E

N
F
E
MALNUTRITION R
TYPE MARASMUS M
E
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Í
A
NATIONAL UNIVERSITY JOSÉ FAUSTINO SÁNCHEZ CARRIÓN

FACULTY OF HUMAN MEDICINE

PROFESSIONAL NURSING SCHOOL

Subject:

Nursing in Child and Adolescent Health II

Teacher:

Cabanillas Jáuregui, Tomasa Hormecinda

Members:

Flores Nazario, Maryliza Lisbeth

Maldonado Daorta, Marisol Karolai

Vanessa Alexandra Rivas Chirito

Rodríguez Quiche, María Reyna

Yessenia Karina Villegas Arroyo

Cycle:

VIII

Huacho–Peru

2021
 INTRODUCTION

Malnutrition is a common cause of childhood morbidity and mortality, of decrease

in the performance of the child and adolescent, and in the adulthood of the reduction in the
work performance.

Marasmus is a type of childhood malnutrition; this disease occurs as a consequence of

a serious diet deficient in proteins and calories. It is common in most of the
developing countries and especially in children under 18 months. There are risk factors
that contribute to its appearance. For infants a few weeks old, it is the
prematurity or low birth weight. The lack of breastfeeding due to death or separation
from the mother, or due to partial or total lack of milk from the mother can be other causes, that
in poor societies it is the only feasible way to adequately feed the
infants.

Infants or children with marasmus have a distinctive appearance. They are extremely
thin, with a sometimes prominent abdomen, with intense emaciation, loss of fat
subcutaneous, very prominent ribs, old man's face, skin hanging in folds. The main
characteristics consist of growth delay, weight below 60% of the estimated for
her age, short stature, low subcutaneous fat, evident loss of muscle mass,
extremidades delgadas, infecciones, diarrea, infección respiratoria, inflamación crónica,
tuberculosis, parasitosis, and signs of nutritional deficiencies, such as xerophthalmia, deficiency
of vitamin B, nutritional anemia and others. The child's mood may be more anxious.
how sad and apathetic, may have anorexia or good appetite, have diarrhea, etc.

Current efforts are aimed at increasing the consumption of cereals, legumes, and others.
locally produced foods, preventing and controlling infections and diseases
parasitic, and promote the consumption of oil, fat, and other products that reduce the
volume and increase the energy of foods. These measures are likely to have a
greater impact if accompanied by growth controls, vaccinations, treatments
of oral rehydration in cases of diarrhea, early treatment of diseases,
deworming and addressing the underlying causes of malnutrition such as poverty and
inequality.

2
 INDEX

INTRODUCTION 2

EPIDEMIOLOGY 4

DEFINITION 4

ETIOLOGY 4

SIGNS AND SYMPTOMS: 5

PATHOPHYSIOLOGY 6

DIAGNOSIS 8

TREATMENT 9

Nursing Interventions 12

COMPLICATIONS 12

CLINICAL CASE 13

CARE PLAN 17

CONCLUSIONS 18

RECOMMENDATIONS 18

BIBLIOGRAPHY 19

ANNEXES 24

3
 MALNUTRITION TYPE MARASMUS

1. EPIDEMIOLOGY:

Marasmus is one of the main public health problems in Peru.

and affects the poorest departments, 0.2% of children under five years old
they present cases of malnutrition, which would add up to 5660 cases per year and a mortality
estimated at 7471 children per year for this reason.

2. DEFINITION:

It is a type of malnutrition due to energy deficiency, causing a caloric deficit.

total, without alteration of the protein contribution. In this case, the weight is primarily altered,

since the fat deposits are consumed.

3. ETIOLOGY:

The cause of marasmus is due to the lack of adequate protein foods or by the
inability to take advantage of existing resources, which will lead to the organism
to use their own reserves.
Biological and dietary factors
Maternal malnutrition can lead to intrauterine malnutrition and low birth weight.
This leads to the emergence of protein-energy malnutrition (PEM) in a
early stage of life.

Vicious circle of malnutrition: When a woman is malnourished

she becomes pregnant and during her pregnancy her nutritional status does not improve, the

newborn will have low weight. If during the course of life the child is fed
inadequately will grow as a malnourished child and if the poor diet
he will continue to become a malnourished adult and thus this vicious circle will repeat.
Virtuous circle of good nutrition: When a woman of childbearing age has
a good nutritional status and becomes pregnant, the newborn will have good weight, and
if good nutrition continues, the baby will grow up well-nourished and will be an adult
healthy.

