Protein-Energy Malnutrition (PEM)
PEM is a spectrum of disorders resulting from an inadequate intake of protein and/or energy. It is broadly categorized into two clinical presentations: Marasmus (energy deficiency) and Kwashiorkor (protein deficiency).
1. Comparison: Marasmus vs. Kwashiorkor
| Feature | Marasmus | Kwashiorkor |
|---|---|---|
| Deficiency | Generalized (Calories + Protein) | Primarily Protein |
| Edema | Absent | Present (bilateral, pitting) |
| Appearance | “Old man face,” severe wasting | “Moon face,” flaky-paint dermatosis |
| Liver | Normal | Fatty liver (steatosis) |
2. Management Phases (WHO Protocol)
- Stabilization (Days 1–7): Treat hypoglycemia, hypothermia, dehydration (use ReSoMal, not standard ORS), and infection. High-protein/calorie diets are NOT introduced yet (danger of Refeeding Syndrome).
- Rehabilitation (Weeks 2–6): Gradually increase caloric and protein intake to facilitate “catch-up” growth.
3. High-Yield Clinical Pearls
- Refeeding Syndrome: A critical danger of introducing high-calorie diets too quickly; characterized by severe hypophosphatemia, hypokalemia, and cardiac failure.
- MUAC: Mid-Upper Arm Circumference is a quick, field-ready tool to screen for severe acute malnutrition (SAM) in community settings.
NEET PG Hint: Remember: Standard ORS has a high sodium and low potassium content, which can be dangerous in severe malnutrition. Always use ReSoMal (Rehydration Solution for Malnutrition), which is low-sodium and high-potassium. For more high-yield nutrition protocols and free medical questions, visit mymedschool.org.