Protein energy malnutrition is a type of malnutrition resulting from deficiency of protein and calories in the food over long period of time.

It is very common in young children who are rapid growth.

(Stage of rapid growth and development)

Children usually below 5 years  are usually affected.

Types

The most serious form of PEM are Kwashiorkor and Marasmus.

Nutritional Marasmus are more common and frequent than Kwashiorkor.

Incidence

PEM mainly problem of all developing countries.

In india the extreme of incidence is 1to 2%.

5% death among pre school children.

Aetiology

Insufficient feeding

Decreased intake of food

Excessive loss of protein and calories- because of diarrhoea and vomiting.

Increased demand, decreased absorption.

Infection (Tuberculosis, meningitis)

Social factors - poverty, illiteracy, ignorance, overcrowding, large family size, poor maternal health, improper weaning practice, failure of lactation, faulty feeding practice.

Kwashiorkor

Cause

Deficiency of mainly protein

Clinical Feature

Dull

Apathetic

Anorexia

Bloated moon like face 

Oedema present

Lusterness hair

Flag sign +ve

Paint like patches on skin

Mental changing present

Muscular wasting (but not seen because of oedema)

Liver enlargement

Growth failure - moderate

Prognosis - Bad

Investigation

Total serum protein level

Albumin- low

Globulin- low

Vita A and carotene and potassium level- decrease

Urine for sugar

Urine for culture and sensitivity test

Mantoux test

X-ray

ECG

Marasmus

Cause

Mainly calories deficiency.

Clinical Feature

Alert and irritable

Shrivelled monkey like face

Muscular wasting obvious

Growth failure-very severe

Oedema absent

Hair change in texture, thin, silky

Flag sign -ve

Prognosis

Good

Investigation

Urine for sugar

Urine for culture and sensitivity test.

Mantoux test

X- ray

ECG

Management

Antibiotics drug

Correction of social factor

Adequate diet to provide 150kal of evening per day

3-4gm of protein per kg per weight per day.

Advice- given to mother for prevention of recurrence of malnutrition in child.

Growth monitoring- Road to Health card to monitor the growth curve.

Oral rehydration therapy (ors)

Breast feeding-

Exclusive breastfeeding to give 6 months

Breast feeding is to be continue upto 2 min

Immunization

Health education

Improvement in living condition

Nutrition care of pregnant mother to prevent low birth weight

Nutritional care of lactation mother

Fortification of food

Protein and energy rich diet ( milk, egg)

Homoeopathic medicine for malnutrition

1. Natrum Mur
2. Silicea
3. Cina
4. Calc phos
5. Abrotanum

Natrum Mur

Natrum Mur is very important remedy for malnutrition.

Emaciation most notable in neck.

Great debility, most weakness felt in the morning in bed.

The prolonged taking of excessive salt causes profound nutritive changes to take place in the system, and there arise not only the symptoms of salt retention as evidenced by dropsies and oedema, but also an alternation in the blood causing a condition of anaemia.

Silicea

Lack of vital heat.

Marked prostration.

Distended abdomen.

Nervous and excitable.

Great sensitive.

Difficulty in holding head up.

Dizziness, especially in evening.

Calc phos

Calc phos is an important remedy for malnutrition.

Child can not hold the head up.

Children losses flesh, will not stand, do not learn to walk.

Slow dentition.

Frontanelles remain open too long, or close and reopen.

Abrotanum

A very useful medicine for Marasmus, especially of lower extremities only yet with good appetite.

Tuberculosis

Great weakness

Irritable

Anxious

Depressed

Wrinkle, cold, dry, pale.

Blue ring around dull looking eyes.

Emaciation

Distended abdomen

Skin flabby and losses

Falling out of hair and itching.

The selection of homoeopathic remedies based on symptom similarities and doses according to the Susceptibility of patient.

Don't take homoeopathic medicine without any prescription / without any advise of physician.