4
 From the vicious circle to the virtuous circle: The vicious circle of malnutrition
breaks when the malnourished mother eats properly and
improves her nutritional status during pregnancy. She will have a newborn.
With a good weight, if he continues with a good diet, the child will grow well.
nourished.

Social and economic factors

Poverty is often associated with DPE due to low access to the
food, unsanitary living conditions, overcrowding, and care
inadequate for children. Ignorance leads to poor childcare practices,
reduction in the practice and duration of breastfeeding, cultural practices and
social norms that impose taboos or prohibitions on certain foods.

4. SIGNS AND SYMPTOMS:

Poor growth. In all cases, the child does not grow properly.
If the age is known, the weight will be very low according to normal standards.
Emaciation. The muscles are always found to be very diminished. There is little
subcutaneous fat. The skin hangs in wrinkles, especially around the buttocks
and the thighs. When the skin is pinched between the index finger and thumb, the absence is noticeable.

from the usual layer of adipose tissue. The child seems to be just skin and bones.
Bichact ball. There is a loss of the fat deposits that are found.
on the cheeks which gives a monkey-like appearance.
Irritability: Children with marasmus may manifest irritability due to
excessive hunger they feel.
Increased appetite. The child has a voracious hunger. They often suck their fingers.

hands violently or the clothes or anything else within reach.

Skin ulcerations. There may be pressure sores on the prominences.
oceans, not in friction areas.
Cachexia appearance: Characterized by weight loss and loss
muscular. The prominent bones of the face, ribs, and
upper and lower extremities.
Vitamin deficiency: It is due to the starvation of the diet.

5
 Liquid feces. Fecal matter is usually loose with particles of
undigested food.
Decrease of hemoglobin. The concentration of hemoglobin adapts.
according to the body.
5. PATHOPHYSIOLOGY:
This process allows for a series of metabolic and behavioral adjustments that
result from a decreased need for nutrients.

➔ Metabolic and Endocrine Responses:

There is a reduction in energy intake; if this is very severe, one begins to

using body fat as an energy substrate, lean mass decreases more
slowly, and the catabolism of muscle proteins produces amino acids
free, especially alanine, which are used as energy substrates. They
characterized by hypometabolism, as food intake decreases, the rate of
growth is also reduced, puberty is delayed, and height is decreased.
In relation to the pituitary-thyroid axis, the function is diminished, the uptake of iodine.
it is low, there is a decrease in growth hormone. The decrease in the
plasma insulin allows free fatty acids and amino acids to
mobilized from adipose tissues and muscle to supply compounds
(lactate, glycerol, and amino acids) that enter the gluconeogenic pathway and maintain the
oxidative metabolism of the organism, while conserving glucose for the
brain metabolism. In addition, there is peripheral insulin resistance due to
effect of growth hormone, cortisol, catecholamines, free fatty acids
and interleukins.

➔ Hematology and oxygen transport

In the malaise, there is a reduction in the number of erythrocytes and the decrease

hemoglobin concentration, which causes a decrease in demand for

oxygen, due to the reduction of body mass. A can develop a
severe anemia due to a marked deficiency of iron and folates, or a loss
blood chronicle.

6
Cardiovascular and renal functions

In patients with marasmus, cardiac output and blood pressure are reduced.
due to the loss of body mass. Renal plasma flow and filtration
glomerular can decrease as a result of reduced cardiac output. The
cellular exchange of sodium and potassium is altered, due to renal immaturity
As a consequence of early malnutrition, the capacity for acidification of
the urine is altered and can cause metabolic acidosis.

Immune System

A variety of immune functions are diminished in marasmus.

greater predisposition to infections that tend to be more prolonged and severe,
due to the activity of neutrophils and the reduction of production
T lymphocytes.

Gastrointestinal functions

The mucosa of the small intestine is atrophied, and the production of enzymes
digestive and nutrient transporters are reduced, which affects digestion and
absorption. The absorption of nutrients is poor when large amounts are consumed
quantities of food. Intestinal motility decreases as well as the
luminal bacterial proliferation.

Central and peripheral nervous system

The lack of nutrients during brain maturation periods is associated

both to biochemical changes and to modifications in myelination and
decrease in neurotransmitters, number of cells, and acid
neuronal deoxyribonucleic. This situation alters the structures and functions of
brain.

