3.

1 Malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health
problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other
nutrients" which adversely affects the body's tissues and form.
3.1.1 Specialty
Critical care medicine
3.1.2 Symptoms
Problems with physical or mental development; poor energy levels; hair loss; swollen legs and
abdomen
3.1.3 Causes
Eating a diet with too few or too many nutrients; malabsorption
3.1.4 Risk factors
Lack of breastfeeding; gastroenteritis; pneumonia; malaria; measles; poverty; homelessness[5]
3.1.5 Prevention
Improving agricultural practices; reducing poverty; improving sanitation
3.1.6 Treatment
Improved nutrition; supplementation; ready-to-use therapeutic foods; treating the underlying
cause
3.2 Diabetes
Diabetes is a condition that impairs the body’s ability to process blood glucose, otherwise known
as blood sugar. There are several types of diabetes, which have various treatments.
3.2.1 Types of diabetes
3.2.1.1 Type 1 diabetes
Also known as juvenile diabetes, type 1 diabetes occurs when the body does not produce insulin.
Insulin is a hormone responsible for breaking down the sugar in the blood for use throughout the
body. A person living with type 1 diabetes mayTrusted Source receive a diagnosis during
childhood.
People living with type 1 diabetes need to administer insulin on a regularTrusted Source basis.
Individuals may do this with injections or an insulin pump.
There is no cure for type 1 diabetes. Once a person receives their diagnosis, they will need to
regularly monitor their blood sugar levels, administer insulin, and make some lifestyle changes
to help manage the condition.
Successfully managing blood sugar levels can help people living with type 1 diabetes avoid
serious complications. Some common complications include:
 ketoacidosis
 nerve damage
 issues with the eyes
 increased risk of skin infection
 issues with the kidneys
 cardiovascular disease
 foot problems, including numbness
 high blood pressure
 stroke
3.2.1.2 Type 2 diabetes
People with type 2 diabetes do not make or use insulin effectively. According to the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Trusted Source, this is the
most common type of diabetes, and it has strong links with obesity.
A person living with type 2 diabetes may or may not need insulin. In many cases, medication
along with changes in exercise and diet can help manage the condition.
Anyone, including children and adults, can develop type 2 diabetes. The most common risk
factors for type 2 diabetes include:
 age 45 or older
 overweight
 family history
3.2.1.3 Gestational diabetes
Gestational diabetes occurs during pregnancy when an individual becomes less sensitive to
insulin. According to the Centers for Disease Control and Prevention (CDC), between 2–
10%Trusted Source of pregnancies each year result in gestational diabetes. Individuals who are
overweight going into their pregnancy have an elevated risk of developing the condition.
The CDC adds that around 50% of people with gestational diabetes will later develop type 2
diabetes.
During pregnancy, individuals can take steps to manage the condition. These include:
 staying active
 monitoring the growth and development of the fetus
 adjusting their diet
 monitoring blood sugar levels
Gestational diabetes can increase a person’s risk of developing high blood pressure during
pregnancy. It can also cause:
 premature birth
 increased birth weight
 blood sugar issues with the newborn, which typically clear up within a few days
 increased risk of the baby developing type 2 diabetes later in life
3.2.1.4 Prediabetes
Prediabetes, or borderline diabetes, occurs when a person’s blood sugar levels are elevated but
not enough for a diagnosis of diabetes. For a doctor to diagnose prediabetes, an individual must
meet the following Trusted Source criteria:
 glucose tolerance levels of 140–199 milligrams per deciliter (mg/dl)
 an A1C test result of 5.7–6.4%
 fasting blood sugar levels between 100–125 mg/dl
People living with prediabetes have a higher risk of developing type 2 diabetes, but they do not
usually experience the symptoms of full diabetes.
