Severe weight loss is "skinny"

Introduction Patients with protein-energy malnutrition disease, clinical manifestations of weight loss, characterized by weight loss, subcutaneous fat disappeared, dry skin and loss of elasticity and luster, severe skinny and skins. It is one of the clinical symptoms of protein-energy malnutrition. Protein energy malnutrition (PEM) is a nutritional deficiency caused by insufficient food supply or disease factors, clinically manifested as marasmus and mastic dystrophy syndrome (kwashiorkor). Weight loss is the result of chronic lack of calories, protein and other nutrients in the diet, or problems caused by the patient's digestion, absorption and utilization of food. This type is mainly characterized by lack of energy and lack of protein. It is characterized by progressive weight loss, reduction of subcutaneous fat, edema and dysfunction of various organs. Malignant malnutrition is characterized by a lack of protein in the diet, and the supply of heat is still sufficient, mainly manifested as dystrophic edema. However, most patients are somewhere in between. Light chronic protein-energy malnutrition is often neglected. It affects children's growth and development, immune function, and is easy to get sick and difficult to recover.

Cause

(1) Causes of the disease

Protein-energy malnutrition can be caused by severe protein deficiency and/or insufficient energy intake. There are several reasons for this:

1 Insufficient intake: food shortage or imbalance caused by famine, war or economic backwardness. Patients with mental disorders, anorexia nervosa and upper gastrointestinal obstruction cannot be fed as normal.

2 digestion and malabsorption: stubborn and long-term vomiting, diarrhea and digestive dysfunction associated with other diseases.

3 The body needs to be increased and the supply is insufficient: more common in infants, pregnant and lactating women. In addition, consumptive diseases such as hyperthyroidism, tumors, tuberculosis, and diabetes all increase the consumption of various nutrients in the body, and protein-energy malnutrition can occur if the supplement is insufficient.

(two) pathogenesis

The occurrence of protein-energy malnutrition is a complex pathophysiological process. When the protein and energy supply in food is insufficient, the body begins to reduce the nutrient requirements of tissues and organs through physiological regulation, which allows the body to survive in a low-nutrient environment, but when protein and energy continue to be lacking, physiological functions are dysfunctional and adapted. Failure of the mechanism can lead to death.

Protein metabolism

When the protein and energy supply is insufficient, the protein content in the plasma decreases, and the rate of protein synthesis and decomposition slows down.

Albumin: The content of the body bank is reduced, mainly in the extravascular part, and the rate of decomposition and synthesis decreases. When serum albumin drops to 30g/L, other substances in the body such as lipoprotein, alanine and proline are obvious. change.

Globulin: The concentration in plasma and the distribution in the body are not significantly changed, but plasma ferritin is significantly decreased. In vivo protein conversion rate: Although the degree of protein deficiency in various tissues and organs in the body is different, the rate of synthesis and decomposition changes. Generally, after 5 to 6 weeks of protein deficiency, the conversion rate decreases by 30%. In animal experiments, high-protein feed is supplied, and 23% of the amino acids are converted to urea for excretion. However, when the protein is insufficient, only 3.4% of the amino acids are converted into urea, and the amount of nitrogen is reduced.

2. Amino acid metabolism

In severe protein-energy malnutrition, the concentration of amino acids in plasma can be reduced to 1/2 of normal, especially branched-chain amino acids and threonine. The edematous type of proline can be reduced to 30mol/L (250mol/L in normal children), and the concentration of alanine in plasma in the early stage of edema may be due to enhanced gluconeogenesis or decreased urea production. In the late stage, alanine is utilized as a substance forming glucose, at which time the concentration in the plasma is lowered. The ratio of phenylalanine to tyrosine also decreased in late protein-energy malnutrition.

3. Carbohydrate metabolism

In the case of protein-energy malnutrition, blood sugar is generally reduced, the lean type is more pronounced than the edema type, and the gluconeogenesis is enhanced. Studies have shown that in malnourished children, 8% of glucose comes from protein breakdown products, and the recovery period can be increased to 16%.

4. Lipid metabolism

Protein-energy malnutrition is often associated with fatty liver. The content of triacylglycerol, cholesterol and -lipoprotein in the wasted blood is normal or slightly increased. The content of triacylglycerol, cholesterol and -lipoprotein in edematous blood is normal or slightly lower.

5. Body fluids and minerals

Protein-energy malnutrition, whether it is thin or edematous, has fluid retention and edema. The enlargement of the extravascular fluid gap is the main cause of the increase in body fluids, and the degree of edema is associated with hypoalbuminemia. The mechanism of edema can be seen in Figure 1. In the case of protein-energy malnutrition, the total potassium content and magnesium content are reduced, and the sodium content is increased.

an examination

Related inspection

Ultrasound examination of thyroid gland and parathyroid gland thyroid-binding globulin (TBG) thyroxine-binding globulin thyroid gland 131 iodine test thyroid hormone inhibition test

Because of the different clinical types of protein-energy malnutrition, it is difficult to diagnose mild, moderate, and chronic malnutrition, so comprehensive diagnosis is needed.

History

According to the dietary situation, understand the history of inadequate food intake and the history of diseases affecting the body's digestion and absorption.

2. Clinical manifestations

(1) Symptoms:

There were no obvious symptoms in the early stage, only the appetite was poor, and the child's height and weight were slightly lower than normal. The condition continues to develop, and digestive dysfunction may occur, which is prone to respiratory infections. People with severe malnutrition have thinness, refusal to eat, apathy, and unresponsiveness, often accompanied by multiple vitamin deficiency and various complications such as angular cheilitis, corneal softening, purpura, etc., and finally into systemic edema and inhibition.

(2) Signs:

1 Weight: Protein-energy malnutrition can affect the growth and weight loss of children. Gomez et al have suggested that the weight of I degree malnutrition is 75% to 90% of the standard weight, the degree II malnutrition is 60% to 75% of the standard weight, and the III degree malnutrition is <60%, which is of diagnostic significance.

2 Height: During childhood, the height of the body rises linearly, and the increase of protein-energy malnutrition continues to slow down. Generally, it is compared with the average height of the region. The middle and lower heights are X±2S~X±S, and the lower finger height is below X±2S. However, it is necessary to pay attention to the comprehensive analysis, because protein-energy malnutrition can occur because of normal height; otherwise, the short stature is not all malnourished.

Differential diagnosis

Severe weight loss is a differential diagnosis of "skinny":

1. Systemic weight loss: systemic weight loss refers to the body's weight loss due to disease or certain factors. When it is less than 10% of the standard weight, it is weight loss. (The author believes that those who are 10% or more lower than the standard weight are lean. Less than 20% is called weight loss).

2, heart palpitations with weight loss, diarrhea: elderly patients with hyperthyroidism onset, not the same as the typical symptoms of young people with hyperthyroidism, most of them with arrhythmia, high blood pressure, loss of appetite, diarrhea, weight loss and other cardiovascular and gastrointestinal symptoms . Therefore, if a 60-year-old person has palpitations, diarrhea, weight loss, but a good mental state, be alert to the attack.

3, progressive weight loss: progressive thinning refers to the short-term progress, there is a weight comparison before and after the weight loss, and there are obvious clothes widening, the belt becomes loose, the shoes become larger and the subcutaneous fat is reduced, the muscles are thin, Symptoms such as loose skin and prominent bones. Due to the different clinical types of protein-energy malnutrition, it is difficult to diagnose mild, moderate and chronic malnutrition, so comprehensive diagnosis is needed.

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