下载文档原格式
湘雅儿科课件-PROTEIN-ENERGY MALNUTRITIONPROTEIN-ENERGYMALNUTRITION PEMDepartment Of PediatricsLiqun Liu第五章第六节1中南大学儿科学教研室To master the clinical manifestation of PEM To master the ways of prevention andtreatment of PEMTo master the complications of PEM To be familiar with the etiology andpathophysiology of PEM 能量和或蛋白质缺乏energy and protein deficiency所致的一种营养缺乏症多见于3岁以下的婴幼儿体重减轻loss of body weight皮下脂肪减少decrease of subcutaneous fat水肿edema器官功能紊乱disturbance ofthe function of visceral organs andtissuesDefinition长期摄入不足 insufficient intakeof protein and energy in long periods消化吸收障碍the disturbanceofdigestion and absorption需要量增多requirements increasing消耗量过大consumption enlargingEtiologyReasonable feeding to advocate breast feeding Reasonable regimePrevent and treat diseases correct deformityMonitor the growth and developmentprevention新陈代谢异常蛋白质低蛋白血症水肿edema脂肪消瘦emaciation肝脏脂肪浸润及变性fattyinfiltration and degeneration碳水化合物糖原不足低血糖hypoglycemia水盐代谢脱水低血钾低血钙等体温调节病理生理各系统功能低下消化系统食欲不振Anorexia 腹泻diarrhea循环系统血压下降脉搏细弱肢凉泌尿系统多尿低比重尿神经系统表情淡漠智力低下学习困难免疫功能易感染病理生理Marasmus total calorie deficiencyEdema protein deficiencyMarasmus - edemaclinical typesmarasmus edema体重不增为最早症状体重减轻 Initiated with failure to gain weight followed by loss of weight皮下脂肪减少消失顺序abdomen truck buttocklimbs face 器官功能紊乱disorders of multiple organs and tissues 临床分度消瘦型3岁以下儿童营养不良特点ⅠⅡⅢ体重低于正常 15-25 25-40 40腹壁皮褶厚度 08-04cm 04cm消失身长正常稍低明显低消瘦不明显明显皮包骨样皮肤正常苍白松弛苍白无弹性精神正常轻度萎靡抑制烦躁交替肌张力正常降低低下临床分度消瘦型3岁以上儿童营养不良分度轻度重度体重低于正常15-30 30Nutritional microcytic anemiaAll kinds of vitamins deficiencyInfectionsSpontaneous hypoglycemiaComplications 体重低下underweight生长迟缓stunting消瘦wastingDiagnosisAgesIt usually affects the infant underthree years old of ageHistory Feeding history and a history of infection and systemic diseaseClinical manifestations loss of weight decrease and disappearance of subcutaneous fatAssistant examinationIGF-1PrealbuminDiagnosisExcluding causesAdjusting dietscalories mild60-80kcalkgdmid-severe40-55kcalkgdprotein 15-20gKgdmultiple vitamins and minerals supplyingTreatmentFacilitating digestionThe therapy of complicationsIntensive careTreatment各统功能低下免疫功能消化系统泌尿系统循环系统神经系统各种感染食欲不振腹泻多尿低比重尿血压下降脉弱肢凉表情淡漠学习困难智力低下饮食不当疾病因素营养不良低蛋白血症脂肪消耗糖原累积不足细胞外液容量增加肝脂肪浸润及变性消瘦低血糖低渗性脱水低钾血症低钠血症皮下脂肪减少近消失体重减轻并发症贫血维生素缺乏营养不良病理生理临床表现以及并发症之间的关系病因临床表现并发症新陈代谢异常。
湘雅儿科课件-Rickets of VitD Deficiency维生素D缺乏性佝偻病Rickets of VitD Deficiency中南大学儿科学教研室刘晓艳第五章第五节(2)PurposeBe familiar with etiology andpathogenesis of rickits and tetany ofVitamin D deficiency.To master their clinical manifestations,diagnosis ,treatment and preventionTo understand their differentialdiagnosis.Definition?Rickets is a very common nutritionaldeficient disease in young childrenespecially under two years old of age.VitD deficiency cause rickets, ametabolic disorder of calcium andphosphorus with a failure tomineralize osteoid tissue of growingbone resulting in bony deformities.