The risk factors for a person developing prediabetes and type 2 diabetes are similar. They
include:
 being overweight
 a family history of diabetes
 having a high-density lipoprotein (HDL) cholesterol level lower than 40 mg/dl or 50
mg/dl
 a history of high blood pressure
 having gestational diabetes or giving birth to a child with a birth weight of more than 9
pounds
  a history of polycystic ovary syndrome (PCOS)
 being of African-American, Native American, Latin American, or Asian-Pacific Islander
descent
 being more than 45 years of age
 having a sedentary lifestyle.
3.2.2 Prevention
A person cannot prevent type 1 diabetes.
However, people can take some steps to help prevent type 2 diabetes. Some ways to help prevent
type 2 diabetes includeTrusted Source:
 maintaining a moderate weight
 eating a balanced diet low in added sugars, saturated fats, and processed foods
 exercising regularly
To reduce the risk of developing gestational diabetes, a person should maintain a moderate
weight before becoming pregnant.
While these steps can help, it is important to note that people may still develop either type 2 or
gestational diabetes.
3.3 Hypertension
High blood pressure, also called hypertension, is blood pressure that is higher than normal. Your
blood pressure changes throughout the day based on your activities. Having blood pressure
measures consistently above normal may result in a diagnosis of high blood pressure (or
hypertension).
The higher your blood pressure levels, the more risk you have for other health problems, such as
heart disease, heart attack, and stroke.
3.3.1 Types of Hypertension
There are two primary hypertension types. For 95 percent of people with high blood pressure, the
cause of their hypertension is unknown — this is called essential, or primary, hypertension.
When a cause can be found, the condition is called secondary hypertension.
Essential Hypertension. This type of hypertension is diagnosed after a doctor notices that your
blood pressure is high on three or more visits and eliminates all other causes of hypertension.
Usually people with essential hypertension have no symptoms, but you may experience frequent
headaches, tiredness, dizziness, or nose bleeds. Although the cause is unknown, researchers do
know that obesity, smoking, alcohol, diet, and heredity all play a role in essential hypertension.
Secondary Hypertension. The most common cause of secondary hypertension is an abnormality
in the arteries supplying blood to the kidneys. Other causes include airway obstruction during
sleep, diseases and tumors of the adrenal glands, hormone abnormalities, thyroid disease, and too
much salt or alcohol in the diet. Drugs can cause secondary hypertension, including over-the-
counter medications such as ibuprofen (Motrin, Advil, and others) and pseudoephedrine (Afrin,
Sudafed, and others). The good news is that if the cause is found, hypertension can often be
controlled.
Additional Hypertension Types: Isolated Systolic, Malignant, and Resistant
Isolated systolic hypertension, malignant hypertension, and resistant hypertension are all
recognized hypertension types with specific diagnostic criteria.
Isolated systolic hypertension. Blood pressure is recorded in two numbers: The upper, or first,
number is the systolic pressure, which is the pressure exerted during the heartbeat; the lower, or
second, number is the diastolic pressure, which is the pressure as the heart is resting between
beats. Normal blood pressure is considered under 120/80. With isolated systolic hypertension,
the systolic pressure rises above 140, while the lower number stays near the normal range, below
90. This type of hypertension is most common in people over the age of 65 and is caused by the
loss of elasticity in the arteries. The systolic pressure is much more important than the diastolic
pressure when it comes to the risk of cardiovascular disease for an older person.
Malignant hypertension. This hypertension type occurs in only about 1 percent of people with
hypertension. It is more common in younger adults, African-American men, and women who
have pregnancy toxemia. Malignant hypertension occurs when your blood pressure rises
extremely quickly. If your diastolic pressure goes over 130, you may have malignant
hypertension. This is a medical emergency and should be treated in a hospital. Symptoms include
numbness in the arms and legs, blurred vision, confusion, chest pain, and headache.
Resistant hypertension. If your doctor has prescribed three different types of antihypertensive
medications and your blood pressure is still too high, you may have resistant hypertension.
Resistant hypertension may occur in 20 to 30 percent of high blood pressure cases. Resistant
hypertension may have a genetic component and is more common in people who are older,
obese, female, African American, or have an underlying illness, such as diabetes or kidney
disease.
