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The Initial Metabolic Medicine Hospital Consult
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
We discussed the issue of PCM terminology earlier and we recognize the limitation of the literal words. But we are in the habit of using PCM as a placeholder for all things involving a faulty nutritional status. Our patient may have a problem with food intake, but the condition is much more than a malady of eating. It is muscle loss. It is adipose depletion. It is low colloid osmotic pressure and diminished functional capacity. At one time, substituting the term Kwashiorkor to describe this most common form of PCM became commonplace. The problem is that Kwashiorkor is a pediatric diagnosis derived from studies performed on African famine victims (Heikens and Malary 2009). To correct for this inconsistency, the term ‘adult Kwashiorkor’8 was coined.
Diagnosis
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
It is difficult to adopt global criteria for diagnosing malnutrition when the clinical presentation of malnutrition varies. The concepts of kwashiorkor and marasmus are seen in children suffering from famine; however, these conditions are rarely found in most parts of the world. In North America, the etiology of malnutrition stems from a combination of multiple factors involving the presence of acute or chronic illness, and the degree and recurrence of the inflammatory process that lead to reductions in oral intake, weight, and fat and lean body mass. While disease processes may influence the ability to consume, absorb and utilize nutrients, they may also increase physiological demand or nutrient utilization.4 Malnutrition can also occur in the social or environmental context such as food insecurity or voluntary restriction.2 The issue becomes even more complicated when other related conditions overlap with malnutrition.
Malnutrition
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Laura Gearman, Catherine Larson-Nath
Marasmus and kwashiorkor are specific processes associated with severe acute malnutrition most often seen in low- and middle-income countries. Clinical characteristics of marasmus include wasting without edema. Marasmus is associated with fat and muscle loss and stunting without edema. In marasmus, serum albumin remains normal. Kwashiorkor is characterized by the presence of symmetric peripheral edema (and ascites), muscle wasting, and low serum albumin. Traditionally, marasmus has been considered the end result of severe inadequate energy intake and kwashiorkor has been thought to be the end result of inadequate consumption of protein in the face of relatively adequate energy intake. However, the actual causes of each of these presentations are complex and involve inadequate nutrition and the intestinal microbiome.
Kwashiorkor on the south shore
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Samuel T. Arcieri, Szeya Cheung, Alexander Belkin, Ajish Pillai, Ravi Gupta
Kwashiorkor is almost exclusively seen among the pediatric population in developing countries where there is limited food supply and is rarely seen in the developed countries such as the USA [1]. According to the WHO, as of 2019, 6.9% of children under the age of 5 worldwide, and 0.4% in the USA suffer from a form of malnutrition called wasting, when a child is too thin for his or her height due to the failure to gain weight [2]. Kwashiorkor is a severe form of protein energy malnutrition believed to be caused by protein deficiency. Albumin, a protein, acts to increase oncotic pressure and holds fluids within the vasculature; in kwashiorkor syndrome, profound hypoalbuminemia due to protein deficiency causes an imbalance between the oncotic and hydrostatic pressures across the capillary blood vessel walls, which ultimately results in intravascular fluids escaping into the third space, causing abdominal distension, ascites, and peripheral edema; other signs include hepatomegaly and marked muscle atrophy [3].
Community health volunteers and their role in health system strengthening in peri-urban areas: A qualitative study of Epworth, Zimbabwe
Published in International Journal of Healthcare Management, 2021
This view was supported by community members who revealed that CHVs had acted as a means through which locals have become more knowledgeable about HIV/AIDS, which also helped reduce stigma and improved the uptake of treatment within affected households. Peer educators and community members also confirmed positive outcomes regarding the attitude of people towards HIV/AIDS patients. Apart from HIV/AIDS and TB interventions, it was also established from the focus group discussions that CHVs also play an important part in children's health in this peri-urban community. In regard to this matter, one CHVs stated the following: As Village Health Workers, our role is to identify malnourished children in the community and also to educate mothers about Kwashiorkor and Measles because there are mothers that are not aware about it. We also encourage breastfeeding and that mothers follow instructions given by nurses at clinics regarding what the child should eat at different age categories as they grow. We also encourage mothers to take their children for child growth monitoring at clinics because that is also where the health of the child is also assessed.
Paediatric deaths in a tertiary government hospital setting, Malawi
Published in Paediatrics and International Child Health, 2019
Caroline Harris, Rowena Mills, Ezgi Seager, Sarah Blackstock, Tamanda Hiwa, James Pumphrey, Josephine Langton, Neil Kennedy
Patient weights were recorded on admission and nutritional status was determined using the 2013 WHO weight-for-age charts [10]. A child was considered to be underweight-for-age if weight was ≥2 SDs below the median for age [10]. In children who presented with evidence of severe wasting or peripheral oedema, the nutrition team carried out a detailed assessment including weight-for-height (or length) and mid-upper-arm circumference (MUAC). Marasmus was defined as weight-for-height >3 SDs below the median or if MUAC was <11.5 cm in children aged 1–5 years. Kwashiorkor was defined as evidence of peripheral oedema unexplained by other causes and a clinical history and features of malnutrition such as hypopigmentation, ulceration and thinning hair. Children who met the criteria for marasmus together with clinical features of kwashiorkor were defined as having marasmic kwashiorkor.