皮肤中7-脱氢胆固醇(主要)7- dehydrocholesterol食物中摄取麦角固醇(次要) plant ergosterolVitD2Originates of VitD紫外线照射ultraviolet内源性VitD31,25(OH)2D3的作用促进小肠粘膜对钙磷的吸收促进肾小管对钙磷的重吸收促进旧骨脱钙,增加细胞外液钙磷的浓度Ingested from food Human skin contains 7-dehydrocholesterolultraviolet rairradiationVit D3Liver25-hydroxylase kidney 1-hydroxylase 1,25-OH 2-D31, 25-dihydroxycholecalciferolMetabolism of VitD25-OH -D3( 25-dihydroxycholecalciferol)Vit DLiver25-OH D3Hypo serum P Hyper serum PKidneyPTH CalcitoninHypo serum Ca Hyper serum Ca1,25- OH2 D3-+ --+++--Regulation of metabolism of Vit D3病因 Etiology?日光照射不足Lack of sunshine摄入不足 Underfeeding ?生长过快 Rapid growth?疾病影响 Influence of diseases药物影响 Influence of medicine预防 Prevention 多晒太阳补充VitD制剂,预防剂量为400~800IU/d提倡母乳喂养,及时添加辅食积极治疗原发病孕妇多户外活动,注意营养Vit D deficiencyDisturbance ofcalcification ofosteoid tissue +decalcificationof skeletonDiminished absorption ofCa and P from intestineA fall of serum CaCompensatory functionof parathyroidProliferation ofosteoid tissueIncreased InsufficientPathogenesisRachiticmetaphasesand softenshaftExcretion ofurine Pincreasedincreaseddecalcificationof old boneCa of oldbone can’t bemobilizedSerum CadecreasedA fall ofserum PSerum Ca remainnormal or slightlyloweredRachiticTetany CaP product decreasedRicketsPathogenesis 初期 The early stage 年龄 3 months? 症状神经精神症状 (neuro-psychic symptoms)? 体征枕秃( the loss of hair in the occipital position) 生化改变 Ca normal ,P normal or ?, Ca ?P, AKPX线 No obvious skeletal changes临床表现 Clinical manifestations枕秃the loss of hair in the occipital position?激期The advanced stage 症状和体征生化改变 Ca ↓, P ↓↓ Ca ?P 30, AKP ↑? X线Clinical manifestations方颅 Square head肋骨串珠 Rachitic rosary 漏斗胸 Funnel breast赫氏沟 Harrison grooves脊柱弯曲Spinal column鸡胸Chicken breast猫背Cat back手镯bracelets of hands O型腿bowlegsX型腿knock kneesClinical manifestations?恢复期Recovered stage of rickets 症状These becomesubsided体征生化 Ca and P return to normal Ca ?P returns to normalAKP may be return slowly to normal X线 it returns to normal after 2 to 3 weeks?后遗症期 Sequela stage of rickets年龄 more than 2 years old? 症状without any clinical symptoms体征in severe case the deformities ofbones may remain生化all the serum level of Ca, P and AKP arenormal? X线Clinical manifestations诊断 Diagnosis?病史?症状:尤其注意早期症状?骨骼改变:注意年龄不同而出现的骨骼畸形有所不同?实验室检查结合年龄、季节做出综合判断鉴别诊断 Differential diagnosis先天性甲低 congental hypothyroidism骨软骨营养不良Achondroplasia脑积水HydrocephalusVitD抵抗性佝偻病 Vit D resitant rickets 先天性甲状腺功能低下congental hypothyroidism骨软骨营养不良Achondroplasia脑积水Hydrocephalus治疗 Treatment目的控制活动期,防止畸形和复发?关于VitD制剂的应用●对活动期的患儿,VitD剂量2000- 4000UI/d, 视临床症状和X-线改善情况于1个月改为预防量●对有并发症者或无法口服者可肌注VitD3一次,量为20-30万IU,3个月后改为口服预防量。
