2025 – PAGE 225 – VITAMIN AND NUTRITIONAL DISORDERS

NUTRITIONAL DEFICIENCIES

ENERGY REQUIREMENTS IN CHILDREN

PEARL: You can use the daily fluid requirement formula to calculate the daily energy requirement as well. The formulas are extremely similar. Instead of ml, use kcal. So, 100 kcal/kg for the first 10 kg, 50 kcal/kg for the next 10 kg, and 25 kcal/kg beyond that. So, for a 22 kg child, the daily fluid requirement would be 1000 + 500 + 50 = 1550 ml. The daily energy requirement would be approximately 1550 kcal.

KWASHIORKOR

Kwashiorkor is a complex, multi-system disease caused largely by PROTEIN DEFICIENCY. These children have pitting edema, large abdomens, hepatomegaly, and can have an associated rash.

IMAGE: www.pbrlinks.com/KWASHIORKOR1 (copyright free)
IMAGE: www.pbrlinks.com/KWASHIORKOR2

MNEMONICS: These kids are sometimes referred to as “sugar babies” because of a carbohydrate-heavy (usually rice) diet. Also, “kwashi” sounds like “cushy,” which should help remind you that these babies have cushy, spongy skin with pitting edema.

MARASMUS

Marasmus is deficiency of all nutrients. These children do NOT have edema. They are thin, anorexic-looking children with severe muscle wasting. The patient looks like a thin, old man.

IMAGE: www.pbrlinks.com/MARASMUS1

MNEMONIC: Ever notice how skinny Marvin the “MARTIAN” is?

(DOUBLE TAKE) ESSENTIAL FATTY ACID DEFICIENCIES

Essential fatty acids include LINOLEIC ACID and alpha-linolenic acid. Deficiency results in alopecia, a scaly dermatitis, and thrombocytopenia. Treat with IV lipids.

MNEMONIC: Imagine a fish whose red SCALES are shaped like HAIRY PLATELETS. As the fish struggles to find food, it becomes SKINNIER and skinnier (malnourished) and the hairy platelets begin to fall off. What’s left is a SKINNY (fat-free), BALD, and THROMBOCYTOPENIC fish!