3.3.2 Dietary Management
Dietary Approaches to Stop Hypertension (high blood pressure). The diet is simple:
 Eat more fruits, vegetables, and low-fat dairy foods
 Cut back on foods that are high in saturated fat, cholesterol, and trans fats
 Eat more whole-grain foods, fish, poultry, and nuts
 Limit sodium, sweets, sugary drinks, and red meats
3.4 Chronic Kidney Disease
Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney
function. Your kidneys filter wastes and excess fluids from your blood, which are then removed
in your urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes
and wastes to build up in your body.
3.4.1 Symptoms
Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses
slowly. Loss of kidney function can cause a buildup of fluid or body waste or electrolyte
problems. Depending on how severe it is, loss of kidney function can cause:
 Nausea
 Vomiting
 Loss of appetite
 Fatigue and weakness
 Sleep problems
 Urinating more or less
 Decreased mental sharpness
 Muscle cramps
 Swelling of feet and ankles
 Dry, itchy skin
 High blood pressure (hypertension) that's difficult to control
 Shortness of breath, if fluid builds up in the lungs
 Chest pain, if fluid builds up around the lining of the heart
3.4.2 Risk Factors of Chronic Kidney Disease
Factors that can increase your risk of chronic kidney disease include:
 Diabetes.
 High blood pressure.
 Heart (cardiovascular) disease.
 Smoking.
 Obesity.
 Being Black, Native American or Asian American.
 Family history of kidney disease.
 Abnormal kidney structure.
3.4.3 Stages of Chronic Kidney Disease
Five stages of chronic kidney disease
 Stage 1 with normal or high GFR (GFR > 90 mL/min)
 Stage 2 Mild CKD (GFR = 60-89 mL/min)
 Stage 3A Moderate CKD (GFR = 45-59 mL/min)
 Stage 3B Moderate CKD (GFR = 30-44 mL/min)
 Stage 4 Severe CKD (GFR = 15-29 mL/min)
 Stage 5 End Stage CKD (GFR <15 mL/min)
3.4.5 Dietary Management of Chronic Kidney Disease
You may need to make changes to your diet when you have chronic kidney disease (CKD).
These changes may include limiting fluids, eating a low-protein diet, limiting salt, potassium,
phosphorous, and other electrolytes, and getting enough calories if you are losing weight.
3.5 Congestive Cardiac Failure
Heart failure — sometimes known as congestive heart failure — occurs when the heart muscle
doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can
build up in the lungs, causing shortness of breath.
Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high
blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.
3.5.1 Dietary Management
Reduce the salt content in your diet by trying the following suggestions:
 Choose plenty of fresh fruits and vegetables. They contain only small amounts of salt.
  Choose foods that are low in salt, such as fresh meats, poultry, fish, dry and fresh
legumes, eggs, milk and yogurt. Plain rice, pasta and oatmeal are good low-sodium
choices. However, the sodium content can increase if salt or other high-sodium
ingredients are added during their preparation.
 Season with herbs, spices, herbed vinegar and fruit juices. Avoid herb or spice mixtures
that contain salt or sodium. Use lemon juice or fresh ground pepper to accent natural
flavors. Try orange or pineapple juice as a base for meat marinades. See "Salt-Free Herb
Blends," below, for other ideas.
 Read food labels before you buy packaged foods. Check the nutrition facts on the label
for sodium content per serving. Find out the number of servings in the package.
3.6 Cardiovascular diseases
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They
include:
 coronary heart disease – a disease of the blood vessels supplying the heart muscle;
 cerebrovascular disease – a disease of the blood vessels supplying the brain;
 peripheral arterial disease – a disease of blood vessels supplying the arms and legs;
 rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic
fever, caused by streptococcal bacteria;
 congenital heart disease – birth defects that affect the normal development and
functioning of the heart caused by malformations of the heart structure from birth; and
 deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can
dislodge and move to the heart and lungs.
