Protein energy malnutrition differential diagnosis: Difference between revisions
Line 297: | Line 297: | ||
| style="background: #F5F5F5; padding: 5px;" | <16years | | style="background: #F5F5F5; padding: 5px;" | <16years | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Nephrotic-range proteinuria | * [[Proteinuria|Nephrotic-range proteinuria]] | ||
* Edema | * [[Edema]] | ||
* Hyperlipidemia | * [[Hyperlipidemia]] | ||
* Hypoalbuminemia | * [[Hypoalbuminemia]] | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
* Avoid infections and drugs that may predispose to nephrotic syndrome | * Avoid [[infections]] and [[drugs]] that may predispose to [[nephrotic syndrome]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Urinalysis | * [[Urinalysis]] | ||
* Urine protein quantification (by first-morning urine protein/creatinine or 24-hour urine protein) | * [[Urine catecholamines|Urine protein]] quantification (by first-morning urine [[protein]] / [[creatinine]] or 24-hour urine protein) | ||
* Serum albumin | * [[Serum albumin]] | ||
* Lipid panel | * [[Lipid|Lipid panel]] | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
* Prognosis depends on whether the nephrotic syndrome is steroid responsive or steroid resistant | * Prognosis depends on whether the [[nephrotic syndrome]] is [[Steroid responsive nephrotic syndrome|steroid responsive]] or steroid resistant | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Corticosteroids | * [[Corticosteroids]] | ||
* Diuretics | * [[Diuretics]] | ||
* Antihypertensive agents | * [[Antihypertensive agents]] | ||
* Alkylating agents | * [[Alkylating agent|Alkylating agents]] | ||
* Calcineurin inhibitors | * [[Calcineurin inhibitor|Calcineurin inhibitors]] | ||
* Home monitoring of urine protein and fluid status | * Home monitoring of urine [[protein]] and fluid status | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Portal cirrhosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Liver cirrhosis|Portal cirrhosis]] | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
* Hepatitis C (26%) | * [[Hepatitis C]] (26%) | ||
* Alcoholic liver disease (21%) | * [[Alcoholic liver disease]] (21%) | ||
* Hepatitis C plus alcoholic liver disease (15%) | * [[Hepatitis C]] plus [[alcoholic liver disease]] (15%) | ||
* Cryptogenic causes (18%) - Many cases actually are due to NAFLD | * [[Cryptogenic cirrhosis|Cryptogenic]] causes (18%) - Many cases actually are due to [[NAFLD]] | ||
* Hepatitis B - May be coincident with hepatitis D (15%) | * [[Hepatitis B]] - May be coincident with [[hepatitis D]] (15%) | ||
* Miscellaneous (5%) | * Miscellaneous (5%) | ||
| style="background: #F5F5F5; padding: 5px;" | 5th - 6th decade of life | | style="background: #F5F5F5; padding: 5px;" | 5th - 6th decade of life | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Hepatomegaly | * [[Hepatomegaly]] | ||
* Abdominal pain | * [[Abdominal pain]] | ||
* Ascites | * [[Ascites]] | ||
* Abdominal distension | * [[Abdominal distension]] | ||
* Bulging flanks | * [[Bulging flanks]] | ||
* Shifting dullness | * [[Shifting dullness]] | ||
* Puddle sign | * [[Puddle sign]] | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
* Avoid alcohol | * Avoid [[alcohol]] | ||
* Treatment and vaccination against hepatitis | * Treatment and [[vaccination]] against [[hepatitis]] | ||
* Good diet and exercise | * Good diet and exercise | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* CBC | * [[Complete blood count|CBC]] | ||
* Albumin | * [[Albumin]] | ||
* Culture | * [[Culture collection|Culture]] | ||
* Total protein | * [[Total protein]] | ||
* Serum ascites albumin gradient | * Serum ascites albumin gradient | ||
* Ammonia level | * [[Ammonia production|Ammonia level]] | ||
| style="background: #DCDCDC; padding: 5px;" | Prognosis is poor | | style="background: #DCDCDC; padding: 5px;" | Prognosis is poor | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Prednisone and azathioprine - For autoimmune hepatitis | * [[Prednisone]] and [[azathioprine]] - For [[autoimmune hepatitis]] | ||
* Interferon and other antiviral agents - For hepatitis B and C | * [[Interferon]] and other [[Antiviral|antiviral agents]] - For [[hepatitis B]] and [[Hepatitis C|C]] | ||
* Phlebotomy - For hemochromatosis | * [[Phlebotomy]] - For [[hemochromatosis]] | ||
* Ursodeoxycholic acid - For primary biliary cirrhosis | * [[Ursodeoxycholic acid]] - For [[primary biliary cirrhosis]] | ||
* Trientine and zinc - For Wilson disease | * [[Trientine]] and [[zinc]] - For [[Wilson disease]] | ||
* Liver transplantation | * [[Liver transplantation]] | ||
|} | |} | ||
<small>Table adapted from CDC Pinkbook.<ref name="CDC90">{{cite web | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | url = http://www.cdc.gov/vaccines/pubs/pinkbook/table-of-contents.html }}</ref></small> | <small>Table adapted from CDC Pinkbook.<ref name="CDC90">{{cite web | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | url = http://www.cdc.gov/vaccines/pubs/pinkbook/table-of-contents.html }}</ref></small> |
Revision as of 13:10, 14 August 2017
Protein energy malnutrition Microchapters |
Patient Information |
---|
Differentiating Protein energy malnutrition from other Diseases |
Diagnosis |
Treatment |
Case Studies |
Protein energy malnutrition differential diagnosis On the Web |
American Roentgen Ray Society Images of Protein energy malnutrition differential diagnosis |
Protein energy malnutrition differential diagnosis in the news |
Risk calculators and risk factors for Protein energy malnutrition differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Protein energy malnutrition must be differentiated from other diseases that cause failure to thrive, edema, wasting recurrent infections, skin and hair changes. It is important to also differentiate kwashiorkor from marasmus as the two diseases belong to the protein energy malnutrition.
