Severe Acute Malnutrition

Malnutrition

Malnutrition is defined by the World Health Organization as a 'cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions. Many diseases are directly or indirectly caused by a lack of essential nutrients in the diet.

Signs and symptoms

Clinical signs and symptoms of PEM include the following:

• Poor weight gain
• Slowing of linear growth
• Behavioral changes: Irritability, apathy, decreased social responsiveness, anxiety, and attention deficitsThe most common and clinically significant micronutrient deficiencies and their consequences include the following:
• Iron: Fatigue, anemia, decreased cognitive function, headache, glossitis, and nail changes
• Iodine: Goiter, developmental delay, and mental retardation
• Vitamin D: Poor growth, rickets, and hypocalcemia
• Vitamin A: Night blindness, xerophthalmia, poor growth, and hair changes
• Folate - Glossitis, anemia (megaloblastic), and neural tube defects (in fetuses of women without folate supplementation)
• Zinc: Anemia, dwarfism, hepatosplenomegaly, hyperpigmentation and hypogonadism, acrodermatitis enteropathica, diminished immune response, and poor wound healing

Physical examination

Physical findings that are associated with PEM include the following :

• Decreased subcutaneous tissue: Areas that are most affected are the legs, arms, buttocks, and face
• Edema: Areas that are most affected are the distal extremities and anasarca (generalized edema)
• Oral changes: Cheilosis, angular stomatitis, and papillar atrophy
• Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration
• Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma
• Nail changes: Fissured or ridged nails
• Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or reddish color

Diagnosis

Initial diagnostic laboratory studies include the following: Complete blood count, Sedimentation rate, Serum electrolytes, Urinalysis, Culture

Management

Children with chronic malnutrition may require caloric intakes of more than 120-150 kcal/kg/day to achieve appropriate weight gain. Most children with mild malnutrition respond to increased oral caloric intake and supplementation with vitamin, iron, and folate supplements. The requirement for increased protein is met typically by increasing the food intake. In moderate to severe cases of malnutrition, enteral supplementation via tube feedings may be necessary.