Marasmus - Wikipedia
Apart from marasmus and kwashiorkor (the 2 forms of protein– energy .. is bioavailable and how much rice must be consumed to meet an individual's needs . Kwashiorkor and marasmus are two separate diseases, but the former is so often At first, this provides sufficient nutrients to meet internal metabolic needs, but. Marasmus is a form of severe malnutrition caused by a shortage of protein and calories. It is said to affect 20 million children and babies under.
One gram of potassium chloride provides 13mEq, and whole milk contains about 40mEq per liter. In mild cases, treatment for the first days is sufficient. Moderate and Severe kwashiorkor with marked clinical signs of dehydration The basic problems in these cases are severe dehydration, hyperosmolarity, metabolic acidosis, and multiple anion and cation loss, especially of potassium.
As soon as possible after admission, the child should be given a buffered hypotonic solution intravenously to counteract the acidosis and hyperosmolarity, and should begin the correction of the dehydration and oliguria.
If laboratory facilities for determining CO2 combining power and serum electrolytes are not available, this therapy must depend on clinical observation. The dosage varies from 40ml per kg to 50ml per kg, administered intravenously at a rate of drops per minute. If facilities are not available for preparing this solution, the Ringer-lactate solution of Hartman can be used, which, however, contains less lactate.
In most cases, diuresis begins after the preceding treatment has been administered. If not, the solution can be continued some hours longer at a slower rate.
It is usually necessary to give between ml and ml of fluid per kg in the first 24 hours. Close and frequent examination is required to guide this therapy, since clinical signs of diuresis are the best indices of the amount of fluids required. Oral feeding should begin as soon as the patient's condition permits, even within a few hours after admission. If vomiting has been sufficiently acute to produce alkalosis, the sodium lactate should be omitted from the solution given.
The remainder of the treatment is essentially the same. Skim milk has been found most readily available for the dietary treatment of kwashiorkor and marasmus, but some workers have obtained good therapeutic results with vegetable protein mixtures. In Guatemala, a mixture of cottonseed flour and lime-treated maize with added nutrients has given results equivalent to those with skim milk powder. Properly processed soybean, peanut meal, or cotton seed meal can also be used in this manner if skim milk is not available.
General Treatment Measures Because the skin of the child with kwashiorkor is likely to be excoriated, good nursing care is required to control secondary infection of the involved areas.
Because of their initial apathy and anorexia, these children will not ordinarily eat well enough of their own accord for satisfactory recovery and may stay in one position without moving.
Kwashiorkor and Marasmus
This must be taken into consideration by the nursing staff, particularly in the feeding of children during early treatment. In general, they are backward in psychosocial and psychomotor development because of neglect and a longstanding lack of good nutrition.
A friendly attitude on part of the staff and a play area with toys will result in a better outcome.
Advantage should be taken of the visits by the parents, as this is a good time to explain to them the purely dietary nature of the treatment and the fact that a poor diet was responsible for the development of the disease in their child.
Even when the child is not febrile and pneumonia cannot be detected by auscultation, pneumonia will be evident on an x-ray of the lungs.
It is for this reason that penicillin or another antibiotic should be started on admission and continued throughout the initial recovery.
Marasmus: A type of malnutrition
Even when infections are not initially present, the susceptibility of the child with kwashiorkor to infections is so great that routine antibiotic therapy is recommended.
In advanced kwashiorkor, neither fever nor elevated leucocyte count may develop, even when the infection is severe. Best results are obtained when penicillin or a broad-spectrum antibiotic is given as soon as possible after admission for 6 to 8 more days.
During treatment, the child with kwashiorkor should be isolated from cross infections as much as possible.
In early studies, children with kwashiorkor treated on an open pediatric ward frequently showed little or no growth for weeks after initial recovery. When it was possible to study kwashiorkor children in individual cubicles, such a stationary growth period was never again observed.
There is no doubt that episodes of infectious diarrhea are frequently precipitating factors for kwashiorkor in an already malnourished child, but diarrhea is such a constant accompaniment of kwashiorkor that it may or may not be due entirely to infection. This cannot be said, however, of the diarrhea that persists after initial recovery.
This must be considered and treated as infectious. In addition to the treatment described for severe malnutrition, specific treatment for these infectious diseases should be provided promptly.
Children living under circumstances responsible for their severe malnutrition are almost certain to have one or more common intestinal parasites such as Ascaris, Tricuris, Giardia, and others.
These are not likely to be a major factor in the development of either marasmus or kwashiorkor, but after initial recovery, should be eliminated by specific treatment.
Anemias Children with kwashiorkor usually have anemia, but its cause may be complex. When potential etiological factors are explored sequentially, there is a mild reticulocyte response to the protein therapy that soon ends. The administration of iron usually results in a more marked and prolonged reticulocyte response and recovery from the anemia.
However, there often remains some anemia that responds only to B vitamins. It is best to give iron and B vitamins routinely early in therapy. Optimal Therapeutic Approach for this Disease The principles of therapy do not differ with severity, but the rapidity of moving from one stage of treatment to the next may vary. The need for this is usually evident from the response of the child, guided by both clinical response and the rate of improvement in the laboratory findings.
Causes and risk factors not having enough nutrition or having too little food consuming the wrong nutrients or too much of one and not enough of another having a health condition that makes it difficult to absorb or process nutrients correctly Older adults who live alone and find it difficult to prepare food and care for themselves may be at risk.
Sometimes marasmus can affect an older adult who has not eaten healthfully over a period of some months or years, say the University of Kansas Landon Center on Aging. While consuming the wrong nutrients and having a health condition can contribute to marasmus, each of these alone would probably not be enough to cause it, as long as calories are available.
In places where food can be scarce, breastfeeding infants for as long as possible may help reduce the risk of malnutrition. However, if breastfeeding continues for longer than 6 months without an infant receiving solid food, the risk of marasmus can also increase, especially if the mother is malnourished herself.
Those born preterm or with low birth weight may also have a predisposition to malnutrition afterward. Appropriate support and nutrition during pregnancy and in a child's early years are essential for preventing malnutrition. Symptoms A loss of muscle and body weight are key symptoms of marasmus. The primary symptom of marasmus is an acute loss of body fat and muscle tissues, leading to an unusually low body mass index BMI.
Marasmus is a type of wasting. In a child, the main symptom of marasmus is a failure to grow, known as stunted growth. In adults and older children, the main symptom may be wasting, or a loss of body tissue and fat.
An older child with wasting may have standard height for their age. A child with marasmus may also be very hungry and suck on their clothes or hands as if looking for something to eat. But some people with marasmus will have anorexia, and they will not want or be able to eat. Over time, a person with marasmus will lose body tissue and fat in their face.