Protein energy malnutrition differential diagnosis: Difference between revisions
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* Deficiency of protein-rich foods like meat and poultry in diet | * Deficiency of protein-rich foods like meat and poultry in diet | ||
* Early weaning | * Early weaning | ||
| style="background: #F5F5F5; padding: 5px;" | < 1 | | style="background: #F5F5F5; padding: 5px;" | | ||
* < 1 | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Apathy | * Apathy | ||
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* Genetic diseases | * Genetic diseases | ||
* End stage renal diseases | * End stage renal diseases | ||
| style="background: #F5F5F5; padding: 5px;" | < 5 | | style="background: #F5F5F5; padding: 5px;" | | ||
* < 5 | |||
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* Hypo / hyperthermia | * Hypo / hyperthermia | ||
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* Neoplasms affecting the GI tract | * Neoplasms affecting the GI tract | ||
* | * | ||
| style="background: #F5F5F5; padding: 5px;" | All age groups | | style="background: #F5F5F5; padding: 5px;" | | ||
* All age groups | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Generalized peripheral edema | * Generalized peripheral edema | ||
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|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Anasarca''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Anasarca''' | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''HIV wasting syndrome''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" | '''HIV wasting syndrome''' | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | HIV infection | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | * All age groups | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | * >10% total body weight loss | ||
| style="background: #DCDCDC; padding: 5px;" | | * Severe diarrhea | ||
| style="background: #F5F5F5; padding: 5px;" | | * Chronic weakness | ||
* Fever lasting for more than three to four weeks | |||
* HIV infection | |||
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* Use of HAART | |||
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* Nutritional assessment | |||
* Serial measurements of weight | |||
* Body mass index (BMI) | |||
* Evaluate LBM, | |||
* Total body water and fat | |||
* Sequential anthropometry (mid arm circumference, triceps skinfold thickness) to predict prognosis | |||
| style="background: #DCDCDC; padding: 5px;" | Prognosis is good with the use of HAART | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* HAART | |||
* Megestrol acetate | |||
* Marijuana (in some states) | |||
* Dronabinol | |||
* Somatropin | |||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Congenital heart disease | | style="background: #F5F5F5; padding: 5px; text-align: center;" | Congenital heart disease | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Chronic pancreatitis''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Chronic pancreatitis''' | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | * Tumors or stones | ||
| style="background: #F5F5F5; padding: 5px;" | | * Toxic metabolites | ||
| style="background: #DCDCDC; padding: 5px;" | | * Necrosis | ||
| style="background: #F5F5F5; padding: 5px;" | | * Fibrosis | ||
| style="background: #DCDCDC; padding: 5px;" | | * Oxidative stress | ||
| style="background: #F5F5F5; padding: 5px;" | | * Ischemia | ||
* Alcohol consumption | |||
* Autoimmune disorders | |||
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* 30 to 40 years | |||
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* Epigastric abdominal pain | |||
* Nausea | |||
* Vomiting | |||
* Decreased appetite | |||
* Exocrine and endocrine dysfunction | |||
* Weight loss | |||
* Protein deficiency | |||
* Diarrhea and steatorrhoea | |||
* Secondary diabetes mellitus | |||
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* Avoiding alcohol can reduce the risk for the development of chronic pancreatitis. | |||
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* Pancreatic enzymes | |||
* Blood sugar | |||
* Stool analysis for presence of enzymes and fat | |||
* Computerized tomography | |||
* X-rays | |||
* Magnetic resonance cholangiopancreatography | |||
* Transabdominal ultrasound | |||
| style="background: #DCDCDC; padding: 5px;" | | |||
* Patients who get medical care early have a good prognosis | |||
* increased risk of pancreatic cancer | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Ibuprofen and acetaminophen along with antioxidants | |||
* Surgical options are considered if medical options fail | |||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Congenital nephrotic syndrome''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Congenital nephrotic syndrome''' | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Portal cirrhosis | | style="background: #F5F5F5; padding: 5px; text-align: center;" | Portal cirrhosis | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|} | |} | ||
<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 14:29, 11 August 2017
Protein energy malnutrition Microchapters |
Patient Information |
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Differentiating Protein energy malnutrition from other Diseases |
Diagnosis |
Treatment |
Case Studies |
Protein energy malnutrition differential diagnosis On the Web |
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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 childhood malnutrition
Disease | Cause | Age(years) | Presentation | Prevention | Workup | Prognosis | Treatment |
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Kwashiorkor |
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Marasmus |
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Protein losing enteropathy |
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Anasarca | |||||||
HIV wasting syndrome | HIV infection |
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Prognosis is good with the use of HAART |
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Congenital heart disease | |||||||
Chronic pancreatitis |
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Congenital nephrotic syndrome | |||||||
Portal cirrhosis |
Table adapted from CDC Pinkbook.[2]
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.
- ↑ "Epidemiology and Prevention of Vaccine-Preventable Diseases".