Re: FW: Hospital chain, under scrutiny, reports rare illness | Local News | PE.com | Southern California News | News for Inland Southern California

[Guest guest]

Marasmus is starvation, kwashiorkor is protein starvation and electrolyte

imbalance. A Today's Dietitian article a few months age directed me to B1 for

refeeding anorexia - it worked - I was so disoriented, and my heart was fluttery

and weird. The magazine had flipped open to that page and it was a life saver.

When you are that underfed, there really is no appetite - zinc deficiency

worsens appetite I believe. The magnesium deficiency adds to the edema problem

that the lack of albumin causes. Loss of muscle tone, alopecia, and dermatologic

symptoms would all relate to protein deficiency. Getting rehydrated was

necessary before I could swallow much food. When one or two bites feels like

sawdust it is easy to give up eating and not figure out how to start again.

Rehydration requires magnesium as well as sodium and potassium. Many major

electrolyte brands don't even have magnesium - it was regulated out sometime in

the 20's - 30's.

I think that that doctor and hospital system is recognizing the problem I've

been working on - we can't heal and regenerate tissue if we don't have the

nutrients. As for increased Medicare billing I hope the hospital/doctor is

figuring out how to use that money to actually nourish the starving seniors and

isn't just bonusing it out to executives.

Kwashiorkor was more prevalent in starving children countries - edamatous belly

- but I just saw that in my father-in-law. I couldn't find a formula that didn't

have the high calcium level that throws off absorption. Our enteral feedings

are not based on ratios that the chronically ill can absorb. The feeding made

him worse, 40 pounds edamatous. So painfully swollen with water and skin

integrity you could poke a fingernail through (it seemed). He is getting better

finally.

Providing " Health Shakes " and supplemental formulas that are high in calcium

isn't helping. The problem is not that there is no protein in the diet or even

in the body - the problem is keeping the protein in the cells and blood vessels

where it can do some good. Magnesium is what is needed to prevent the leaky

membranes and in the chronically ill calcium is being preferentially absorbed.

I want to make sweet potato ginger smoothies boosted with garbanzo bean puree

for everybody.

http://www.nutritionmd.org/health_care_providers/general_nutrition/protein_malnu\

trition.html

Protein-Calorie Malnutrition: Overview and Treatment

Protein-calorie malnutritionresults in 2 similar but distinct

diseases, marasmus and kwashiorkor.

Marasmus is defined simply as chronic deprivation of energy needed

to maintain body weight. Its extreme form is characterized by severe

weight loss and cachexia.1 Marasmus is further characterized by

subnormal body temperature, decreased pulse and metabolic rate, loss

of skin turgor, constipation, and starvation diarrhea, consisting of

frequent, small, mucus-containing stools.2

Kwashiorkor is a somewhat more complex disease. It is characterized

by edema, low capillary-filtration rate, hypoalbuminemia, and

dermatitis.

Derived from an African term meaning " the disease that occurs when

the next baby is born " , kwashiorkor was initially thought to result

from a diet high in calories (mainly carbohydrates, such as maize),

yet deficient in protein. However, infection, aflatoxin poisoning,

and oxidative stress may also play causative roles.1,3 Edema, a defining

characteristic of kwashiorkor, resolves with treatment, despite

continuing hypoalbuminemia, suggesting that the edema is due to

leaky cell membranes, low capillary filtration rates, high

concentrations of free iron, and free radicals that increase capillary

permeability.4 Kwashiorkor is further distinguished from marasmus by

the following findings:

* Massive edema of the hands and feet.

* Profound irritability.

* Anorexia.

* Dermatologic symptoms (desquamative rash, hypopigmentation).

* Alopecia or hair discoloration.

* Fatty liver.

* Loss of muscle tone.

* Anemia and low blood concentrations of albumin, glucose, potassium,

and magnesium.5,6

Kwashiorkor may also involve severe, life-threatening hypophosphatemia

(<1.0 mg/dL), which has been found to triple the mortality rate when

compared with children who have normal phosphorus levels.7

Treatment

Individuals treated for protein-energy malnutrition are at risk for

refeeding syndrome, in which hypophosphatemia, hypokalemia, and

hypomagnesemia may lead to disturbances in the cardiac, neurologic,

gastrointestinal, respiratory, hematologic, skeletal, and endocrine

systems. Guidelines have been developed to help prevent these complications

and to establish a transition to normalcy. Treatment consists of 2

phases: stabilization and rehabilitation.

