PROTEIN ENERGY

MALNUTRITION
 PROTEIN ENERGY MALNUTRITION

A group of clinical condition that

may result from varying degree of
protein deficiency and energy
inadequacy.
 CAUSES AND RISK FACTORS
1. AGE
BETWEEN 6 MONTHS – 4 YEARS
2. SEX
BOYS > GIRLS
3. MORE OF CHILDREN IN A FAMILY
4. LACK OF SPACE IN BETWEEN CHILDREN
5. LOW BIRTH WEIGHT BABY
6. TWIN AND MULTIPLE BIRTHS
7. MOTHER FAIL TO BREAST FEED
8. POOR GROWTH IN FIRST FEW MONTHS
• MOTHER FAIL TO BREAST FEED
• SYSTEMATIC DISORDERS AND GIT STRUCTURAL DISORDERS

9 DELAYED WEANING
10. INFECTIOUS DISEASES
11. ACUTE ILLNESS OR SURGERY
12. SINGLE PARENT / ORPHAN
 CLASSIFICATION
GOMEZ CLASSIFICATION
CHILDS WEIGHT IS COMPARED TO THE NORMAL CHILD AT THE SAME AGE
WFA = WEIGHT OF THE CHILD
X 100
WEIGHT OF NORAL CHILD AT THE SAME AGE
 KWASHIORKOR
• ACUTE FORM OF PEMCHRACTERISED BY INADEQUATE ROTEIN INTAKE
AND REASONABLE ENERGY INTAKE SEEN USUALLY AFTER WEANING
• CHARACTERISED BY :
1. EDEMA
2. ANOREXIA
3. ENLARGED LIVER
4. ULCERATING DERMATOSES
5. IRRITABILITY
 PATHOPHYSIOLOGY

• PROTEIN INTAKE LESS

• DECREASED SYNTHESIS OF VISCERAL PROTEIN

• HYPOALBUMINEMIA

• EXTRAVASCULAR FLUID ACCUMULATION

 CLINICAL MANIFESTATION
• GROWTH RETARDATION
1. Weight is diminished
2. Linear growth is retarded
3. Head circumference is affected

• EDEMA : soft pitting more on dependent parts

1. Due to hypoproteinemia
2. Begins in feet and ascends
3. Cheeks look pale , waxyand bulky
• DISTURBED MUSCLE TO FAT RATIO
1. Muscle wasting seen
2. Some subcutaneous fat is reserved
3. Mid arm circumference reduced
• PSYCHOMOTOR CHANGES
1. Apathy
2. Misery
3. Indifferent
4. Do not move , look or smile
• DEPIGMENTATION OF HAIR
1. And turn reddish grey
2. Due to deficiency of vit B 5 and sulfur containing amino acids
• GI DISTURBANCE : DIARRHOEA

1. Due to infections
2. Malabsorption
3. Reduced secretion of pancreatic enzymes

• Skin changes
1. Rashes appear in increased pigmentation area
2. L : mainly axillae and back of the thighs

• Hepatic changes
1. fatty infiltration may or may not lead to hepatomegaly
• Anemia due to other nutrients deficiency
 LABORATORY FINDINGS

• REDUCED LEVELS OF :
1. Plasma proteins
2. Serum albumin
3. Urea in blood
4. Serum sodium & potassium due to diarrhoea
 MARASMUS
• A disease mainly of childhood but can occur at any age
• Severe form of PEM in which body weight is less than 60 % of
expected weight
• Body is disproportionate
• Long body , thin limbs & large head
• Scapulae look winged
• Abdomen distended
• Atrophic muscles seen under thin and wrinkled skin
• Fat is severely depleted in providing energy
• Skin – dry , inelastic
• Bony points look prominent
• Hypothermia due to loss of subcut fat
• Chronic diarrhoea with or without vomiting
• Usually hungry with good appetite
 LABORATORY FINDINGS
• Plasma protein – normal or slightly reduced( because
they use muscle protein )
• Blood urea – less because protein used is endogenous
• Blood glucose – low due to deficient stores in liver
 COMPLICATIONS
• DIARRHOEA , DEHYDRATION , ELECTROLYTE , ACID – BASE
DISTURBANCES
• INFECTIONS : BROCHOPNEUMONIA, TB , UTI
• HYPOTHERMIA
• HYPOGLYCAEMIA
• MENTAL RETARDATION
 MANAGEMENT
• CLINICALLY IT IS ASSESED AND CLASSIFIED AS :
• MODERATE
• SEVERE
MODERATE :
TREATED AT HOME BY PROVIDING ADEQUATE PROTEINS AND CALORIES
PARENTS ARE GUIDED ACCORDINGLING .
SEVERE : TREATED IN 10 STEPS

