7.6 Protein: Protein Energy Malnutrition


– WELCOME TO THE LAST SECTION
IN OUR SERIES ON PROTEIN. THIS SECTION WILL BE COVERING
PROTEIN ENERGY MALNUTRITION. WE’RE GOING TO START
BY LOOKING AT KWASHIORKOR, AND THIS IS AN EXAMPLE
OF A CHILD WITH KWASHIORKOR. KWASHIORKOR HAS AN ACUTE ONSET,
AND IT GENERALLY OCCURS WHEN THE MOTHER’S PREGNANT, HAS ANOTHER CHILD AND STARTS
BREASTFEEDING THE NEW BORN AND ALL OF A SUDDEN
STOPS BREASTFEEDING THE CHILD. WHAT THIS RESULTS
IN IS A SUDDEN HOLT IN PROTEIN CONSUMPTION
BY THE CHILD, SO IT DOES HAPPEN
ALL OF A SUDDEN. THEY MIGHT BE SWITCHED
TO SOME SORT OF GRAINS, AND ALTHOUGH THEY MAY BE GETTING ENOUGH CALORIES THERE’S
GENERALLY NOT ENOUGH PROTEIN. ONE OF THE CHARACTERISTICS OF KWASHIORKOR IS
THE SWOLLEN BELLY THAT YOU SAW– IT’S COVERED UP NOW BUT YOU
SAW IN THE INITIAL PICTURE. BUT ALSO LOOK AT THESE
SWOLLEN FEET AND SWOLLEN LEGS CONSIDERING HOW
THIN THE ARMS ARE. AND THIS IS BECAUSE OF
A FLUID IMBALANCE. REMEMBER WHEN WE TALKED
ABOUT PROTEIN FUNCTIONS. PROTEINS ARE VERY IMPORTANT
IN MAINTAINING FLUID BALANCE. AND PROTEINS DO A GOOD JOB OF KEEPING FLUID IN
THE BLOODSTREAM. IF IT’S NOT IN THE BLOODSTREAM
IT’S GOING TO LEAK OUT INTO THE SURROUNDING TISSUES,
ACCUMULATE AROUND THE ABDOMEN, AND THEN IN THE
LOWER EXTREMITIES, THE LEGS, ANKLES,
AND FEET. ANOTHER REASON THAT
THE ABDOMEN MAY BE EXTENDED IS BECAUSE OF
A FATTY LIVER. THE OTHER TYPE OF PROTEIN ENERGY
MALNUTRITION IS CALLED MARASMUS. AND THIS CHILD
HERE HAS MARASMUS. NOW, THIS STARTS GENERALLY
IMMEDIATELY AFTER BIRTH. SO THE CHILD IS BORN BUT
THERE’S JUST NOT ENOUGH FOOD. AND IT COULD BE THAT THE
MOTHER’S BREASTFEEDING MULTIPLE CHILDS OR DOESN’T
HAVE ENOUGH BREAST MILK, BUT THERE’S ALSO NOT
ENOUGH OF OTHER TYPES OF FOOD OR GRAINS
TO FEED THE CHILD. SO THIS STARTS
AFTER BIRTH BUT IT’S A LITTLE BIT MORE
SLOW TO DEVELOP. IT’S NOT THAT ACUTE START
AS THE KWASHIORKOR IS. I DO WANT TO POINT
OUT THAT IT IS A DEFICIENCY OF CALORIES
IN ADDITION TO PROTEIN, NOT GETTING ENOUGH OF
ANY OF THE NUTRIENTS. AND IT CREATES THIS MATCHSTICK
ARM OR REALLY, REALLY THIN ARMS. YOU CAN SEE THE RIBS ARE
SHOWING THROUGH HERE, FACE IS GENERALLY SUNKEN. YOU CAN USUALLY SEE A
LOT OF THE CHEEKBONES. THEY TEND TO LOOK LIKE LITTLE
OLD MEN, THESE CHILDREN. SO, AGAIN, ONE OF THE MORE
IMPORTANT POINTS ABOUT THIS IS THAT IT’S A LACK
OF PROTEIN AND CALORIES. STARTING IMMEDIATELY AFTER
BIRTH THESE CHILDREN– THIS IS AN OLDER CHILD BUT A LOT
OF THESE CHILDREN DON’T SURVIVE. KWASHIORKOR IS THAT
LACK OF PROTEIN, BUT THEY DO GET CALORIES, SO THEY DO HAVE
LONGER SURVIVALS. BUT IT’S THAT ACUTE ONSET
AND DEFICIENCY OF PROTEIN. SO MAKE SURE YOU ARE ABLE TO
DIFFERENTIATE BETWEEN THESE TWO TYPES OF PROTEIN
ENERGY MALNUTRITION. AND THIS IS THE END OF
OUR SERIES ON PROTEIN.  

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