Protein energy malnutrition physical examination: Difference between revisions
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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
Physical Examination
Patients with kwashiorkor usually appear retarded in growth in the late breast-feeding, weaning, and post weaning ages, with changes in skin and hair color and edema in the most dependent areas of the body ascending upward toward the head. Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, hyperkeratosis and hyperpigmentation of the skin, and distended abdomen due to an enlarged liver.[1][2][3]
Appearance of the Patient
Patients with kwashiorkor are usually apathetic and have a listless affect, with a round face with prominent cheeks known as the moon face. Despite this looks, they have very thin extremities and edema of the dependent areas such as the feet and sacral areas of the back. there is a marked discoloration of the skin and hair with a fluffy texture.
Vital signs
- Normal body temperature/ Hypothermia
- Hypotension
- Bradycardia
Skin
- Thin, dry, peeling skin with confluent areas of hyperkeratosis and hyperpigmentation
- Enamel paint dermatosis
HEENT
- Abnormalities of the head/hair may include presence of sparse and discoloured hair.
- Eyes are jaundiced
- There is pursed appearance of the mouth
Neck
- Hepatojugular reflex may be present because of the hepatomegaly
Lungs
- Decreased chest expansion
- Distant breath sounds maybe present
Heart
- Bradycardia
- Hypotension
- Presence of heart failure in severe cases
Abdomen
- Hepatomegaly
Back
- Presacral edema
Genitourinary
- Reduced glomerular filtration rate
- Reduced capacity of the kidney to excrete sodium
- Excess acid
- Reduced water load
- Urinary tract infections
Extremities
- Pitting edema of the lower extremities
- Muscle atrophy
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Altered mental status / mental retardation may be seen
- Hyporeflexia / areflexia
- Generalised muscle weakness
References
- ↑ Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN; et al. (2003). "Bacteriuria and urinary tract infections in malnourished children". Pediatr Nephrol. 18 (4): 366–70. doi:10.1007/s00467-003-1118-0. PMID 12700964.
- ↑ Jones KD, Berkley JA (2014). "Severe acute malnutrition and infection". Paediatr Int Child Health. 34 Suppl 1: S1–S29. doi:10.1179/2046904714Z.000000000218. PMC 4266374. PMID 25475887.
- ↑ Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J; et al. (2015). "Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania". Ital J Pediatr. 41: 44. doi:10.1186/s13052-015-0151-5. PMC 4472394. PMID 26084628.