The initial (stabilization) phase proceeds from days 1 through 7. It

consists of treatment and prevention of hypoglycemia, hypothermia,

dehydration, and infection; correction of electrolyte imbalance and

micronutrient deficiencies; and a cautious feeding regimen.

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm

Protein-calorie malnutrition: Excerpt from Professional Guide to Diseases

(Eighth Edition)

" Both kwashiorkor (edematous PCM) and marasmus (nonedematous PCM) are common in

underdeveloped countries and in areas in which dietary amino acid content is

insufficient to satisfy growth requirements. Kwashiorkor typically occurs at

about age 1, after infants are weaned from breast milk to a protein-deficient

diet of starchy gruels or sugar water, but it can develop at any time during

the formative years. Marasmus affects infants ages 6 to 18 months as a result

of breast-feeding failure, or a debilitating condition such as chronic

diarrhea.

In industrialized countries, PCM may occur secondary to chronic metabolic

disease that decreases protein and calorie intake or absorption, or trauma that

increases protein and calorie requirements. In the United States, PCM is

estimated to occur to some extent in 50% of elderly people in nursing homes.

Those who aren’t allowed anything by mouth for an extended period are at high

risk of developing PCM. Conditions that increase protein-calorie requirements

include severe burns and injuries, systemic infections, and cancer (accounts

for the largest group of hospitalized patients with PCM). Conditions that cause

defective utilization of nutrients include malabsorption syndrome,

short-bowel syndrome, and Crohn’s disease.

Read more at

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm?ktrack=kcplink

Signs and symptoms

Children with chronic PCM are small for their chronological age and tend to be

physically inactive, mentally apathetic, and susceptible to frequent

infections. Anorexia and diarrhea are common.

In acute PCM, children are small, gaunt, and emaciated, with no adipose tissue.

Skin is dry and “baggy,†and hair is sparse and dull brown or

reddish-yellow.

Temperature is low; pulse rate and respirations are slowed. Such children are

weak, irritable, and usually hungry, although they may have anorexia, with

nausea and vomiting.

Unlike marasmus, chronic kwashiorkor allows the patient to grow in height, but

adipose tissue diminishes as fat metabolizes to meet energy demands. Edema

often masks severe muscle wasting; dry, peeling skin and hepatomegaly are

common. Patients with secondary PCM show signs similar to marasmus, primarily

loss of adipose tissue and lean body mass, lethargy, and edema. Severe

secondary PCM may cause loss of immunocompetence.

Diagnosis

CONFIRMING DIAGNOSIS Clinical appearance, dietary history, and anthropometry

confirm PCM. If the patient doesn’t suffer from fluid retention, weight

change

over time is the best index of nutritional status.

The following factors support the diagnosis:

①height and weight less than 80% of standard for the patient’s age and

sex,

and below-normal arm circumference and triceps skinfold

â‘ serum albumin level less than 2.8 g/dl (normal: 3.3 to 4.3 g/dl)

â‘ urinary creatinine (24-hour) level used to show lean body mass status by

relating creatinine excretion to height and ideal body weight, to yield

creatinine-height index.

R Vajda, R.D.

www.GingerJens.com

________________________________

To: rd-usa ; dhcc@...

Sent: Sun, February 20, 2011 8:50:58 PM

Subject: FW: Hospital chain, under scrutiny, reports rare illness |

Local News | PE.com | Southern California News | News for Inland Southern

California

This is a very interesting article. Aside from the fact that our tax $$ are

now going to our neighbor to the North, what is the accurate definition of

Kwashiorkor IYO? And how is it diagnosed?

Digna

Hospital chain, under scrutiny, reports rare illness | Local News |

PE.com | Southern California News | News for Inland Southern California

http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.h

tml

[Guest guest]

Wow, , you know your medical nutrition! So glad you joined

this list! When it comes to human disease, it all goes back to

nutrition!

Sent from my iPhone

On Feb 21, 2011, at 11:04 AM, Vajda

wrote:

> Marasmus is starvation, kwashiorkor is protein starvation and

> electrolyte

> imbalance. A Today's Dietitian article a few months age directed me

> to B1 for

> refeeding anorexia - it worked - I was so disoriented, and my heart

> was fluttery

> and weird. The magazine had flipped open to that page and it was a

> life saver.

