Malnutrition

Malnutrition - a disease caused by prolonged fasting or insufficient caloric and poor protein food that does not comply with the energy expenditure of the body. The development of malnutrition contribute cold, heavy physical activity and emotional strain. The pathogenesis of malnutrition complicated. When malnutrition body consumes first of all its fat stores; decrease the reserves of glycogen in the liver and muscles. In the future, the body spends their own proteins. Develop atrophy muscular system, internal organs, endocrine glands. In the late stages of the disease join signs of vitamin a deficiency. Subjective signs of malnutrition: improved appetite, muscle pain in the legs, back, and fatigue. An objectively progressive weight loss, lowering body temperature. The skin is dry, scaly, pale yellowish tint and decreased turgor. Subcutaneous fat layer is missing, the muscles atrophied. A number of patients appear gradually increasing swelling. Initially marked unstable aetiology. The slightest movement, physical stress cause increased heart rate. In the latter stages of malnutrition bradycardia may be replaced tachycardia. Heart sounds deaf. Hypotension. Language - with varnished surface due to atrophy of papillae. Gastric secretion reduced. At the first stage of malnutrition observed meteorism and constipationassociated with atoniej intestines, then they are replaced by intermittent or systematic diarrhea. Urinating more frequent. During the many months for malnutrition come anemia, leucopenia and thrombocytopenia. The total protein content of serum blood is decreased. Marked lowering of intellectual activity, headaches, forgetfulness, the weakening of hearing, sight, smell. Endocrine disorders are manifested by increased skin pigmentation, cessation of menstruation and sexual potency. On the severity of clinical course there are three degrees of malnutrition: easy (I)when lowering power but it is expressed, but atrophy of muscles is not yet reached, the ability to work a little suffering; moderate (II)when the rapidly deteriorating General condition and are clearly revealed symptoms; severe (III)when observed disappearance of subcutaneous fat and sharp atrophy skeletal muscles with full disability. Clinical features distinguish swollen and vasotecno (dry) form. When malnutrition can develop coma, accompanied by decrease of breath, and sometimes the appearance of periodic breathing type Biota and Cheyne - Stokes equations, the fall of the pulse, the collapse. The most frequent complications of malnutrition: tuberculosis, dysentery, pneumonia, septic processes. The diagnosis is facilitated by history. It is necessary to exclude diseases of internal organs and endocrine system as the root cause of the depletion.
The forecast is unfavorable III-degree malnutrition and decreases considerably accession of infection.
For the treatment of malnutrition I degree sufficient to appoint a high-calorie diet. When malnutrition II and III patients hospitalized and placed in a well-heated chamber. In food, which should be not less than 6 times a day, injected a large amount of protein in the form of ground meat. Carbohydrates limit. General calorie food 3500 - 4000 kcal. In the treatment of diarrhea take into account the principle of sparing of mechanical. Also nominated sulfa drugs (sulgin, ftalazol to 4 grams a day for 5-6 days), hydrochloric acid. Edema fluid limit to 3 - 4 glasses per day. Assign table wine 30-50 ml 1-3 times a day before meal, vitamins C and complex In therapeutic doses of intravenous infusion of 40% solution of glucose 50-100 ml per day. Blood transfusion (under the supervision of a physician) apply with malnutrition II degree, and at the III degree enter a dry plasma (under medical supervision), blood solutions. Emergency assistance in a coma: the total warming (careful obkladyvanii heaters), intravenous alcohol (10 ml 33% solution), the infusion of 40% glucose solution in 40 ml every 3 hours up to an exit from a coma, intravenous solution of chloride calcium (5-10 ml 10% solution), especially when convulsions. When surface-respiration - lobeline (1 ml of 1 % solution) intramuscularly or intravenously, caffeine-benzoate sodium 1 ml of 10% solution under the skin, epinephrine 1 ml of 0.1% solution under the skin. Inside - hot wine, hot sweet tea, coffee.

