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Protein–Energy Malnutrition

Rinku J. Patel, DO Reviewed 06/2019
 


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 consum...

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
Balint JP. Physical findings in nutritional deficiencies. Pediatr Clin North Am.  1998;45(1):245–260. [View Abstract on OvidMedline]
2
White JV, Guenter P, Jensen G, et al; for Academy ...

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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