> When you are that underfed, there really is no appetite - zinc

> deficiency

> worsens appetite I believe. The magnesium deficiency adds to the

> edema problem

> that the lack of albumin causes. Loss of muscle tone, alopecia, and

> dermatologic

> symptoms would all relate to protein deficiency. Getting rehydrated

> was

> necessary before I could swallow much food. When one or two bites

> feels like

> sawdust it is easy to give up eating and not figure out how to start

> again.

> Rehydration requires magnesium as well as sodium and potassium. Many

> major

> electrolyte brands don't even have magnesium - it was regulated out

> sometime in

> the 20's - 30's.

>

> I think that that doctor and hospital system is recognizing the

> problem I've

> been working on - we can't heal and regenerate tissue if we don't

> have the

> nutrients. As for increased Medicare billing I hope the hospital/

> doctor is

> figuring out how to use that money to actually nourish the starving

> seniors and

> isn't just bonusing it out to executives.

>

> Kwashiorkor was more prevalent in starving children countries -

> edamatous belly

> - but I just saw that in my father-in-law. I couldn't find a formula

> that didn't

> have the high calcium level that throws off absorption. Our enteral

> feedings

> are not based on ratios that the chronically ill can absorb. The

> feeding made

> him worse, 40 pounds edamatous. So painfully swollen with water and

> skin

> integrity you could poke a fingernail through (it seemed). He is

> getting better

> finally.

>

> Providing " Health Shakes " and supplemental formulas that are high in

> calcium

> isn't helping. The problem is not that there is no protein in the

> diet or even

> in the body - the problem is keeping the protein in the cells and

> blood vessels

> where it can do some good. Magnesium is what is needed to prevent

> the leaky

> membranes and in the chronically ill calcium is being preferentially

> absorbed.

>

> I want to make sweet potato ginger smoothies boosted with garbanzo

> bean puree

> for everybody.

>

>

http://www.nutritionmd.org/health_care_providers/general_nutrition/protein_malnu\

trition.html

>

> Protein-Calorie Malnutrition: Overview and Treatment

> Protein-calorie malnutritionresults in 2 similar but distinct

> diseases, marasmus and kwashiorkor.

>

> Marasmus is defined simply as chronic deprivation of energy needed

> to maintain body weight. Its extreme form is characterized by severe

> weight loss and cachexia.1 Marasmus is further characterized by

> subnormal body temperature, decreased pulse and metabolic rate, loss

> of skin turgor, constipation, and starvation diarrhea, consisting of

> frequent, small, mucus-containing stools.2

> Kwashiorkor is a somewhat more complex disease. It is characterized

> by edema, low capillary-filtration rate, hypoalbuminemia, and

> dermatitis.

>

> Derived from an African term meaning " the disease that occurs when

> the next baby is born " , kwashiorkor was initially thought to result

> from a diet high in calories (mainly carbohydrates, such as maize),

> yet deficient in protein. However, infection, aflatoxin poisoning,

> and oxidative stress may also play causative roles.1,3 Edema, a

> defining

> characteristic of kwashiorkor, resolves with treatment, despite

> continuing hypoalbuminemia, suggesting that the edema is due to

> leaky cell membranes, low capillary filtration rates, high

> concentrations of free iron, and free radicals that increase capillary

> permeability.4 Kwashiorkor is further distinguished from marasmus by

> the following findings:

> * Massive edema of the hands and feet.

> * Profound irritability.

> * Anorexia.

> * Dermatologic symptoms (desquamative rash, hypopigmentation).

> * Alopecia or hair discoloration.

> * Fatty liver.

> * Loss of muscle tone.

> * Anemia and low blood concentrations of albumin, glucose, potassium,

> and magnesium.5,6

> Kwashiorkor may also involve severe, life-threatening hypophosphatemia

> (<1.0 mg/dL), which has been found to triple the mortality rate when

> compared with children who have normal phosphorus levels.7

> Treatment

> Individuals treated for protein-energy malnutrition are at risk for

> refeeding syndrome, in which hypophosphatemia, hypokalemia, and

> hypomagnesemia may lead to disturbances in the cardiac, neurologic,

> gastrointestinal, respiratory, hematologic, skeletal, and endocrine

> systems. Guidelines have been developed to help prevent these

> complications

> and to establish a transition to normalcy. Treatment consists of 2

> phases: stabilization and rehabilitation.

>

> The initial (stabilization) phase proceeds from days 1 through 7. It

> consists of treatment and prevention of hypoglycemia, hypothermia,

> dehydration, and infection; correction of electrolyte imbalance and

> micronutrient deficiencies; and a cautious feeding regimen.

