Wasting

Wasting - chronic eating disorder characterized by varying degrees of weight loss. As a rule, malnutrition affects young children.

Etiology, pathogenesis. Polyetiology disease. There are congenital (prenatal) and acquired (postnatal) malnutrition. Congenital malnutrition often due to illness or the mother is associated with fetal hypoxia, fetal infection, genomic and chromosomal mutations. Among the causes of acquired malnutrition distinguish exogenous and endogenous. The former include nutritional factors (hypogalactia his mother, wrong calculated diet with bottle-fed, one-sided feeding, etc..), Pyloric stenosis and pilorospazm, drug poisoning (hypervitaminosis D and others.), Infections of the gastrointestinal tract, leaving deficiencies regime, education and so on. d. endogenous causes of malnutrition may be a malformation of the gastrointestinal tract and other organs, lesions of the central nervous system, hereditary metabolic abnormalities, and immunodeficiency disorders, endocrine disorders, and so on. d.

In the pathogenesis of malnutrition based on the decrease in utilization of food substances in violation of the digestion process, absorption and assimilation of them under the influence of various factors.

There are I, II and III degree malnutrition severity.

The clinical picture. Wasting I degree is characterized by loss of body weight is not more than 20% of a would-age. Thinner layer of subcutaneous fat on the abdomen, decreased tissue turgor. The curve flattened body weight increase. Other parameters are generally within the normal or slightly reduced.

When the degree of malnutrition II body weight loss is 25-30% compared to the age norm. The subcutaneous layer is preserved only on the face, especially thinned it on the abdomen and extremities. The skin is dry, easily going to fold here and there hanging. There is a lag in growth, reduced appetite, the child becomes irritable, lose previously acquired skills, impaired thermoregulation. Unstable chair, "hungry" chair (lean, dry, discolored, with a sharp and unpleasant smell) is replaced by dyspeptic (green, undigested food particles, with mucus). When malnutrition III degree of body weight loss of more than 30% of a would to age. The increase in body weight is not available, the child is significantly behind in growth. Externally - extreme exhaustion, skin pale gray, completely absent subcutaneous fat layer. Mucous membranes are pale, dry mouth elements of thrush (yeast infection). Breathing shallow, heart sounds are muffled, blood pressure is reduced. The body temperature is lowered, marked periodic upgrades to subfebrile, there is no difference between the axillary and rectal temperature. Infectious processes are ma-losimptomno. Often there are signs of subacute current rickets.

malnutrition diagnosis is usually not difficult. Much more difficult to find out the causes of malnutrition.

Treatment of patients should be comprehensive and include measures aimed at 'the elimination or correction of cause-significant factors, diet therapy, the purpose of restorative procedures, enzymes and symptomatic treatment, the elimination of foci of infection, vitamin therapy. In all cases, the appointment of a diet is necessary to find out tolerance to food. During the period of enhanced food needs scatological load control.

When the degree of malnutrition 1 protein and carbohydrate are usually calculated per 1 kg of body weight, a would age and fat-on 1 kg of body mass existing.

At the II degree malnutrition establish tolerance to food is carried out for 3-5 days. Assign usually breast milk or sour mix (kefir, acidophilic "Baby", biolact et al.). Calculation of the short run lead to the existing child's body weight, followed by about a would (existing 20), and only then on a would. With 3-4-th day gradually increase the protein load, then the carbohydrate and fat in the least.

When malnutrition III degree diet therapy is preferred to start with the introduction of breast milk every 2 hours for 20-30 ml. Bringing the amount of food to 50 ml, reduce the number of feedings. The order of increasing stress proteins, carbohydrates and fats is the same as in the II degree malnutrition, but more gradual. Tolerance to food turns out for 2 weeks. When hypotrophy II and III degree missing amount of fluid, nutrient and electrolyte injected / drip 5-10% glucose solution, isotonic sodium chloride solution, Ringer's solution, protein hydrolysates, albumin, protein, etc. (3-5 ml albumin. / kg ,; gemodez to 15 ml / kg, but not more than 200 ml; reopoligljukin 8.3 ml / kg). Displaying holding insulinglyukozoterapii (n / k 1 u of insulin on glucose 5 g input). Treating malnutrition II- III level should be carried out in a hospital.

In the presence of foci of infection prescribe antibiotics (to avoid nephrotoxicity, hepato and ototoxic drugs), surgery is carried out if necessary. Widely used fermentoterapii, vitamin therapy. Of the stimulants prescribed apilak, gamma globulin, albumin, plasma, a blood transfusion. In some cases, it is advisable to use anabolic hormones (retabolil 1 mg / kg, 1 time in 2 weeks, and others.). Showing massage and exercise therapy, exposure to fresh air.

The prognosis depends on the cause that led to malnutrition and possibilities of its elimination. In primary malnutrition III degree prognosis is always serious; mortality rate of up to 30%.

Prevention. If possible, providing a natural feeding, treatment hypogalactia, rational feeding, early diagnosis of diseases of newborns and infants.