antrhop malnutr agt 2014
DESCRIPTION
Antrhop Malnutr Agt 2014TRANSCRIPT
MALNUTRITION TUTORIAL
PEDIATRIC NUTRITION CARE PROCESS
1) Assessment 2) Requirement 3) Route 4) Dietary Regimen/Formula 5) Evaluation
Assessment
Clinical sign/problems Anthropometry Laboratory Dietary analysis
ANTHROPOMETRY
Ideal Body weight (%) Z score BMI
Growth Curves WHO 2005 CDC 2000
Classification Waterlow
Ideal body weight
90-110 % Normal
70-90% Mild to moderate mal nutrition
< 70% Severe malnutrition
110-120% Overweight
>120% Obese
BMI for age
P 85- 95 Overweight
P > 95 Obese
Classification WHO
Case 1
A baby girl 9 months years old came for immunization. Bodyweight 6,8 Kg, body height 70 cm.
Define her nutritional status based on: Z score with WHO 2005 charts
Nutritional Status
Answer case 1
Mild to moderate mild nutrition
WHO 2005 Z score between -2SD and - 3SD Ideal bodyweight 8,2 kg
WHO Anthro
Requirement
Calorie = Ideal bodyweight x RDA Severe malnutrition
must not be given directly the target calorie begins with lower calorie and adjust slowly
Obese Begin with higher than ideal target then reduce
slowly
Age (year)
Energy (kcal/kg body weight/day)
0-1 110-120
1-3 100
4-6 90
7-9 80
10-12 Male: 60-70Female: 50-60
12-18 Male: 50-60Female: 40-50
Recommended Daily Allowance
Case 2
Define calorie needed by case 1
Height age : Ideal bodyweight x RDA 8,2 x 110 = 902 kcal
900 kcal
Height age
Case 3
Boy, 15 months old with bodyweight 6,5 Kg, body length 75 cm admitted to hospital because of recurrent diarrhea. He looked very thin and physical examination revealed baggy pants appearance.
Defined diagnosis and initial treatment
Nutritional Status
Diagnosis
Clinical signs : baggy pants, very thin
IBW = 6,5 : 9,5 = 68% Z score = < - 3 SD Severe malnutrition
Requirement
Height age = 1 year Ideal Caloric Requirement :
9,5 x 110 = 1045 ≈ 1000 kcal
Management
…Management
Find and treat emergencies Hypothermia Hypoglycemia Dehydration Electrolyte imbalance
Find and treat underlying diseases Infection
…Management
Nutritional treatment Stabilization phase
Formula 75 Energy 80-100 Kcal/kgBW Fluid 130 mL/kgBW/day
Transition and rehabilitation phase Formula 100
…Management
Fluid requirement 6,5 x 130 mL = 845 mL
Energy requirement6,5 Kg x 80 – 100 = 520 – 650 Kcal
Formula 75 : 100 mL = 75 KcalVolume F 75 = (520:0,75) – (650:0,75)
= 693 – 866 mL
…Management
Frequency : every 2-3 hours Tolerance
8 x 100 mL
Transitional and Rehabilitation Phase Increase volume or concentration
…Management
Micronutrient Mineral mix Vitamin A Folic Acid Iron supplementation
Vitamin A 200.000 IU Folic Acid 5 mg at first day then 1 mg/day
Case 4
Lola, a 4,5 -year old girl with body weight 23 Kg, body height 104 cm.
Define the nutritional status Define the calorie needed State the principles of treatment
Answer
Ideal body weight (%) 23/16 = 143% BMI = 23/(1.04)2 = 21.2
BMI CDC 2000 : > p95 Obese
23/16.4 = 140% WHO > 3 SD Obese
Requirement 16 kg x 100 kcal/kg = 1600 kcal
Dietary advice Regular meal time and snack Fruit and vegetables consumption Plain water Calorie?? Reduce 300-500 kcal than usual diet
Principles of management
Dietary management Physical activity Behavior modification
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