Nutritional Pathology Topics Nutritional ... - มหาวิทยาลัยนเรศวร

9/7/2012Secondary PEM.SyndromeClinicalsettingTimecourseClinical featuresLaboratoryfindingsPrognosis1. marasmuslikePEMChronicillness (e.g.,chronic lungdisease,cancer)MonthsHistory of weightloss, musclewasting, absentsubcutaneous fat“Cachexia”Normal ormildlyreducedserumproteinsVariable;dependsonunderlyingdiseaseKwashiorkor2. kwashiorkorlikePEMAcute,catabolicillness (e.g.,severetrauma,burn, sepsis)WeeksNormal fat andmuscle , edema,easily pluckablehairSerumalbumin 2.8 gm/dlpoorTopics• Nutritional deficiencies– Protein – Energy Malnutrition– Anorexia Nervosa and Bulimia– Vitamin Deficiencies– Mineral Deficiencies• Obesity• Diet and Systemic DiseasesAnorexia Nervosa• Self-induced starvation, resulting in markedweight loss• Manifested as severe PEM with endocrineabnormalities– Amenorrhea (GnRH, LH, FSH)– Decreased bone density (low estrogen level)– Decreased thyroid hormone release (coldintolerance, bradycardia, constipation)• Increased susceptibility to cardiacarrhythmia and sudden death4