Protein energy malnutrition differential diagnosis: Difference between revisions
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* [[Lactase]] if [[lactose intolerant]] | * [[Lactase]] if [[lactose intolerant]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | Marasmus | | style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Marasmus]] | ||
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* Protein energy malnutrition (PEM) | * [[Protein energy malnutrition]] ([[PEM]]) | ||
* Hospitalized patients with malignancy | * [[Hospitalized]] patients with [[malignancy]] | ||
* Cystic fibrosis | * [[Cystic fibrosis]] | ||
* Neurologic diseases | * [[Neurologic diseases]] | ||
* Genetic diseases | * [[Genetic diseases]] | ||
* End stage renal diseases | * [[End stage renal disease|End stage renal diseases]] | ||
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* < 5 | * < 5 | ||
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* Hypo / hyperthermia | * [[Hypothermia|Hypo]] / [[hyperthermia]] | ||
* Dehydration | * [[Dehydration]] | ||
* Skin pallor | * Skin pallor | ||
* Anemia | * [[Anemia]] | ||
* Corneal lesions (due to vitamin A deficiency) | * [[Corneal disease|Corneal lesions]] (due to [[vitamin A deficiency]]) | ||
* Decreased distal pulses | * Decreased distal pulses | ||
* Confusion | * [[Confusion]] | ||
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* Balanced diet | * [[Balanced diet]] | ||
* Prophylactic antibiotics | * [[Antibiotics|Prophylactic antibiotics]] | ||
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* Blood glucose | * [[Blood glucose]] | ||
* Peripheral blood smear | * [[Peripheral blood smear]] | ||
* Hemoglobin | * [[Hemoglobin]] | ||
* Urinalysis and culture | * [[Urinalysis]] and culture | ||
* Stool exam | * [[Stool examination|Stool exam]] | ||
* Albumin tests | * [[Serum albumin|Albumin tests]] | ||
* Electrolyte level | * [[Electrolyte|Electrolyte level]] | ||
| style="background: #DCDCDC; padding: 5px;" | : | | style="background: #DCDCDC; padding: 5px;" | : | ||
* Prognosis good if underlying medical illness treated | * Prognosis is good if underlying medical illness is treated | ||
* Bacterial infection and renal failure may portend a poorer prognosis | * [[Bacterial infection]] and [[renal failure]] may portend a poorer prognosis | ||
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* Blood glucose control | * [[Blood glucose]] control | ||
* Prevent hypothermia | * Prevent [[hypothermia]] | ||
* Prompt correction of dehydration | * Prompt correction of [[dehydration]] | ||
* Early detection and correction of electrolyte imbalance | * Early detection and correction of [[electrolyte imbalance]] | ||
* Active control of infections | * Active control of [[infections]] | ||
* Screening and stabilization of micronutrient deficiencies | * Screening and stabilization of [[Micronutrient malnutrition|micronutrient deficiencies]] | ||
* Feeding for initial stabilization | * Feeding for initial stabilization | ||
* Nutritional support to support normal growth | * [[Nutritional supplement|Nutritional support]] to support normal growth | ||
* Psychological support, care and stimulation | * [[Psychological analysis|Psychological support]], care and stimulation | ||
* Careful follow-up of cases upon discharge | * Careful follow-up of cases upon discharge | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Protein losing enteropathy]] | ||
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* Infectious agents | * [[Infectious agents]] | ||
* Immune related diseases | * [[Immune disorder|Immune related diseases]] | ||
* Neoplasms affecting the GI tract | * [[Neoplasms]] affecting the [[Gastrointestinal tract|GI tract]] | ||
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* All age groups | * All age groups | ||
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* Generalized peripheral edema | * Generalized [[peripheral edema]] | ||
* Gastrointestinal disorders | * [[Gastrointestinal disorders]] | ||
* Abdominal pain | * [[Abdominal pain]] | ||
* Diarrhea | * [[Diarrhea]] | ||
* Malnutrition | * [[Malnutrition]] | ||
* Weight loss | * [[Weight loss]] | ||
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* Avoidance of infections and other diseases associated with protein losing enteropathy | * Avoidance of [[infections]] and other [[diseases]] associated with [[protein losing enteropathy]] | ||
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* Measurement of albumin/globulin levels | * Measurement of [[albumin]] / [[globulin]] levels | ||
* Presence of α1-antitrypsin in stool samples | * Presence of [[Alpha 1-antitrypsin deficiency|α1-antitrypsin]] in stool samples | ||
* Measuremnent of vitamins A, D, E and K | * Measuremnent of [[Vitamin A Deficiency|vitamins A]], [[Vitamin D Deficiency|D]], [[Vitamin E deficiency|E]] and [[Vitamin K Deficiency|K]] | ||
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* Prognosis largely depends on the underlying disease | * Prognosis largely depends on the [[Disease|underlying disease]] | ||
* If it is potentially curable, prognosis improves considerably | * If it is potentially curable, prognosis improves considerably | ||
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* Antiparasitic agents | * [[Antiparasitics|Antiparasitic agents]] | ||
* ACE inhibitors and diuretics | * [[ACE inhibitor|ACE inhibitors]] and [[diuretics]] | ||
* Surgical interventions may be required to resect neoplasms | * [[Surgery|Surgical interventions]] may be required to [[Resection|resect neoplasms]] | ||
* Low-fat diets supplemented with medium-chain triglycerides | * [[Low-fat diet|Low-fat diets]] supplemented with [[Medium-chain fatty acids|medium-chain triglycerides]] | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | | | style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Anasarca]] | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
* Protein energy malnutrition | * [[Protein energy malnutrition]] | ||
* Increased hydrostatic pressure | * Increased [[hydrostatic pressure]] | ||
* Reduced oncotic pressure | * Reduced [[oncotic pressure]] | ||
* Lymphatic obstruction | * [[Lymphatic obstruction]] | ||
* Some cancers | * Some [[cancers]] | ||
| style="background: #F5F5F5; padding: 5px;" | 1-4 | | style="background: #F5F5F5; padding: 5px;" | 1-4 | ||
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* | * [[Generalized edema]] of body tissues with profound subcutaneous [[Edema|swelling]] | ||
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* Healthy balanced diet in children | * Healthy [[balanced diet]] in children | ||
* Treatment of underlying heart problems | * Treatment of underlying [[Heart failure|heart problems]] | ||
* Treatment of cancers | * Treatment of cancers | ||
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Revision as of 12:21, 14 August 2017
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Differentiating Protein energy malnutrition from other Diseases |
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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
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 |
|
Congenital heart disease | |||||||
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".