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Protein–Energy Malnutrition

Dylan N Gerlach, M.S. , D.O. Reviewed 06/2022
 


BASICS

DESCRIPTION

  • Protein–energy malnutrition (PEM) is present when sufficient energy and/or protein is not available to meet metabolic demands, leading to impairment in normal physiologic processes. ...

DIAGNOSIS

HISTORY

  • Diagnostic historical criteria for malnutrition:

    • Inadequate nutrient intake, based on estimated energy needs (indirect calorimetry or standard equations) versus measured energy consume...

TREATMENT

GENERAL MEASURES

  • Slowly restore and maintain fluid and electrolyte balance.

  • Initiate oral iron and folate supplements (begin iron therapy ~2 weeks after initiation of dietary treatment to avoi...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Children are discharged from a nutritional rehabilitation program when W:H ratio is >85%, at least 1 week of consistent weight gain has been achieved, and all ...

REFERENCES

1
Dwyer JT, Gahche JJ, Weiler M, et al. Screening community-living older adults for protein energy malnutrition and frailty: update and next steps. J Community Health. 2020;45(3):640–660.
2
...

ADDITIONAL READING

  • Keller H, de van der Schueren MAE, GLIM Consortium, et al. Guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults. ...

CODES

ICD10

  • E46 Unspecified protein-calorie malnutrition

  • E41 Nutritional marasmus

  • E40 Kwashiorkor

  • E61.8 Deficiency of other specified nutrient elements

  • E42 Marasmic kwashiorkor

  • E44.0 Moderate protein-calori...

CLINICAL PEARLS

  • Older patients may experience elevated BUN levels from excessive protein supplementation; routine monitoring is suggested.

  • Decreased muscle mass in patients with malnutrition may lower ...

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