nutritional disorders
Protein Energy Undernutrition (PEU)
Symptoms and Signs of Protein Energy Undernutrition
Symptoms of moderate PEU can be constitutional or involve specific organ systems. Apathy and irritability are common. The patient is weak, and work capacity decreases. Cognition and sometimes consciousness are impaired. Temporary lactose deficiency and achlorhydria develop. Diarrhea is common and can be aggravated by deficiency of intestinal disaccharidases, especially Etiology . Gonadal tissues atrophy. PEU can cause amenorrhea in women and loss of libido in men and women. Wasting of fat and muscle is common in all forms of PEU. If starvation is prolonged, weight loss may reach 50% in adults and possibly more in children. In adults, cachexia is most obvious in areas where prominent fat depots normally exist (eg, ribs, hips, facial bones, spine). Muscles shrink and bones protrude. The skin becomes thin, dry, inelastic, pale, and cold. The hair is dry and falls out easily, becoming sparse. Wound healing is impaired. In older patients, risk of hip fractures and pressure (decubitus) ulcers increases. With acute or chronic severe PEU, heart size and cardiac output decrease; pulse slows and blood pressure falls. Respiratory rate and vital capacity decrease. Body temperature falls, sometimes contributing to death. Edema, anemia, jaundice, and petechiae can develop. Liver, kidney, or heart failure may occur. Marasmusin infants causes hunger, weight loss, growth retardation, and wasting of subcutaneous fat and muscle. Ribs and facial bones appear prominent. Loose, thin skin hangs in folds. . The abdomen protrudes because abdominal muscles are weakened, the intestine is distended, the liver enlarges, and Ascites is present. The skin is dry, thin, and wrinkled; it can become hyperpigmented and fissured and later hypopigmented, friable, and atrophic. Skin in different areas of the body may be affected at different times. The hair can become thin, reddish brown, or gray. Scalp hair falls out easily, eventually becoming sparse, but eyelash hair may grow excessively. Alternating episodes of undernutrition and adequate nutrition may cause the hair to have a dramatic “striped flag” appearance. Affected children may be apathetic but become irritable when held. Total starvationis fatal in 8 to 12 weeks. Thus, certain symptoms of PEU do not have time to develop. 