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that
prevents blood from flowing to the heart or brain. The most common reason for this is a build-up
of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can
be caused by bleeding from a blood vessel in the brain or from blood clots.
3.6.1 Dietary Management
Nutrition Management of Cardiovascular Disease
 Consume a diet rich in fruits and vegetables.
 Choose whole grain, high fiber foods.
 Consume fish at least twice a week.
  Limit saturated fat to less than 7% of total calories, trans fats to less than 1% of calories,
and cholesterol to less than 300 mg per day.
3.7 Hepatitis
Hepatitis is a general term used to describe inflammation of the liver. Liver inflammation can be
caused by several viruses (viral hepatitis), chemicals, drugs, alcohol, certain genetic disorders or
by an overactive immune system that mistakenly attacks the liver, called autoimmune hepatitis.
Depending on its course, hepatitis can be acute, which flares up suddenly and then goes away, or
chronic, which is a long-term condition usually producing more subtle symptoms and
progressive liver damage. There are several different types of hepatitis. Some types will pass
without any serious problems, while others can be long-lasting (chronic) and cause scarring of
the liver (cirrhosis), loss of liver function and, in some cases, liver cancer.
3.7.1 Types of Hepatitis
There are five viruses that cause the different forms of viral hepatitis: hepatitis A, B, C, D and E.
Hepatitis A is mostly a food-borne illness and can be spread through contaminated water and
unwashed food. It is the easiest to transmit, especially in children, but is also the least likely to
damage the liver and is usually mild and is completely resolved within six months. Hepatitis B
can be transmitted through exposure to contaminated blood, needles, syringes or bodily fluids
and from mother to baby. It is a chronic disorder and in some cases may lead to long-term liver
damage, liver cancer and cirrhosis of the liver after many years of carrying the virus. Hepatitis C
is only transmitted through infected blood or from mother to newborn during childbirth. It too
can lead to liver cancer and cirrhosis in the long term. Hepatitis D is only found in people who
are also infected with hepatitis B. Hepatitis E is predominantly found in Africa, Asia and South
America. Certain generally safe medications can be toxic to the liver and cause hepatitis (drug-
induced hepatitis) when taken in excess or in very high doses. These include acetaminophen
(Tylenol) and even vitamin A. Check with your pediatrician about appropriate dosing for your
child.
3.7.2 Symptoms of hepatitis
Short-term (acute) hepatitis often has no noticeable symptoms, so you may not realise you have
it.
If symptoms do develop, they can include:
 muscle and joint pain
  a high temperature
 feeling and being sick
 feeling unusually tired all the time
 a general sense of feeling unwell
 loss of appetite
 tummy pain
 dark urine
 pale, grey-coloured poo
 itchy skin
 yellowing of the eyes and skin (jaundice)
3.7.3 Dietary Management of Hepatitis
For a patient with Hepatitis food choices are not limited to a few bland dishes. There are plenty
of healthy, tasty food options which are both beneficial for the liver and for the recovery process.
 Whole grains are very beneficial to consume as part of a healthy Hepatitis diet. These can
be in the form of bran, whole wheat bread or cereal, brown rice, whole grain pasta or
porridge. Include other whole grains such as whole oats, wild rice, rye, oatmeal and corn.
 Fruits and vegetables should be a significant part of any diet to help in recovering from a
liver disease. They are full of essential nutrients and are easy to digest. As a bonus, they
also contain antioxidants, which can protect the liver cells from damage. However, it is
recommended that one go easy on starchy vegetables such as potatoes when on a
Hepatitis recovery diet. While canned or frozen fruits are fine it is always a good idea to
try and eat fresh and seasonal produce when possible.
 Olive oil, canola oil and flaxseed oil are all healthy fats that are recommended as part of a
diet for patients with Hepatitis.