>

> http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm

>

> Protein-calorie malnutrition: Excerpt from Professional Guide to

> Diseases

> (Eighth Edition)

> " Both kwashiorkor (edematous PCM) and marasmus (nonedematous PCM)

> are common in

> underdeveloped countries and in areas in which dietary amino acid

> content is

> insufficient to satisfy growth requirements. Kwashiorkor typically

> occurs at

> about age 1, after infants are weaned from breast milk to a protein-

> deficient

> diet of starchy gruels or sugar water, but it can develop at any

> time during

> the formative years. Marasmus affects infants ages 6 to 18 months as

> a result

> of breast-feeding failure, or a debilitating condition such as chronic

> diarrhea.

>

> In industrialized countries, PCM may occur secondary to chronic

> metabolic

> disease that decreases protein and calorie intake or absorption, or

> trauma that

> increases protein and calorie requirements. In the United States,

> PCM is

> estimated to occur to some extent in 50% of elderly people in

> nursing homes.

> Those who aren’t allowed anything by mouth for an extended period ar

> e at high

> risk of developing PCM. Conditions that increase protein-calorie

> requirements

> include severe burns and injuries, systemic infections, and cancer

> (accounts

> for the largest group of hospitalized patients with PCM). Conditions

> that cause

> defective utilization of nutrients include malabsorption syndrome,

> short-bowel syndrome, and Crohn’s disease.

>

> Read more at

>

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm?ktrack=kcplink

>

> Signs and symptoms

> Children with chronic PCM are small for their chronological age and

> tend to be

> physically inactive, mentally apathetic, and susceptible to frequent

> infections. Anorexia and diarrhea are common.

>

> In acute PCM, children are small, gaunt, and emaciated, with no

> adipose tissue.

> Skin is dry and “baggy,†and hair is sparse and dull brown or

> reddish-yellow.

> Temperature is low; pulse rate and respirations are slowed. Such

> children are

> weak, irritable, and usually hungry, although they may have

> anorexia, with

> nausea and vomiting.

>

> Unlike marasmus, chronic kwashiorkor allows the patient to grow in

> height, but

> adipose tissue diminishes as fat metabolizes to meet energy demands.

> Edema

> often masks severe muscle wasting; dry, peeling skin and

> hepatomegaly are

> common. Patients with secondary PCM show signs similar to marasmus,

> primarily

> loss of adipose tissue and lean body mass, lethargy, and edema. Severe

> secondary PCM may cause loss of immunocompetence.

>

> Diagnosis

> CONFIRMING DIAGNOSIS Clinical appearance, dietary history, and

> anthropometry

> confirm PCM. If the patient doesn’t suffer from fluid retention, wei

> ght change

> over time is the best index of nutritional status.

>

> The following factors support the diagnosis:

> ①height and weight less than 80% of standard for the patient’s

> age and sex,

> and below-normal arm circumference and triceps skinfold

>

> â‘ serum albumin level less than 2.8 g/dl (normal: 3.3 to 4.3 g/dl)

> â‘ urinary creatinine (24-hour) level used to show lean body mass sta

> tus by

> relating creatinine excretion to height and ideal body weight, to

> yield

> creatinine-height index.

>

> R Vajda, R.D.

> www.GingerJens.com

>

> ________________________________

>

> To: rd-usa ; dhcc@...

> Sent: Sun, February 20, 2011 8:50:58 PM

> Subject: FW: Hospital chain, under scrutiny, reports rare

> illness |

> Local News | PE.com | Southern California News | News for Inland

> Southern

> California

>

> This is a very interesting article. Aside from the fact that our tax

> $$ are

> now going to our neighbor to the North, what is the accurate

> definition of

> Kwashiorkor IYO? And how is it diagnosed?

>

> Digna

>

> Hospital chain, under scrutiny, reports rare illness |

> Local News |

> PE.com | Southern California News | News for Inland Southern

> California

>

> http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.h

> tml

>

>

[Guest guest]

Wow, , you know your medical nutrition! So glad you joined

this list! When it comes to human disease, it all goes back to

nutrition!

Sent from my iPhone

On Feb 21, 2011, at 11:04 AM, Vajda

wrote:

> Marasmus is starvation, kwashiorkor is protein starvation and

> electrolyte

> imbalance. A Today's Dietitian article a few months age directed me

> to B1 for

> refeeding anorexia - it worked - I was so disoriented, and my heart

> was fluttery

> and weird. The magazine had flipped open to that page and it was a

> life saver.