Skin and glands

The skin and subcutaneous fat atrophy, causing loose folds of skin.
There is a reduction in sweat production due to the atrophy of glands.
sudoriferous, lacrimal and salivary.
7
6. DIAGNOSIS:

Complete physical examination: During the physical examination, the doctor performs the

evaluation of the patient's appearance, considering aspects such as their

height and body weight, depending on their sex and age. Subsequently, it performs the
palpation of their body, which establishes the degree of malnutrition that
presents. Especially with evidence such as the lack of body fat, the
absence of muscles and the texture of their wrinkled and sometimes hanging skin.
In addition to considering the presence of a skeletal appearance, with the
protruding shoulder blades, and an appearance of old age on his face.

Classification of malnutrition according to Gómez

Percentage (%) of weight Percentage (%) of
CLASSIFICATION
standard for age weight deficit
Normal > 90 less than 10%

Grade I (mild malnutrition) 75–89.9 10–24%

Grade II (malnutrition) 60–74.9 25–39%
moderate)
Grade III (severe malnutrition) <60 40%

Laboratory data: hematological, blood chemistry, stool and urine, examination

of electrolytes, complete blood count.
COMPLETE BLOOD COUNT
ANALYSIS NORMAL VALUES UNITS
WHITE BLOOD CELLS 4,000–10,000 mm/3
RED BLOOD CELLS 3,500,000 – 5,500,000 mm/3
Hematocrit 37–54 %
Hemoglobin 11 - 16 GR

8
 ELECTROLYTES EXAM
ANALYSIS NORMAL VALUES
CHLORIDE (Cl) 90 to 110 mEq/l
POTASSIUM (K) 3.4 to 4.7 mEq/l
Sodium (Na) 138 to 146 mEq/l

7. TREATMENT:

It must be established gradually to achieve the readaptation of the functions.

metabolic and intestinal, depends on the degree of malnutrition, metabolic stress or
infectious that the child suffers from. The measures proposed such as the nutrients that
they are used and their routes of administration will be individualized and modified in
function of the patient's response.
Stages of treatment:
1st phase: Fluid management
Correct the electrolyte imbalance.
Antibiotic treatment:
Amoxicillin 90 mg/kg/day
Ampicillin 50mg/kg/IV every 6 hours for 2 days
Correct micronutrient deficiencies.
As a base, a liquid formula of good nutritional quality.
Increase those amounts slowly and gradually.
Administer food frequently and in small volumes, both during the day
like at night.
Avoid fasting, even for a few hours.
Help the patient eat, but without forcing them.
Continue with breastfeeding. If the patient is breastfeeding, the mother must
stay in the hospital to breastfeed him.
Supplement the diet with minerals and vitamins.
Do not give iron during the first week
Be patient and show affection to the child, especially when feeding them.

9
 Do not let the child eat alone, unsupervised.
Involve the mother, other relatives, and caregivers in the child's recovery.
oh girl.
Evaluate the patient's progress every day.
2nd phase: Stabilization
Administer 75 kcal and 0.9g protein/100ml (F-75 formula)
We will give 130 mL/kg/day for 100 kcal/kg/day.

Increase food intake to regain lost weight.

LIQUID NUTRITIONAL RECOVERY FORMULAS

For the urgent phase of the treatment, using different foods:

No. Main food Amount of Flour Sugar Oil Water

(g o ml) of corn (g) (ml) until
the rice complete

1 Whole powdered milk 35 50 100 --- 1,000

2 Powdered milk 25 50 100 10 1,000

skimmed

3 Fresh milk (liquid), 250 50 100 --- 1,000

integral

4 Incaparina, flour 65 --- 100 15 1,000

5 CSB flour 70 --- 100 10 1,000

6 Commercial formulas 85 --- 75 --- 1,000

with isolated protein from
soy, powder

Diet management
The treatment should begin with a liquid or semi-solid formula giving it
frequently and in small amounts to avoid vomiting and an overload
of the intestine, liver, and kidneys. For this, the formula for one day will be divided into 8 to 12

