Protein energy malnutrition medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
In some cases, protein-energy malnutrition (PEM) may be complicated by dehydration and specific infections such as pneumonia and septicemia. In such cases, protein-energy malnutrition is a medical emergency and requires prompt treatment with oral rehydration and antibiotics.
Medical Therapy
In some cases, protein-energy malnutrition (PEM) may be complicated by dehydration and specific infections, such as pneumonia and septicemia. In such cases, protein-energy malnutrition is a medical emergency and requires prompt treatment with antibiotics.[1]
Protein energy malnutrition complicated by mild dehydration[2][3]
Most patients with PEM and mild to moderate dehydration can be treated with oral or nasogastric administration of fluids.
- The "oral rehydration salts" (ORS) solution is recommended, that is prepared by dissolving one packet of these special salts in 1 litre of clean drinking water
Protein energy malnutrition complicated by severe dehydration[4][5][6]
Patients with severe dehydration and patients who do not respond after oral or nasogastric fluids must be treated by intravenous fluid.
- Compound solution of sodium lactate (Ringer's lactate solution for injection; Hartmann's solution)
Protein energy malnutrition complicated by infections[1]
- Infants 6 months to 1 year
- Preferred regimen (1): Procaine benzyl-penicillin (water-miscible)IM (1-2 ml q1d for 5-10 days)
- Preferred regimen (2): Ampicillin 125 mg at q6h intervals for 5-10 days (maximum, 500 mg per dose)
- Alternative regimen (1): Chloramphenicol 50 mg/kg body weight q24h 6-hour intervals for 5 days (maximum, 500 mg per day)
- Alternative regimen (2): Tetracycline 5-50 mg/kg body weight orally q24h at 6-hour intervals for 5 days, or 10-15 mg/kg body weight intravenously q24h at 12hour intervals for 5 days
Treatment of Protein energy malnutrition in the first week[5]
The malnourished child should be fed a dilute milk feed, such as half-strength milk, for a day or two. When the patient accepts this well, a full-strength milk feed can be given on days 4 and 5. Towards the end of the week, when feeding is satisfactory, a high-energy milk feed is started.
- Quantity: Malnourished patients should be fed 125 ml/kg body weight each day for the first 4 or 5 days. As the child's appetite increases on days 6, 7, and 8, oral feeds are increased in amount to 150 ml/kg body weight per day, and are given every 4 hours (6 feeds per 24 hours)
- Frequency: For the first 2 days malnourished children should be fed every 2 hours, 12 times daily
This frequency of feeding reduces the risk of the patient developing hypothermia and hypoglycemia. Severe vomiting and diarrhea are less likely to occur. When the patient is feeding satisfactorily, feeds should be given every 3 hours, for the next 2 or 3 days, and then every 4 hours..
- Type of feed: Either fluid milk (cow's, goat's, buffalo's, camel's and canned evaporated milk) or milk powder (skimmed or full-cream powder) can be used to prepare milk feeds
- Cow milk: About 1 liter of full-strength milk feed is prepared by adding 50 g (10 teaspoons) of sugar to 1000 ml undiluted milk
- Evaporated milk: 500 ml of evaporated milk is mixed with 500 ml of water and 50 g of sugar added to prepare about 1 liter of full-strength milk
- Full-cream milk powder: Add 150 g of milk powder - i.e., 30 teaspoons or 30 level scoops (as supplied with the tin)-and 50 g of sugar to 1000 ml of water to prepare approximately 1 liter of full-strength milk
- Skimmed milk powder: Mix 75 g (15 teaspoons) of skimmed milk powder with 30 g (35 ml) of vegetable oil (6 teaspoons) and 50 g of sugar (10 teaspoons) to a smooth paste. Gradually add: Mix 50 g 00 teaspoons) of sugar into 1000 ml of yogurt to make approximately 1 litre of full-strength feed
Mineral and vitamin supplements[4][5][6]
References
- ↑ 1.0 1.1 Spady DW, Payne PR, Picou D, Waterlow JC (1976). "Energy balance during recovery from malnutrition". Am J Clin Nutr. 29 (10): 1073–88. PMID 823814.
- ↑ DEAN RF (1953). "Treatment and prevention of kwashiorkor". Bull. World Health Organ. 9 (6): 767–83. PMC 2542052. PMID 13141130.
- ↑ BEHAR MB, VITERI F, BRESSANI R, ARROYAVE G, SQUIBB RL, SCRIMSHAW NS (1958). "Principles of treatment and prevention of severe protein malnutrition in children (kwashiorkor)". Ann. N. Y. Acad. Sci. 69 (5): 954–68. PMID 13509556.
- ↑ 4.0 4.1 DEAN RF (1952). "The treatment of kwashiorkor with milk and vegetable proteins". Br Med J. 2 (4788): 791–6. PMC 2021539. PMID 12978333.
- ↑ 5.0 5.1 5.2 BEHAR M, VITERI F, SCRIMSHAW NS (1957). "[Treatment of severe protein deficiency in children (kwashiorkor)]". Am. J. Clin. Nutr. (in Undetermined). 5 (5): 506–15. PMID 13469752.
- ↑ 6.0 6.1 DEAN RF (1956). "Advances in the treatment of kwashiorkor". Bull. World Health Organ. 14 (4): 798–801. PMC 2538069. PMID 13356148.