> When you are that underfed, there really is no appetite - zinc

> deficiency

> worsens appetite I believe. The magnesium deficiency adds to the

> edema problem

> that the lack of albumin causes. Loss of muscle tone, alopecia, and

> dermatologic

> symptoms would all relate to protein deficiency. Getting rehydrated

> was

> necessary before I could swallow much food. When one or two bites

> feels like

> sawdust it is easy to give up eating and not figure out how to start

> again.

> Rehydration requires magnesium as well as sodium and potassium. Many

> major

> electrolyte brands don't even have magnesium - it was regulated out

> sometime in

> the 20's - 30's.

>

> I think that that doctor and hospital system is recognizing the

> problem I've

> been working on - we can't heal and regenerate tissue if we don't

> have the

> nutrients. As for increased Medicare billing I hope the hospital/

> doctor is

> figuring out how to use that money to actually nourish the starving

> seniors and

> isn't just bonusing it out to executives.

>

> Kwashiorkor was more prevalent in starving children countries -

> edamatous belly

> - but I just saw that in my father-in-law. I couldn't find a formula

> that didn't

> have the high calcium level that throws off absorption. Our enteral

> feedings

> are not based on ratios that the chronically ill can absorb. The

> feeding made

> him worse, 40 pounds edamatous. So painfully swollen with water and

> skin

> integrity you could poke a fingernail through (it seemed). He is

> getting better

> finally.

>

> Providing " Health Shakes " and supplemental formulas that are high in

> calcium

> isn't helping. The problem is not that there is no protein in the

> diet or even

> in the body - the problem is keeping the protein in the cells and

> blood vessels

> where it can do some good. Magnesium is what is needed to prevent

> the leaky

> membranes and in the chronically ill calcium is being preferentially

> absorbed.

>

> I want to make sweet potato ginger smoothies boosted with garbanzo

> bean puree

> for everybody.

>

>

http://www.nutritionmd.org/health_care_providers/general_nutrition/protein_malnu\

trition.html

>

> Protein-Calorie Malnutrition: Overview and Treatment

> Protein-calorie malnutritionresults in 2 similar but distinct

> diseases, marasmus and kwashiorkor.

>

> Marasmus is defined simply as chronic deprivation of energy needed

> to maintain body weight. Its extreme form is characterized by severe

> weight loss and cachexia.1 Marasmus is further characterized by

> subnormal body temperature, decreased pulse and metabolic rate, loss

> of skin turgor, constipation, and starvation diarrhea, consisting of

> frequent, small, mucus-containing stools.2

> Kwashiorkor is a somewhat more complex disease. It is characterized

> by edema, low capillary-filtration rate, hypoalbuminemia, and

> dermatitis.

>

> Derived from an African term meaning " the disease that occurs when

> the next baby is born " , kwashiorkor was initially thought to result

> from a diet high in calories (mainly carbohydrates, such as maize),

> yet deficient in protein. However, infection, aflatoxin poisoning,

> and oxidative stress may also play causative roles.1,3 Edema, a

> defining

> characteristic of kwashiorkor, resolves with treatment, despite

> continuing hypoalbuminemia, suggesting that the edema is due to

> leaky cell membranes, low capillary filtration rates, high

> concentrations of free iron, and free radicals that increase capillary

> permeability.4 Kwashiorkor is further distinguished from marasmus by

> the following findings:

> * Massive edema of the hands and feet.

> * Profound irritability.

> * Anorexia.

> * Dermatologic symptoms (desquamative rash, hypopigmentation).

> * Alopecia or hair discoloration.

> * Fatty liver.

> * Loss of muscle tone.

> * Anemia and low blood concentrations of albumin, glucose, potassium,

> and magnesium.5,6

> Kwashiorkor may also involve severe, life-threatening hypophosphatemia

> (<1.0 mg/dL), which has been found to triple the mortality rate when

> compared with children who have normal phosphorus levels.7

> Treatment

> Individuals treated for protein-energy malnutrition are at risk for

> refeeding syndrome, in which hypophosphatemia, hypokalemia, and

> hypomagnesemia may lead to disturbances in the cardiac, neurologic,

> gastrointestinal, respiratory, hematologic, skeletal, and endocrine

> systems. Guidelines have been developed to help prevent these

> complications

> and to establish a transition to normalcy. Treatment consists of 2

> phases: stabilization and rehabilitation.