portions of similar size, administered at intervals of 2-3 hours throughout

from 24 hours. Fasting for more than 4 hours should be avoided in any patient, in order to
prevent hypoglycemia and hypothermia. The volume of the formula should be increased by
gradual form according to weight gain evolution and tolerance to avoid
10
harmful metabolic alterations. It is necessary to have patience and encourage the ...
the children to consume all the foods at each meal, without forcing them and to avoid
vomiting
3rd phase: Maintenance (7 - 26 weeks)
Start caloric and protein intake: 75cal/kg, 1g/kg/24h
Formula F-100 (100kcal and 2.9g protein/100mL)
130 kcal/kg/day 130 mL/kg/day
200 kcal/kg/day 200 mL/kg/day
Therapeutic Formula Ready for Consumption:
20g of FTLC = 100mL of F-100
First week 3–5 ounces/kg/day
Second week 4–5 ounces/kg/day
Third and fourth week 5–7 ounces/kg/day
Therapeutic Formula List for Consumption:
A 92g envelope of FTLC provides 500 kcal
Contains 12.5–15g of protein
Food:
The treatment should continue with formulas (whole powdered milk, milk in
skimmed powder, fresh milk, Incaparina, and commercial formulas with protein
isolated soy). The amount of formula is increased by 10 ml at each feeding.
For example, if the first dose is 60 ml, the second should be 70 ml, and so on.
successively).

If the girl(boy) didn't finish a serving, the same amount should be offered again.
next take. This process must be maintained until something is left over.
formula after most of the shots. From this moment on this will be
the amount that is offered to the girl(boy) in the following days. It should be discarded
any food not consumed; can never be reused for the
next take.

Supplement these diets with syrups or multivitamin and mineral drops in the
recommended dosage according to the patient's age, or add to each liter of diet

11
 20 ml of concentrated mineral solution and 150 mg of the mixture of
vitamins (Retinol, Thiamine, Riboflavin, Pyridoxine, Cyanocobalamin, acid
folic acid, niacin, vitamin K, etc.)

This type of liquid formula should be maintained until the girl (or) is found
better, prepared to continue their feeding at home or at a level
outpatient clinic.

8. NURSING INTERVENTIONS:
Promote exclusive breastfeeding.
Promote adequate and timely complementary feeding
Promote key hygienic behaviors
Provide interventions in micronutrients such as vitamin supplements
And iron for pregnant women, nursing mothers, and young children.
Deworming in endemic areas and oral rehydration in regions with high
prevalence of diarrhea.
Enrichment of frequently consumed foods with micronutrients
(like iodized salt) and staple foods such as wheat, oil
and the sugar with iron, vitamin A, and zinc.
Conservation of optimal nutrition and fluid balance.

9. COMPLICATIONS: Severe prolonged caloric-protein malnutrition

during can generate the following complications:
Hypoglycemia
Hypothermia
Tuberculosis
Sepsis
Urinary tract infections
Pneumonia
Alteration of neurological development
Heart Failure
Accumulation of fluid in the abdominal area and presence of parasites

12
 lack of motor agility and much fatigue, caused by lack of energy
in their body
Growth problems
Organic dysfunction

10. CLINICAL CASE:

PERSONAL DATA:
Joaquín Lucas Márquez Villanueva
03/05/2018
3-year-old male pediatric patient, weighing 10 Kg and a
Height of 75 cm, conscious, lethargic and irritable, with a T°= 36°C, HR= 100 bpm, RR
= 24 rpm. Additionally, it is observed with hanging skin, scarce muscular and cellular tissue.
subcutaneous, pallor and dryness in skin and mucous membranes, sunken eyes. He has a
hematocrit of 30% and a hemoglobin of 9g. According to the mother's reference, it does not count.

with complete and irregular CRED vaccination controls, there are thermal spikes and not
urine for the past 12 hours and if it does, it is in small quantities. His home is
Adobe lacks basic services, has 2 younger siblings, and also has a low income.
access to food due to economic conditions as his father is a porter
and her mother is a housewife.
Relevant data
➔ Deficiency in the increase of ➔ Changes in color and texture
weight and in growth. of the hair
➔ Emaciation ➔ Frequent infections
➔ Irritability ➔ Deficiency vitaminic
➔ Dehydration associated
➔ Prominent facial bones
and sunken eyes
The Gómez classification is applied and the following grade was obtained:
Grade II (Moderate malnutrition)
It is evaluated by the pediatrician who indicates the following treatment:
➔ Vaccination regulations according to age
➔ Parenteral hydration with 10% Dextrose
➔ Start caloric and protein intake: 75cal/kg, 1g/kg/24h
➔ Multivitamin complex:

13
Zinc 1 mg/kg/day orally
Copper 0.3 mg/kg/day orally

Folic acid 1 mg/day orally

1
 CARE PLAN

Data Diagnosis
Objectives Interventions Foundation Evaluation
Relevant of
Nursing
Dryness Imbalance Objective Handwashing. It prevents the proliferation of microorganisms and infections in the patient.