Malnutrition (lat. alimentarius Commission - food) is a disease of malnutrition. Documented in the past under different names: edema disease, hungry disease, hungry swelling and others the Term "malnutrition" suggested by therapists, who worked in Leningrad during the blockade (1941-1942).
Etiology. The cause of malnutrition is the protein starvation; additional factors - cold, physical and psychological stress.
Pathological anatomy. When expressed picture of malnutrition subcutaneous tissue contains no fat (cachexia), muscle and bone atrophy. The heart is reduced in size, the muscle fiber his thinning brown atrophy), sometimes with symptoms of malnutrition. Atrophic changes are expressed throughout the digestive tract from language to the large intestine and the liver, pancreas, to a lesser extent - in the lymph and blood system. In the kidneys and especially in the brain atrophy is insignificant. Inflammatory and degenerative processes (usually secondary) depend on acceding complications.
Pathogenesis complicated. First, malnutrition is compensated by the burning of stored fat and carbohydrates of the body, later, there was a collapse of its own protein (muscle, parenchymatous organs). Protein starvation leads to multiple infringements of a metabolism and the functional state of the endocrine, vegetative and Central nervous systems. Constantly found lipoproteina-Sa. Reduces the content of sugar and cholesterol in the blood. In terminal period is set poisoning (gain decay of tissue proteins).
Clinical course. From the subjective features characteristic reinforced ("wolf") appetite, gnawing hunger, increasing weakness, fatigue, dizziness, muscle pain, paresthesia, sensitivity to cold, thirst, increased need for salt. Objectively - emaciation (50% weight), dryness and wrinkling of the skin (takes the form of parchment), pale yellow complexion, atrophy of skeletal muscles, hypothermia (35-36 degrees). There are coactions (dry) and edematous form of malnutrition. The latter is more benign. Hydrophily tissues characteristic of all clinical variants of the Alexander Palace In some patients develop swelling early, grow rapidly, combined with polyuria, but 1 can easily pass. In the later stages of the disease swelling usually occur on the background of exhaustion, are long-lasting, often accompanied by an accumulation of fluid in the cavities (the so-called ascitic form). Early swelling due to a change in the permeability of the vascular membrane, late - hypoproteinemia.
When malnutrition there aetiology, changing in the late stages tachycardia, arterial and venous hypotension. The velocity of blood is slowed down. Muffled heart sounds; its size is increased. On ECG in severe cases, find low voltage peaks In, reducing the interval S-gas-Electric or negative teeth So Changes respiratory remind picture senile emphysema. Gastro-intestinal tract celebrated sometimes a burning sensation in the tongue, taste perversion, dyspeptic complaints, flatulence, constipation, gravity in the epigastralna area. Gastric secretion decreases sharply, the evacuation of food from the stomach accelerated. The liver and spleen are not enlarged. Kidney function is retained in the later stages are marked polyuria, pollakiuriya, nocturia, sometimes incontinence. Severe anemia hypochromic or hyperchromic type is observed only for persistent forms of malnutrition with diarrhea, avitaminosis, infectious complications. From white blood cells - the tendency to leukopenia, in severe cases - lymphopenia, thrombocytopenia. ROHE in the city limits, with complications - accelerated. Reduced function of sexual glands (amenorrhea, infertility, early menopause), adrenal (weakness, hypotension), thyroid (lethargy, lowering the main exchange, the weakening of intelligence, a tendency to persistent edema), pituitary gland (polydipsia, polyuria). Changes in the nervous system are expressed in the form of musculoskeletal disorders (Amemiya, lethargy, sometimes convulsions), violations of the sensitivity (muscle pain, paresthesia, polyneuritis). The mentality of patients disturbed in the early stages, increased anxiety, irritability, rudeness, aggression, in the late lethargy, indifference. Sometimes there acute psychosis with hallucinations.
According to severity emit light (I degree), moderate (II) and heavy(W) form of the disease. For malnutrition can be acute or chronic. The acute form of the Alexander Palace, occurring usually without edema, seen mostly in young people asthenic Constitution. When death occurs sometimes in a coma, with hypothermia, convulsions, relaxation of the sphincter.
Outcomes A. D. - recovery, transition in prolonged or relapsing forms, death. Clinical visible recovery is far ahead of the actual (biological). The protracted period of the disease is when complications occur, or intercurrent infections. Death can be slow (the extinction of life with the exhaustion), fast (if joined other disease) and flash (instant, without warning cardiac arrest).


Complications. The most frequent - tuberculosis, dysentery and pneumococcal infections.
The diagnosis of malnutrition simple when there are pronounced objective symptoms and relevant medical history. A. D. must be differentiated from TB, cancer, chronic dysentery, pituitary, cachexia, edisonova disease, brucellosis, sepsis, graves ' disease, Andrey narrowing of the esophagus; edematous form A. D. with the defeat of the cardiovascular system and kidneys.
The prognosis depends on the degree of exhaustion and opportunities for improved nutrition. The prediction is less favourable for men, young persons and the astenikiv. Complications sharply worsen the prognosis.
Treatment. The necessary physical and mental peace. In severe cases (stage III) is assigned to the strict bed rest, warm bodies heaters. The increase in the number of calories in food out gradually, initially appointed about 3000 calories, then 3500 - 4000 cal. The fractional power, not less than 5 times a day. The staple food is easily digested protein diet (up to 2 g of protein per 1 kg of body weight) containing all essential amino acids. In severe forms - feeding through a tube. The liquid should be limited to 1-1,5 litres a day, and table salt to 5-10, sufficient food fortification, and with Hypo - or avitaminosis (scurvy, pellagra) - related drugs vitamins. Seriously ill designate glucose (40% solution intravenously 20-50 ml / day). In II and III stages should be fractional blood transfusion (75-100 ml 1-2 days), the plasma and blood solutions. In related anemia - iron products, campolon, Antianemic, vitamin B12. At diarrheas retain high-grade food, but the food is given in mashed form, appoint hydrochloric acid and pepsin, Pancreatin, sulfonamides (sulgin, ftalazol) or antibiotics (syntomycin, chloramphenicol, tetracycline). Coma require emergency assistance: the warming radiators, the introduction of non-glucose (40% - 40 ml every 3 hours), alcohol (33 % -10 ml), calcium chloride (10% - 10 ml)injections lobelina, camphor, caffeine, adrenaline. Inside coffee, hot sweet tea, wine.
Prevention is to nutritious food, especially in time of war or natural disasters, due to possible difficulties in the delivery of food. It is necessary to ensure minimum standards of proteins, which are situated in food casein, soybean, gelatine, yeast; mandatory maximum food fortification. When significant weight loss is facilitated employment regime, the increase in time of rest and sleep, timely hospitalization.