>

> The initial (stabilization) phase proceeds from days 1 through 7. It

> consists of treatment and prevention of hypoglycemia, hypothermia,

> dehydration, and infection; correction of electrolyte imbalance and

> micronutrient deficiencies; and a cautious feeding regimen.

>

> http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm

>

> Protein-calorie malnutrition: Excerpt from Professional Guide to

> Diseases

> (Eighth Edition)

> " Both kwashiorkor (edematous PCM) and marasmus (nonedematous PCM)

> are common in

> underdeveloped countries and in areas in which dietary amino acid

> content is

> insufficient to satisfy growth requirements. Kwashiorkor typically

> occurs at

> about age 1, after infants are weaned from breast milk to a protein-

> deficient

> diet of starchy gruels or sugar water, but it can develop at any

> time during

> the formative years. Marasmus affects infants ages 6 to 18 months as

> a result

> of breast-feeding failure, or a debilitating condition such as chronic

> diarrhea.

>

> In industrialized countries, PCM may occur secondary to chronic

> metabolic

> disease that decreases protein and calorie intake or absorption, or

> trauma that

> increases protein and calorie requirements. In the United States,

> PCM is

> estimated to occur to some extent in 50% of elderly people in

> nursing homes.

> Those who aren’t allowed anything by mouth for an extended period ar

> e at high

> risk of developing PCM. Conditions that increase protein-calorie

> requirements

> include severe burns and injuries, systemic infections, and cancer

> (accounts

> for the largest group of hospitalized patients with PCM). Conditions

> that cause

> defective utilization of nutrients include malabsorption syndrome,

> short-bowel syndrome, and Crohn’s disease.

>

> Read more at

>

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm?ktrack=kcplink

>

> Signs and symptoms

> Children with chronic PCM are small for their chronological age and

> tend to be

> physically inactive, mentally apathetic, and susceptible to frequent

> infections. Anorexia and diarrhea are common.

>

> In acute PCM, children are small, gaunt, and emaciated, with no

> adipose tissue.

> Skin is dry and “baggy,†and hair is sparse and dull brown or

> reddish-yellow.

> Temperature is low; pulse rate and respirations are slowed. Such

> children are

> weak, irritable, and usually hungry, although they may have

> anorexia, with

> nausea and vomiting.

>

> Unlike marasmus, chronic kwashiorkor allows the patient to grow in

> height, but

> adipose tissue diminishes as fat metabolizes to meet energy demands.

> Edema

> often masks severe muscle wasting; dry, peeling skin and

> hepatomegaly are

> common. Patients with secondary PCM show signs similar to marasmus,

> primarily

> loss of adipose tissue and lean body mass, lethargy, and edema. Severe

> secondary PCM may cause loss of immunocompetence.

>

> Diagnosis

> CONFIRMING DIAGNOSIS Clinical appearance, dietary history, and

> anthropometry

> confirm PCM. If the patient doesn’t suffer from fluid retention, wei

> ght change

> over time is the best index of nutritional status.

>

> The following factors support the diagnosis:

> ①height and weight less than 80% of standard for the patient’s

> age and sex,

> and below-normal arm circumference and triceps skinfold

>

> â‘ serum albumin level less than 2.8 g/dl (normal: 3.3 to 4.3 g/dl)

> â‘ urinary creatinine (24-hour) level used to show lean body mass sta

> tus by

> relating creatinine excretion to height and ideal body weight, to

> yield

> creatinine-height index.

>

> R Vajda, R.D.

> www.GingerJens.com

>

> ________________________________

>

> To: rd-usa ; dhcc@...

> Sent: Sun, February 20, 2011 8:50:58 PM

> Subject: FW: Hospital chain, under scrutiny, reports rare

> illness |

> Local News | PE.com | Southern California News | News for Inland

> Southern

> California

>

> This is a very interesting article. Aside from the fact that our tax

> $$ are

> now going to our neighbor to the North, what is the accurate

> definition of

> Kwashiorkor IYO? And how is it diagnosed?

>

> Digna

>

> Hospital chain, under scrutiny, reports rare illness |

> Local News |

> PE.com | Southern California News | News for Inland Southern

> California

>

> http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.h

> tml

>

>

[Guest guest]

Wow, , you know your medical nutrition! So glad you joined

this list! When it comes to human disease, it all goes back to

nutrition!