of skin and hydroelectrolyte general Rating of intra-hospital pediatric

vital functions.
R/C tico missing Balance
mucous membranes, Monitor your vital signs to assess your level of improvement
Hydrate the patient
eyes of contribution of electrolytic VO physical functioning and check for any alterations. progressive
sunk liquid Objective A replacement is made Allows to restore the hydroelectrolytic balance lie the
of liquids
no urine electrolytic specific Allows to replace the intravascular volume to correct the balance
administering
since S/A diet Restoration 10% Dextrose hypovolemia in order to maintain hemodynamics and electrolyte functions
12 hours. inadequate of liquids Carry out balance vital why the
hydric
E/P dryness y It allows to maintain constant recording through income and fever
Maintain via
of skin and electrolytes. intravenous the daily losses. diarrhea and
mucosas, permeable. - Allows direct and quick access to the organism, administration vomits
sunken eyes Evaluate the electrolytic solutions. han
mucous membranes, turgor
and absence of of the skin and thirst. We examine mucous membranes to determine if a person is compromised.
urine twelve Weight is monitored. well hydrated.
hours. Constantly weighing the patient allows discovering any
unusual weight loss, which may be a symptom of
some illness.
 CARE PLAN
Data Diagnosis of
Objectives Interventions Foundation Evaluation
Relevant Nursing
Weight and size Imbalance Hand washing.
Objective: Evita the proliferation of The patient
low nutritional R/C General: Assessment of vital functions. microorganisms e infections pediatric
Oral hygiene intrahospital
scarce intake lower than Balance improvement
Provide the next Monitor their vital signs to evaluate
tissue the needs nutritional dietary treatment: its level of physical functioning and progressively
In phase 2, 75kcal is administered and check for any alterations.
muscular and corporales S/A Objective and the balance
0.9g protein/100ml (formula F- It helps maintain gums and teeth
subcutaneous disabled specific 75) 100 kcal/k/d we will give nutritional
healthy, preventing diseases y
skin resources Increase of 130 mL/kg/day. complications. having a
In phase 3, caloric intake begins. Allows development and training of
pendant economic E/P weight, size increase of 8
and protein: 75cal/kg, 1g/kg/24h the muscles, the brain and the organs
paleness of Weight and size dough Formula F-100 (100kcal and 2.9g) grams per day.
vital to the body, providing nutrients and
skin and low, scarce muscle and proteins/100mL) preventing diseases.
muscle tissue subcutaneous.
mucous membranes. Multivitamin complex: It allows to know the degree to which the
and subcutaneous, . Zinc 1 mg/kg/day orally nutrition meets the needs of
. Copper 0.3 mg/kg/day orally organism.
hanging skin . Folic acid 1 mg/day orally Allows for an assessment of
paleness of skin Assessment of nutritional status
weight gain or loss.
Establish target weight and record
and mucous membranes.
the daily profit process.

15
 CARE PLAN

Data Diagnosis of
Objectives Interventions Foundation Evaluation
Relevant Nursing
Scarce Risk of Objective Hand washing. It prevents the proliferation of microorganisms in the patient.
tissue deterioration of the General: Evaluation of hospital-acquired infection functions. pediatric
vital Monitor their vital signs to assess their level of
muscular and integrity Control and decrease
Monitor the skin. physical operation and check if there is any
cell phone cutaneous R/C detection of Encourage the intake of alteration. the risk of
subcutaneous alteration of risk adequate calories. It helps prevent injuries in people who are ulcers due to
Check the intake at risk of suffering from them.
skin state pressure.
done to see the -Each person has nutritional requirements
hanging and nutritional S/A Objective nutritional content and different, so the diet must be adapted to the
dryness emaciation. Specific: caloric. age, in style, the organic demands and
Massage and hydrate the individual's environment.
in skin Prevention
skin It is important for the body to remain
of the ulcers Avoid hot water and stay hydrated, keeping the correct level of water.
by pressure. use a mild soap. to allow reactions to occur
Inspect the skin of vital chemicals and ensure that the nutrients are
the bony prominences. transporting the organs and tissues.
Excessively high temperatures can
modify metabolic rates, alter function
of the organs and cause damage to the tissues.