 Healthy proteins in the form of low-fat milk and dairy products along with lean meats,
beans, eggs and soy products can also be a part of a healthy liver diet.
3.8 Cancer
Cancer refers to any one of a large number of diseases characterized by the development of
abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal
body tissue. Cancer often has the ability to spread throughout your body.
Cancer is the second-leading cause of death in the world. But survival rates are improving for
many types of cancer, thanks to improvements in cancer screening, treatment and prevention.
3.8.1 Symptoms
Signs and symptoms caused by cancer will vary depending on what part of the body is affected.
Some general signs and symptoms associated with, but not specific to, cancer, include:
 Fatigue
 Lump or area of thickening that can be felt under the skin
 Weight changes, including unintended loss or gain
 Skin changes, such as yellowing, darkening or redness of the skin, sores that won't heal,
or changes to existing moles
 Changes in bowel or bladder habits
 Persistent cough or trouble breathing
 Difficulty swallowing
 Hoarseness
 Persistent indigestion or discomfort after eating
 Persistent, unexplained muscle or joint pain
 Persistent, unexplained fevers or night sweats
 Unexplained bleeding or bruising
3.8.2 Causes
Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is
packaged into a large number of individual genes, each of which contains a set of instructions
telling the cell what functions to perform, as well as how to grow and divide. Errors in the
instructions can cause the cell to stop its normal function and may allow a cell to become
cancerous.
3.8.3 Dietary Management
A diet high in whole foods like fruits, vegetables, whole grains, healthy fats and lean protein may
prevent cancer. Conversely, processed meats, refined carbs, salt and alcohol may increase your
risk. Though no diet has been proven to cure cancer, plant-based and keto diets may lower your
risk or benefit treatment.
3.9 Peripartum cardiomyopathy (PPCM)
Peripartum cardiomyopathy (PPCM) is a rare form of congestive heart failure that is associated
with pregnancy. The condition has not been linked to any other condition or cause. If you have
peripartum cardiomyopathy, your heart becomes weak and larger than normal. Most times,
PPCM occurs in the last trimester of pregnancy or the first month after delivery, but sometimes it
takes up to 6 months after delivery for the condition to occur.
3.9.1 Symptoms
Common symptoms of PPCM are symptoms of heart failure, such as
 Shortness of breath
 Swelling in the legs
 Feeling tired
 Heart palpitations (feeling that your heart is racing)
3.9.2 Dietary Management
 Health care professionals may recommend a low-sodium diet, fluid restrictions or daily
weighing. A weight gain of 3 to 4 pounds or more over a day or two may signal a fluid
buildup.
 Women who smoke and drink alcohol will be advised to stop, because these habits may
make the symptoms worse.
 A heart biopsy may help determine if the underlying cause of cardiomyopathy is a heart
muscle infection (myocarditis). But this procedure is uncommon.
3.10 Chronic Liver Disease
Chronic liver disease in the clinical context is a disease process of the liver that involves a
process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis
and cirrhosis. "Chronic liver disease" refers to disease of the liver which lasts over a period of six
months. It consists of a wide range of liver pathologies which include inflammation (chronic
hepatitis), liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be
experienced.
3.10.1 Signs and symptoms
Signs of chronic liver disease detectable on clinical examination can be divided into those that
are associated with the diagnosis of chronic liver disease, associated with decompensation, and
associated with the cause.
 Chronic liver disease
  Nail clubbing
 Palmar erythema
 Spider nevi (angiomata)
 Gynaecomastia
 Feminising hair distribution
 Testicular atrophy
 Small irregular shrunken liver
 Anaemia
 Caput medusa
 Drowsiness (encephalopathy)
 Hyperventilation (encephalopathy)
 Metabolic flap/asterixis (encephalopathy)
 Jaundice (excretory dysfunction)
 Ascites (portal hypertension and hypoalbuminemia)
 Leukonychia (hypoalbuminaemia)
 Peripheral oedema (hypoalbuminaemia)
 Bruising (coagulopathy)
 Acid-base imbalance, most commonly respiratory alkalosis
3.10.2 Causes
The list of conditions associated with chronic liver disease is extensive and can be categorised in
the following way:
Viral causes
 Hepatitis B
 Hepatitis C
 Cytomegalovirus (CMV), Epstein Barr virus (EBV), and yellow fever viruses cause acute
hepatitis.