TREATMENT OF FOLLOWING 10 CONDITIONS ADEQUATELY

• HYPOGLYCAEMIA :
• HYPOTHERMIA :
 DEHYDRATION :
 CORRECT ELECTROLYTE IMBALANCE :
 TREAT /PREVENT INFECTION :
 CORRECT MICRONUTRIENT DEFICIENCY
 START CAUTIOUS FEEDING
 PROVIDE SENSORY STIMULATION
 PREPARE FOR FOLLOW UP AFTER RECOVERY
 HOMOEOPATHIC APPROACH
•No amount of additional energy as lipids or carbohydrates would enhance convalescence of PEM
unless the deficient specific nutrients are supplied in the balanced form.
 
•Homoeopathy advocates that when there is an imbalance in nutritional requirement and its supply,
the deficient nutrients should be supplied in adequate quantity through natural food, provided the
body can assimilate and absorb the same. In cases where there is deficiency of supply or the body is
so weakened to absorb the natural nutrients, then it is needed to be supplied artificially.

•Hahnemann in § 94 of Organon of Medicine says that “While inquiring into the state of chronic
diseases, the particular circumstances of the patient with regard to his ordinary occupations his
usual mode of living and diet, his domestic situation, and so forth, must be well considered and
scrutinized, to ascertain what there is in them that may tend to produce or to maintain disease, in
order that by their removal the recovery may by prompted.”
•In § 261: “The most appropriate regimen during the employment of medicine in chronic
diseases consists in the removal of such obstacles to recovery, and in supplying where
necessary the reverse: innocent moral and intellectual recreation, active exercise in the
open air in almost all kinds of weather (daily walks, slight manual labour), suitable,
nutritious, unmedicinal food and drink, etc”

•Thus, we need to provide the deficient nutrients in the body through proper diet, food
and regimen to the patient along with the medicine. The different manifesting symptoms
of PEM are taken into account to frame the Totality of the Symptoms to select the most
appropriate similimum for the treatment of PEM following homoeopathic principles.

•In cases where the malnutrition is not due to the deficiency of nutrients alone, but the
body’s inability to use the available nutrients, then it is identified as a constitutional error
in the system and advised its correction through constitutional homoeopathic medication.
HOMOEOPATHIC MEDICAL REPERTORY
•CHILDREN: ABDOMEN, general- enlarged, in-emaciation with – CALC., sanic., sars., sil.
•CHILDREN: ANOREXIA, nervosa- ARS., calc., carc., CHIN., ign., lach., levo., merc., nat-m., perh., puls., rhus-t.,
staph., SULPH., tarent., verat
•CHILDREN: DEVELOPMENT, delayed or arrested- nutritional disturbances, due to: bac., bar-c., calc., calc-p., caust.,
kreos., lac-d., med., nat-m., pin-s., sil., thyr.
•CHILDREN: EMACIATION, children, nutritional, problems, from- bac., bar-c., calc., calc-p., caust., cina., kreos., lac-
d., med., nat-m., ol-j., pin-s., sil., thyr.
•DISEASES: MARASMUS, abrot., acet-ac., AETH., alf., ant-c., apis., arg-n., ars., bac., bar-c., bell., CALC., calc-p., caps.,
cham., coca., con., ferr-m., hydr., iod., kreos., lac-d., lyc., mag-c., med., NAT-M., nux-m., nux-v., ol-j., op., petr., pin-
s., podo., sars., SIL., sulph., thyr., tub.
•Abdomen large- calc
•Angina pectoris with- chin-s
•Belching, with sour, worse during night- con
•Bottle-fed, children who are- nat-p
•Buttocks, emaciated- nat-m
•Exercise, averse to, hollow, wrinkled face, hair dry- calc
•Incipient- cham
•Irritability, child will be approached by no one- iod
•Jerking hiccough after nursing, and belching without bringing up food- teucr
•Last stage, in- nuph
•Nervous., restlesss, weakly children- sul-ac
•Nourishment, from defective- nat-m
•Nutritional disturbances from- aeth., alum., bac., bar-c., calc., calc-p., caust., kreos., lac-d.,
med., nat-m., nat-p., pin-s., sil., thyr
•Old man, like an, had not grown, limbs lax, skin wrinkled, bones of skull had lapped over
during birth- op., syph
•Reduced weight- hydr
•Skin dry and wrinkled- calc
•Tendency to- iod
HOMOEOPATHIC THERAPEUTICS:

•ABROTANUM: Marasmus, especially of the lower extremities, despite a good

appetite emaciation progresses, occurring in weak children who are emaciated,
wrinkled, pale, blue rings around dull looking eyes, gnawing hunger and whining
and bloated abdomen. Cross, irritable, anxious depressed.
•ACETIC ACIDUM: Pale, lean people, with lax, flabby muscles. Wasting and
debility. Irritable. Face is pale, waxen, emaciated. Eyes sunken surrounded dark
rings. Ascites, extremities emaciated oedema of feet and legs. Intense burning thirst
•AETHUSA CYNAPIUM: Restless anxious crying. Inability to think to fix the
attention. Idiocy may alternate with furor and irritability. Photophobia, rolling of
eyes on falling asleep. Dry mouth pustules in throat, intolerance of milk.
Undigested thin, greenish stool preceded by colic with tenesmus followed by
exhaustion and drowsiness. Cholera infantum: child cold, clammy, stupid, with
staring eyes and dilated pupils. Weakness of lower extremities, fingers and thumb
clenched. Child is so exhausted it falls asleep at once, anasarca.
•CALCAREA CARBONICA: Impaired nutrition, children who grow fat, are large
bellied with a large head, pale skin, chalky look. Children craves eggs, eat dirt and
other indigestible things and are prone to diarrhoea. Forgetful, confused low
spirited. Sensitive to light, lachrymation in open air ad early in the morning, eyes
fatigue easily, spots and ulcers on the cornea. Distension of abdomen with
hardness, children are late in learning to walk. Chilblains, nettle rash of skin.
•CALCAREA PHOSPHORICA: Anemic children who are peevish, flabby, have cold
extremities and feeble digestion. Forgetfulness, great hunger with thirst, easy
vomiting in children. Involuntary sighing. Sunken and flabby abdomen. Unable to
support head.
•CINCHONA OFFICINALIS: debility from exhausting discharges, from loss of vital
fluids. Night blindness and photophobia. Hungry without appetite, slow digestion,
severe flatulent colic. Liver and spleen swollen. Anasarca and erysipelas.
•IODIUM: Rapid metabolism, loss of flesh great appetite. Hungry with much thirst. Great
weakness the slightest effort induces perspiration, loss flesh, yet hungry and eating well.
Liver and spleen sore and enlarged. Pain in the eyes, violent lachrymation.

•NATRUM MURIATICUM: Dropsy, edema, anemia. Great debility; maximum weakness is felt
in the morning, in bed. Emaciation most notable on neck. Great weakness and weariness. Dry
mucous membrane. Irritable gets into a passion about trifles, awkward hasty, hungry yet
loose flesh, unquenchable thirst, sweats while eating, craves for salt. Distended abdomen.
Dry eruption on skin, eczema raw, red and inflamed.

•SILICEA: Imperfect assimilation and consequent defective nutrition. Scrofulous, rachitic

children, with a large head, open fontanelles and sutures, distended abdomen, slow in
walking, lack of vital heat. Photophobia. Eruptions on chin, hard bloated abdomen, yellow
hands and blue nails. Much rumbling in bowels. Loss of power in legs. Felons, abscesses,
boils, eruptions itch only during daytime and evening.