Sent from my iPhone

On Feb 21, 2011, at 11:04 AM, Vajda

wrote:

> Marasmus is starvation, kwashiorkor is protein starvation and

> electrolyte

> imbalance. A Today's Dietitian article a few months age directed me

> to B1 for

> refeeding anorexia - it worked - I was so disoriented, and my heart

> was fluttery

> and weird. The magazine had flipped open to that page and it was a

> life saver.

> When you are that underfed, there really is no appetite - zinc

> deficiency

> worsens appetite I believe. The magnesium deficiency adds to the

> edema problem

> that the lack of albumin causes. Loss of muscle tone, alopecia, and

> dermatologic

> symptoms would all relate to protein deficiency. Getting rehydrated

> was

> necessary before I could swallow much food. When one or two bites

> feels like

> sawdust it is easy to give up eating and not figure out how to start

> again.

> Rehydration requires magnesium as well as sodium and potassium. Many

> major

> electrolyte brands don't even have magnesium - it was regulated out

> sometime in

> the 20's - 30's.

>

> I think that that doctor and hospital system is recognizing the

> problem I've

> been working on - we can't heal and regenerate tissue if we don't

> have the

> nutrients. As for increased Medicare billing I hope the hospital/

> doctor is

> figuring out how to use that money to actually nourish the starving

> seniors and

> isn't just bonusing it out to executives.

>

> Kwashiorkor was more prevalent in starving children countries -

> edamatous belly

> - but I just saw that in my father-in-law. I couldn't find a formula

> that didn't

> have the high calcium level that throws off absorption. Our enteral

> feedings

> are not based on ratios that the chronically ill can absorb. The

> feeding made

> him worse, 40 pounds edamatous. So painfully swollen with water and

> skin

> integrity you could poke a fingernail through (it seemed). He is

> getting better

> finally.

>

> Providing " Health Shakes " and supplemental formulas that are high in

> calcium

> isn't helping. The problem is not that there is no protein in the

> diet or even

> in the body - the problem is keeping the protein in the cells and

> blood vessels

> where it can do some good. Magnesium is what is needed to prevent

> the leaky

> membranes and in the chronically ill calcium is being preferentially

> absorbed.

>

> I want to make sweet potato ginger smoothies boosted with garbanzo

> bean puree

> for everybody.

>

>

http://www.nutritionmd.org/health_care_providers/general_nutrition/protein_malnu\

trition.html

>

> Protein-Calorie Malnutrition: Overview and Treatment

> Protein-calorie malnutritionresults in 2 similar but distinct

> diseases, marasmus and kwashiorkor.

>

> Marasmus is defined simply as chronic deprivation of energy needed

> to maintain body weight. Its extreme form is characterized by severe

> weight loss and cachexia.1 Marasmus is further characterized by

> subnormal body temperature, decreased pulse and metabolic rate, loss

> of skin turgor, constipation, and starvation diarrhea, consisting of

> frequent, small, mucus-containing stools.2

> Kwashiorkor is a somewhat more complex disease. It is characterized

> by edema, low capillary-filtration rate, hypoalbuminemia, and

> dermatitis.

>

> Derived from an African term meaning " the disease that occurs when

> the next baby is born " , kwashiorkor was initially thought to result

> from a diet high in calories (mainly carbohydrates, such as maize),

> yet deficient in protein. However, infection, aflatoxin poisoning,

> and oxidative stress may also play causative roles.1,3 Edema, a

> defining

> characteristic of kwashiorkor, resolves with treatment, despite

> continuing hypoalbuminemia, suggesting that the edema is due to

> leaky cell membranes, low capillary filtration rates, high

> concentrations of free iron, and free radicals that increase capillary

> permeability.4 Kwashiorkor is further distinguished from marasmus by

> the following findings:

> * Massive edema of the hands and feet.

> * Profound irritability.

> * Anorexia.

> * Dermatologic symptoms (desquamative rash, hypopigmentation).

> * Alopecia or hair discoloration.

> * Fatty liver.

> * Loss of muscle tone.

> * Anemia and low blood concentrations of albumin, glucose, potassium,

> and magnesium.5,6

> Kwashiorkor may also involve severe, life-threatening hypophosphatemia

> (<1.0 mg/dL), which has been found to triple the mortality rate when

> compared with children who have normal phosphorus levels.7

> Treatment

> Individuals treated for protein-energy malnutrition are at risk for

> refeeding syndrome, in which hypophosphatemia, hypokalemia, and

> hypomagnesemia may lead to disturbances in the cardiac, neurologic,

> gastrointestinal, respiratory, hematologic, skeletal, and endocrine

> systems. Guidelines have been developed to help prevent these

> complications

> and to establish a transition to normalcy. Treatment consists of 2

> phases: stabilization and rehabilitation.