Toxic and drugs
 Alcoholic liver disease
 Rarely drug induced liver disease from methotrexate, amiodarone, nitrofurantoin and
others Paracetamol (acetaminophen) causes acute liver damage.
Metabolic
  Non-alcoholic fatty liver disease
 Haemochromatosis
 Wilson's disease
Autoimmune response causes
 Primary biliary cholangitis (previously known as primary biliary cirrhosis)
 Primary sclerosing cholangitis
 Autoimmune Hepatitis
3.10.3 Risk factors
These differ according to the type of chronic liver disease.[citation needed]
 Excessive alcohol use
 Obesity
 Metabolic syndrome including raised blood lipids
 Health care professionals who are exposed to body fluids and infected blood
 Sharing infected needle and syringes
 Having unprotected sex and multiple sex partners
 Working with toxic chemicals without wearing safety clothes
 Certain prescription medications
3.10.4 Dietary Management
 Start nutritional counselling by a multidisciplinary team supporting the patient for
adequate calories and protein intake in patients with malnutrition and cirrhosis
 Optimal daily energy intake should not be lower than the recommended 35 kcal/kg actual
body weight
 Optimal daily protein intake should not be lower than the recommended 1.5 g/kg actual
body weight
 Include late evening oral nutritional supplementation (ONS) and breakfast containing
some proteins in malnourished decompensated cirrhotic patients
 BCAA supplements and leucine enriched amino acid supplements should be considered
in decompensated cirrhotic patients
 In patients with malnutrition and cirrhosis who are unable to achieve adequate dietary
intake with the oral diet (even with oral supplements), a period of enteral nutrition is
recommended
  Always evaluate nutritional status and sarcopenia in patients with hepatic encephalopathy
(HE)
 Avoid protein restriction in patients with HE
 Optimal daily protein and energy intake should not be lower than the general
recommendations for cirrhotic patients
 Encourage the consumption of vegetables and dairy protein
 BCAA supplementation can be considered to improve neuropsychiatric performance and
to reach the recommended nitrogen intake
 In patients who can tolerate oral intake prefer dietary intake by mouth In patients with
grade III–IV encephalopathy, who are unable to eat, provide nutrition by naso-gastric
tube (in patients with protected airways) or parenterally.
3.11 Tetanus
Tetanus is a serious bacterial infection that affects the nervous system and causes muscles
throughout the body to tighten. It’s also called lockjaw because the infection often causes muscle
contractions in the jaw and neck. However, it can eventually spread to other parts of the body.
3.11.1 Causes
Bacteria called Clostridium tetani cause tetanus. Spores of the bacteria can be found in dust, dirt,
and animal droppings. Spores are small reproductive bodies produced by certain organisms.
They’re often resistant to harsh environmental conditions, such as high heat.
Tetanus infection has been associated with:
 crush injuries
 injuries with dead tissue
 burns
 puncture wounds from piercings, tattoos, injection drug use, or injury (such as stepping
on a nail)
 wounds contaminated with dirt, feces, or saliva
3.11.2 Symptoms
Tetanus affects the nerves that control your muscles, which can lead to difficulty swallowing.
You may also experience spasms and stiffness in various muscles, especially those in your jaw,
abdomen, chest, back, and neck.
Other common tetanus symptoms are:
  fast heart rate
 fever
 sweating
 high blood pressure
The incubation period — the time between exposure to the bacteria and the onset of illness — is
between 3 and 21 days. Symptoms typically appear within 14 days Trusted Source of initial
infection. Infections that occur faster after exposure are typically more severe and have a worse
prognosis.