16
11. CONCLUSIONS:
Marasmus are ailments that arise from a lack of nutrition.
balanced due to the few foods they consume lacking both
calories as proteins that are necessary for the proper development of their
muscles and in general, so they can grow in a healthy and sound way.
Good nutrition is essential for a healthy life and to maintain health.
at the same time helps the body to protect itself from infections.
Nutritional deterioration, besides stunting growth, compromises
an important and early form of the child's immunity, thus resulting in a close
interrelationship between malnutrition and infection.

12. RECOMMENDATIONS:
Be very strict with hygiene in food preparation. In many
cases, infections arise from poor preparation. Habits such as
simple as thefrequent handwashingthe boiling of food
yadequate conservationcan avoid many problems.
Promote thebreastfeedingexclusive. The WHO recommends globally
this type of feeding until six months of age. This avoids the use of other
foods that may be contaminated or the absence ofproteinsin the diet of
babies and children.
Prioritize proper nutrition in mothers. Both before pregnancy,
howduring the sameand thelactation periodto ensure quality
nutritional aspects of breast milk and prevent low birth weight.
Try to provide certain amounts of high biological value proteins: meat,
fishdairyand eggs daily. It is also possible to use cereal mixtures.
with legumes and nuts.

Insist on the need to consume cereals, fats, and vegetables as a source of

calories. Thus, small amounts of protein foods can be used
for its purpose of creating and recovering tissues and using it in growth
infantile.
 If natural enrichment is not enough, assess the need to add
artificial supplementation to the diet: these are products that come in various
formats and flavors to add an extra of proteins or calories to the diet. Without
embargo, should never replace meals, except in very
exceptional.
Checking the condition of the dentition is also interesting, as well as verifying that
theswallowingis carried out correctly.

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marasmus-kwashiorkor mixed

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medicine/nutritional-diseases-marasmus-kwashiorkor

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guzmanmarco/marasmo-valeria

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.slideshare.net/ LuzdelPilarRC/marasmo-34242025

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w0073s/w0073s0g.htm

Malnutrition, A. (n.d.). Retrieved fromInvalid input or URL. Please provide a text for translation.
default/files/document/document/attachments/aiepi_malnutrition_and_anemia.pdf

MINSA. (2016). Malnutrition and Disease. Obtained fromhttp://bvs.minsa.gob.

pe/local/PSNB/701_MS-PSNB318-4.pdf

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professional/nutritional-disorders/malnutrition/malnutrition-
caloric-protein-dcp

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0665/105724/a58435_spa.pdf;jsessionid=EB814FC19FCD3A2C6802840F346A
1527?sequence=1

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nutritional-disorders-in-pediatrics-marasmus-kwashiorkor-mixed
Treatment • Involves the use of diseases
associated conditions, such as marasmus.

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Marasmus is a form of malnutrition,
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Clinical Manifestations.pdf

20
ANNEXES:
Malaise

21
Greater willingness to the PATHOPHYSIOLOGY OF DPE (MARASMUS)
infections, due to the The skin and the fat
activity of neutrophils subcutaneous atrophy
and the reduction of the they cause folds
T lymphocytes. sueltos

Low intake of nutrients, protein, and energy

Atrophy of the mucosa

The decrease of the Reduction in Decrease of the Low availability of the small intestine,
insulin, allows that physical activity body mass of amino acids for decrease of the
free fatty acids lean protein synthesis. enzimas digestivas
and the amino acids are
mobilize from the tissue
adipose and muscular Lower demand Reduction of Reduction in synthesis Decrease of the
to supply of oxygen for the cardiac output and the of hemoglobin and intestinal motility and
compounds that enter fabrics blood pressure. red blood cells of the proliferation
in the glycogenic pathway luminal bacterial.
Decrease in flow
renal plasma and the
glomerular filtration.

Inability to reabsorb the

In, alteration of capacity
of urine acidification

Reduction in concentration of
hemoglobin according to the body
adapts to lower necessity of
transport of O2 (no hypoxia)
in the tissues)
 RECOVERY OF DPE (MARASMUS)

Treatment with a diet rich in proteins and energy

Increase in synthesis Increase in

of fabrics and in bulk physical activity
corporal magra

Higher demand for

oxygen for the
fabrics

Greater need for

hematopoietic factors

When are they available When they are not available

Increase in synthesis of Anemia

hemoglobin and Hypoxia in tissues
erythrocytes

23
SIGNS AND SYMPTOMS

TREATMENT
VICIOUS CIRCLE OF MALNUTRITION

25
VIRTUOUS CIRCLE OF GOOD NUTRITION

26
FROM VICIOUS CIRCLE TO VIRTUOUS CIRCLE

27