>

> The initial (stabilization) phase proceeds from days 1 through 7. It

> consists of treatment and prevention of hypoglycemia, hypothermia,

> dehydration, and infection; correction of electrolyte imbalance and

> micronutrient deficiencies; and a cautious feeding regimen.

>

> http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm

>

> Protein-calorie malnutrition: Excerpt from Professional Guide to

> Diseases

> (Eighth Edition)

> " Both kwashiorkor (edematous PCM) and marasmus (nonedematous PCM)

> are common in

> underdeveloped countries and in areas in which dietary amino acid

> content is

> insufficient to satisfy growth requirements. Kwashiorkor typically

> occurs at

> about age 1, after infants are weaned from breast milk to a protein-

> deficient

> diet of starchy gruels or sugar water, but it can develop at any

> time during

> the formative years. Marasmus affects infants ages 6 to 18 months as

> a result

> of breast-feeding failure, or a debilitating condition such as chronic

> diarrhea.

>

> In industrialized countries, PCM may occur secondary to chronic

> metabolic

> disease that decreases protein and calorie intake or absorption, or

> trauma that

> increases protein and calorie requirements. In the United States,

> PCM is

> estimated to occur to some extent in 50% of elderly people in

> nursing homes.

> Those who aren’t allowed anything by mouth for an extended period ar

> e at high

> risk of developing PCM. Conditions that increase protein-calorie

> requirements

> include severe burns and injuries, systemic infections, and cancer

> (accounts

> for the largest group of hospitalized patients with PCM). Conditions

> that cause

> defective utilization of nutrients include malabsorption syndrome,

> short-bowel syndrome, and Crohn’s disease.

>

> Read more at

>

http://www.wrongdiagnosis.com/k/kwashiorkor/book-diseases-7a.htm?ktrack=kcplink

>

> Signs and symptoms

> Children with chronic PCM are small for their chronological age and

> tend to be

> physically inactive, mentally apathetic, and susceptible to frequent

> infections. Anorexia and diarrhea are common.

>

> In acute PCM, children are small, gaunt, and emaciated, with no

> adipose tissue.

> Skin is dry and “baggy,†and hair is sparse and dull brown or

> reddish-yellow.

> Temperature is low; pulse rate and respirations are slowed. Such

> children are

> weak, irritable, and usually hungry, although they may have

> anorexia, with

> nausea and vomiting.

>

> Unlike marasmus, chronic kwashiorkor allows the patient to grow in

> height, but

> adipose tissue diminishes as fat metabolizes to meet energy demands.

> Edema

> often masks severe muscle wasting; dry, peeling skin and

> hepatomegaly are

> common. Patients with secondary PCM show signs similar to marasmus,

> primarily

> loss of adipose tissue and lean body mass, lethargy, and edema. Severe

> secondary PCM may cause loss of immunocompetence.

>

> Diagnosis

> CONFIRMING DIAGNOSIS Clinical appearance, dietary history, and

> anthropometry

> confirm PCM. If the patient doesn’t suffer from fluid retention, wei

> ght change

> over time is the best index of nutritional status.

>

> The following factors support the diagnosis:

> ①height and weight less than 80% of standard for the patient’s

> age and sex,

> and below-normal arm circumference and triceps skinfold

>

> â‘ serum albumin level less than 2.8 g/dl (normal: 3.3 to 4.3 g/dl)

> â‘ urinary creatinine (24-hour) level used to show lean body mass sta

> tus by

> relating creatinine excretion to height and ideal body weight, to

> yield

> creatinine-height index.

>

> R Vajda, R.D.

> www.GingerJens.com

>

> ________________________________

>

> To: rd-usa ; dhcc@...

> Sent: Sun, February 20, 2011 8:50:58 PM

> Subject: FW: Hospital chain, under scrutiny, reports rare

> illness |

> Local News | PE.com | Southern California News | News for Inland

> Southern

> California

>

> This is a very interesting article. Aside from the fact that our tax

> $$ are

> now going to our neighbor to the North, what is the accurate

> definition of

> Kwashiorkor IYO? And how is it diagnosed?

>

> Digna

>

> Hospital chain, under scrutiny, reports rare illness |

> Local News |

> PE.com | Southern California News | News for Inland Southern

> California

>

> http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.h

> tml

>

>