3.11.3 Dietary Management
 Liquid foods: Since the condition of the jaw does not allow ingestion of whole foods, it is
essential to ensure that the diet plan has food in liquid form.
 Stimulants: A healthy diet to aid in the treatment of tetanus may include certain varieties
of alcohol administered at hourly or two-hour intervals. Stimulants such as whiskey,
wine, and brandy can be given to reduce convulsions and other involuntary muscle
contractions.
 Foods rich in magnesium: It helps in relaxing the locked jaw muscles and relieves the
pain and inflammation. Foods like avocados, flax seeds, corn, oatmeals, curd and
pumpkin etc.
 High protein diet: Studies prove that the tetanus bacteria’s effectiveness is highly reduced
if a high protein diet for tetanus is administered. Foods such as milk, egg, meat, chicken
etc.
3.12 Protein–energy malnutrition (PEM)
Protein–energy malnutrition (PEM), sometimes called protein-energy undernutrition (PEU), is a
form of malnutrition that is defined as a range of conditions arising from coincident lack of
dietary protein and/or energy (calories) in varying proportions. The condition has mild,
moderate, and severe degrees.
Types include:
 Kwashiorkor (protein malnutrition predominant)
 Marasmus (deficiency in calorie intake)
 Marasmic kwashiorkor (marked protein deficiency and marked calorie insufficiency
signs present, sometimes referred to as the most severe form of malnutrition)
3.12.1 Dietary Management
Treatment is designed to provide adequate nutrition , restore normal body composition, and cure
the condition that caused the deficiency. Tube feeding or intravenous feeding is used to supply
nutrients to patients who cannot or will not eat protein-rich foods.
In patients with severe PEM, the first stage of treatment consists of correcting fluid and
electrolyte imbalances, treating infection with antibiotics that do not affect protein synthesis, and
addressing related medical problems. The second phase involves replenishing essential nutrients
slowly to prevent taxing the patient's weakened system with more food than it can handle.
Physical therapy may benefit patients whose muscles have deteriorated significantly.
3.13 Sepsis
Sepsis is a medical emergency caused by the body's response to an infection and can be life-
threatening. Sepsis is the consequence of widespread inflammation (swelling) in the body.
Inflammation and blood clotting during sepsis causes reduced blood flow to limbs and vital
organs, and can lead to organ failure and even death.
3.13.1 Signs and symptoms of sepsis
Symptoms of sepsis can include:
 fever and/or chills
 confusion or disorientation
 difficulty breathing
 fast heart rate or low blood pressure (hypotension)
 extreme pain
 sweaty skin
3.13.2 Risk for Sepsis
Sepsis can affect anyone, but those at particular risk include:
 The very old (older than 65 years old) or very young or pregnant women
 People with pre-existing infections or medical conditions such as diabetes, lung disease,
cancer and kidney disease
 People with weakened immune systems
 Patients who are in the hospital
 People with severe injuries, such as large burns or wounds
 Patients with catheters (IVs, urinary catheters) or a breathing tube
3.13.3 Causes
Bacterial infections are the most common cause of sepsis. Sepsis can also be caused by fungal,
parasitic, or viral infections. The source of the infection can be any of a number of places
throughout the body. Common sites and types of infection that can lead to sepsis include:
 The abdomen: An infection of the appendix (appendicitis), bowel problems, infection of
the abdominal cavity (peritonitis), and gallbladder or liver infections.
 The central nervous system: Infections of the brain or the spinal cord.
 The lungs: Infections such as pneumonia.
 The skin: Bacteria can enter skin through wounds or skin inflammation, or through the
openings made with intravenous (IV) catheters (tubes inserted into the body to give or
drain fluids). Conditions such as cellulitis (inflammation of the skin's connective tissue)
can also cause sepsis.
 The urinary tract (kidneys or bladder): Urinary tract infections are especially likely if the
patient has a urinary catheter to drain urine.
3.13.4 Dietary Management