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MALNUTRITION http://crisbertcualteros.page.tl
COMPUTATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interpretation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],HFA (stunting) C >95  N 90-94 Mild 85-90 Mod <85  Severe
EXAMPLE ,[object Object],[object Object],[object Object],[object Object]
WATERLOW CLASSIFICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
 
COMPUTATION FOR TOTAL CALORIC REQUIREMENT (TCR) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EXAMPLE: 1 yr old baby weighing 10kg
A. Solve for TOTAL CALORIC REQUIREMENT (TCR) ,[object Object],[object Object],[object Object]
B. Determine TCR CHON  in grams,  then convert to calories ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
C. Subtract TCR CHON  from TCR total then get fraction of CHO & fats  (usual ratio 60:40) ,[object Object],[object Object],[object Object]
D. Convert back to grams ,[object Object],[object Object],[object Object]
E. Write final prescription ,[object Object],[object Object],[object Object]
Catch-up Calories ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
COMPUTATION FOR TOTAL CALORIC REQUIREMENT (TCR) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],EXAMPLE: 13yo, girl, BW=29kg
FLUIDS
Fluid Composition
Generalities   ,[object Object],[object Object],[object Object],[object Object]
Maintenance fluid   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Components of Maintenance water 05%  Stool 35% Insensible (skin and lungs) 60% Urine
[object Object],[object Object],[object Object],Maintenance fluid
Body Weight Method for calculating Maintenance Fluid Volume ,[object Object],The maximum total fluid per day is normally 2,400 ml Eg. 25kg child (1000+500+100) = 1600ml/day 100ml/kg/day, plus 50ml/kg/day, plus 20ml/kg/day 1st 10kg BW 2nd 10kg BW BW > 20kg Total Fluid Requirement BW (kg)
Maintenance fluid to gtts/min ,[object Object],[object Object],[object Object]
Maintenance Fluids ,[object Object],Eg. 25kg child: 25kg x 60ml/kg/d = 1500ml/day 75 100 75 60 50 0-3 3-10 10-20 20-30 >30 Volume of Fluid in 24h (ml/kg/d) Weight (kg)
Maintenance Fluids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eg. 8y.o. girl, 25kg, 125cm BSA = 0.931 TFR = 1488ml/day
Comparison ,[object Object],[object Object],[object Object],[object Object]
Maintenance Electrolytes   1-2 meq /kg / 24 hour  Potassium  2-3 meq /kg / 24 hour  Sodium
Composition of Intravenous solutions   28 3 4 109 130 Ringer lactate 38.5 38.5 ¼ Normal Saline (0.225% NaCl) 77 77 ½ Normail Saline (0.45% NaCl) 154 154 Normal saline (0.9%NaCl) Lactate- Ca++ K+ Cl+ Na+ Fluid
Adjustments in maintenance Water   Hypothyroidism  ,[object Object],[object Object],Miscellaneous  Oliguria / anuria  Polyuria  Renal  ,[object Object],[object Object],[object Object],Gastrointestinal Tract  Humidified ventilator  Tachypnea  Lungs  mist tent  ,[object Object],[object Object],[object Object],[object Object],Skin  Causes of Decreased water needs  Causes of Increased Water needs  Source
Replacement Fluid   ,[object Object],[object Object],[object Object]
Replacement Fluid   ,[object Object],[object Object]
Adjusting Fluid therapy in Diarrhea ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adjusting Fluid Therapy for Emesis or Nasogastric losses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU!
Fluid Management of Specific Fluid & Electrolytes Disturbance  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management of Specific Fluid & Electrolytes Disturbance   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Assessment of State of Hydration   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Assessment of State of Hydration
Classify Dehydration ,[object Object],[object Object],[object Object],[object Object]
Additional Clinical Parameters of Dehydration  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Additional Clinical Parameters of Dehydration  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Additional Clinical Parameters of Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classify Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classify Dehydration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Deficit Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Plan A: Treat Diarrhea at Home   ,[object Object],[object Object]
Treatment Plan B: Treat Some Dehydration   with ORS   ,[object Object],[object Object],900-1400  700-900  400-700  200-400 In ml 2 yrs-5 yrs  10-<12 kg  6-<10 kg  < 5kg Weight 2 yrs-5 yrs  12 mos – 2 yrs  4 mos – 12 mos  Up to 4 mos Age
Treatment Plan B: Treat Some Dehydration with ORS   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Plan B: Treat Some Dehydration   with ORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Plan C: Treat severe Dehydration Quickly   ,[object Object],* Repeat  once if radial is still very weak or not detectable 2 ½ hours  30 minutes*  Children (12 mos-5 yrs)  5 hours  1 hour*  Infants (under 12 mos)  Then give 70 ml / kg in: First give 30 ml / kg in: Age
Treatment Plan C: Treat severe Dehydration Quickly   ,[object Object],[object Object],[object Object]
 
FOOD GUIDES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Please visit: ,[object Object]

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