive services (specially M.C.H. Services)

Beside these factors which lead to P,E.M there are some other important which 

 are  responsible for P.E.M these are as below

1.Insufficient food supply for kids or adult

2.Persistept vomiting also lead to P.E.M

3. Anorexia and  Malabsorption.

4.Incrcase energy requirement e.g thyrotoxicosis, trauma and fibril illness.

5.Insreasesd.energy loss i.e diabetes mellitus

CLINICAL FEAUTURE

1.lncreased carving for food

2.Loss of weight

3.Fale, laxy and dry skin with thinning and falling of bait.

4. Loss of subcutaneous fat with muscle wasting

5.Cyanosed and cold skin with body temperature

6. Odcama of the leg (its always due to fluid in the legs, ankle etc its also due to standing or sitting on the same position for long)

7.Increased thirst and nocturia 

8.Impotency Ammenoerhoea

INVESIGATION.

Investigation  are important factors which help us to find out the cause for these we will need the

Measurement of arm circumference It is very important it always lesser than normal as

 compare to other children

ii) Blood glucose is  low.

iii).Plasma free fatty acids are high Presence of ketones in urine 1.e. Ketosis.

iv).Urine has fixed sp. Gravity Anemia and pancytopenia.

ECG shows Brady cardia and low voltages.

MANAGMENT 

1. Daily 1500-2000 KCl energy is given

2. First oral food should be liquid and light as here is villous atrophy of GIT

3. Bile and exocrine pancreatic secretions are dilute, so food should be small but given

 frequently.

4. Food should be palatable i.c. it  should have, sugar, milk and oil.

5. Salt should be restricted as its not good for this.

6. Mg, Zn. Fe and  potassium are given

7. Diet should be balanced i.e. Should have CHO proteins, fats and vitamins.

8. Patient is protected from cold and infection.

•      9. Avoid low fat, sugar-free, diet foods and drinks 
• 
  
•     10.Protein should be given in  meal such as meat, fish, chicken, eggs, beans  e.t.c 

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