Differentiating Protein energy malnutrition from other Diseases
Differentiating kwashiorkor from marasmus[1]
Distinguishing Features | Kwashiorkor | Marasmus |
---|---|---|
Cause | Deficiency of protein in the diet of child | Deficiency of protein as well as energy nutrients (that is carbohydrates and fats) in the diet |
Age | Occurs in children in the age group 1-5 years | Typically occurs in children below the age of 1 year |
Association | More common in villages where there is small gap period between successive pregnancies | More common in towns and cities where breast-feeding in discontinued quite early |
Edema | Presence of edema | Absence of edema |
Muscles | Wasting of muscles | Wasting of muscles is quite evident. The child is reduced to skin and bones |
Skin changes | Dermatitis and Hyperpigmentation noticed | Dry and atrophic skin but no changes in color |
Serum cortisol | Decreased/Normal | Increased |
Fasting blood glucose | Decreased | Decreased |
Growth retardation | Mildly retarded in growth | Severely retarded in growth |
Facial appearance | Moon-like face | Elderly man face |
Abdomen | Protuded | Shrunken |
Vitamin deficiency | Present | Present |
Weight | 60-80% of normal weight for age | <60% of normal weight for age |
Differential diagnosis of edema and wasting [2][3][4][5][6][7][8][9]
Disease | Cause | Age(years) | Presentation | Prevention | Workup | Prognosis | Treatment |
---|---|---|---|---|---|---|---|
Kwashiorkor |
|
|
|
|
| ||
Marasmus |
|
|
:
|
:
| |||
Protein losing enteropathy |
|
|
|
|
|
| |
Anasarca |
|
1-4 |
|
|
Good prognosis if the underlying cause is identified and treated early |
| |
HIV wasting syndrome | HIV infection |
|
|
|
|
Prognosis is good with the use of HAART |
|
Chronic pancreatitis |
|
|
|
| |||
Pediatric nephrotic syndrome | <16years |
|
|
|
| ||
Portal cirrhosis |
|
5th - 6th decade of life |
|
|
Prognosis is poor |
|
Table adapted from CDC Pinkbook.[10]
References
- ↑ Müller O, Krawinkel M (2005). "Malnutrition and health in developing countries". CMAJ. 173 (3): 279–86. doi:10.1503/cmaj.050342. PMC 1180662. PMID 16076825.
- ↑ Cho EJ, Kim MY, Lee JH, Lee IY, Lim YL, Choi DH; et al. (2015). "Diagnostic and Prognostic Values of Noninvasive Predictors of Portal Hypertension in Patients with Alcoholic Cirrhosis". PLoS One. 10 (7): e0133935. doi:10.1371/journal.pone.0133935. PMC 4511411. PMID 26196942.
- ↑ Cuzzoni E, De Iudicibus S, Franca R, Stocco G, Lucafò M, Pelin M; et al. (2015). "Glucocorticoid pharmacogenetics in pediatric idiopathic nephrotic syndrome". Pharmacogenomics. 16 (14): 1631–48. doi:10.2217/pgs.15.101. PMID 26419298.
- ↑ DiMagno MJ, DiMagno EP (2013). "Chronic pancreatitis". Curr Opin Gastroenterol. 29 (5): 531–6. doi:10.1097/MOG.0b013e3283639370. PMC 4387887. PMID 23852141.
- ↑ Keithley JK, Swanson B (2013). "HIV-associated wasting". J Assoc Nurses AIDS Care. 24 (1 Suppl): S103–11. doi:10.1016/j.jana.2012.06.013. PMID 23290370.
- ↑ Nahlen BL, Chu SY, Nwanyanwu OC, Berkelman RL, Martinez SA, Rullan JV (1993). "HIV wasting syndrome in the United States". AIDS. 7 (2): 183–8. PMID 8466680.
- ↑ Vogelaar JL, Loar RW, Bram RJ, Fischer PR, Kaushik R (2014). "Anasarca, hypoalbuminemia, and anemia: what is the correlation?". Clin Pediatr (Phila). 53 (7): 710–2. doi:10.1177/0009922814526990. PMID 24647692.
- ↑ Amiot A (2015). "[Protein-losing enteropathy]". Rev Med Interne. 36 (7): 467–73. doi:10.1016/j.revmed.2014.12.001. PMID 25618488.
- ↑ Ramírez Prada D, Delgado G, Hidalgo Patiño CA, Pérez-Navero J, Gil Campos M (2011). "Using of WHO guidelines for the management of severe malnutrition to cases of marasmus and kwashiorkor in a Colombia children's hospital". Nutr Hosp. 26 (5): 977–83. doi:10.1590/S0212-16112011000500009. PMID 22072341.
- ↑ "Epidemiology and Prevention of Vaccine-Preventable Diseases".