dystrophic edema in children
Introduction
Introduction to dystrophic edema in children Malnutritionaledema, also known as hypoproteinemia, is a special manifestation of nutritional deficiencies. Due to the long-term negative nitrogen balance, plasma protein is reduced, colloid osmotic pressure is reduced, and systemic edema is characteristic. Adverse diseases. Protein deficiency syndrome, also known as malignant dystrophy syndrome or kwashiorkor, which is a local transliteration in Africa, means red child means that the mother no longer feeds the child after weaning, resulting in serious protein in the food. Insufficient, especially the lack of essential amino acids, although the height and weight of the treated children can be improved, but the normal child value of good nutrition is not always achieved. basic knowledge The proportion of illness: 0.13% (the probability of illness in infants and young children is 0.13%) Susceptible people: children Mode of infection: non-infectious Complications: vitamin A deficiency anemia acne sepsis
Cause
Causes of dystrophic edema in children
Excessive protein consumption (30%):
Abscess, lung abscess, ascites, massive blood loss, surgical wound drainage and severe burns, resulting in a large loss of protein in the body, parasitic diseases such as hookworm, malaria, etc., as well as enteritis and systemic infections such as measles, tuberculosis, etc. Excessive decomposition can cause dystrophic edema.
Protein synthesis barriers (20%):
The liver can synthesize various plasma proteins, such as albumin, fibrin, prothrombin, and can also synthesize partial globulin. Patients with liver diseases such as cirrhosis, hepatitis, and intrahepatic fat accumulation, although the supply and absorption of protein are normal, The function of synthesizing plasma protein is significantly reduced, and plasma albumin can be less than 10 g/L, thus causing symptoms such as edema and ascites.
Improper feeding (10%):
The total amount of protein and high-quality protein supplied in the diet can not meet the needs for a long time, and the energy supply can still maintain the minimum level. It is more common in the long-term shortage of breast milk in infants without adding dairy products, or rushing to wean.
Protein absorption disorder (10%):
Long-term diarrhea, chronic disease, intestinal tuberculosis, pyloric fistula or obstruction, lack of trypsin, etc., or affecting appetite; or impeding protein absorption; or protein can not be used can cause edema.
Pathogenesis (10%):
Its pathogenesis is almost the same as that of dystrophic wasting. Due to the long-term lack of protein, cell DNA and RNA synthesis is blocked, various tissues and organs grow and develop slowly, stop, and even severe atrophy and steatosis, resulting in low function.
Prevention
Prevention of dystrophic edema in children
1. Scientific Parenting: To prevent the occurrence of malnutrition, we must first improve the feeding method, master the scientific parenting methods, ensure the full intake of various nutrients, eliminate and correct partial eclipse and picky eaters, and reasonably eat snacks; Pay attention to develop good sleep habits, eating habits, bowel habits and cleansing habits.
2. Prevention and treatment of various diseases: It is necessary to prevent various infectious diseases and cure chronic diseases in time, and correct congenital malformations.
Complication
Pediatric dystrophic edema complications Complications Vitamin A deficiency anemia acne sepsis
1. Vitamin A deficiency and anemia common vitamin A deficiency and anemia.
2. Infection due to decreased systemic resistance, easy to get hemorrhoids, secondary skin infections, respiratory infections and sepsis, acute infection can make malnutrition edema worse, forming a vicious circle.
Symptom
Symptoms of dystrophic edema in children Common symptoms Slow growth T wave low flat or inverted hair dry face yellowish antifeeding thin body non-concave edema facial edema skin dry heart sounds low blunt
Before the onset of edema, children have malnutrition symptoms, and edema is the main cause of this disease.
1. General manifestations of systemic weight loss compared with dystrophic weight loss, sometimes due to systemic edema and weight loss, muscle thinning, atrophy, low muscle tone, subcutaneous fat still exists, body temperature is often lower than normal, limbs cold and cyanosis, reaction Indifferent, do not like activities, crying low, sputum, sometimes irritability, flat chest and abdominal distension, abdominal muscle weakness, loose or ascites, liver often increase, short-term disease has little effect on growth and development, Those with long durations are hindered by growth and development.
2. Depression edema This is an important manifestation of this disease, systemic, bilaterally symmetrical, first seen in the lower limbs, especially in the back of the foot, the long-term disease of the thigh, lumbosacral, external genitalia and even the back of the hand and arms are seen Depressed edema, severe cases can occur in the abdominal wall, face, eyelids and conjunctiva, etc., facial edema is edema and not sag, the lower extremity edema is significant, compared with the chest and back and upper limbs, forming a contrast, ascites and Pleural effusions are only occasionally seen in very severe cases.
Mild edema in infancy, often due to skin elasticity is very good, not easy to identify, must pay attention to the sudden increase in weight, increasing by several hundred grams a day, is a reliable indicator of edema.
3. Skin changes are common in critically ill patients. If skin changes occur, they are characteristic, dry skin, tarnishing, excessive keratinization, loss of elasticity, pigmentation, and sometimes small scattered skin erythema, which then merge into At the beginning of the film, a large erythema appears, gradually deepening the color, with scaly peeling, more common in the limbs and face, which is different from ecdysis, the latter is more common in the sun exposed part, the skin lesions can be extended to the whole body, easy to merge with An ulcer has occurred.
4. Hair nails change hair dry, crisp, tarnished, easy to break off and become sparse, curlers straighten, dark hair gradually becomes lighter, red or gray hair can appear after pigmentation, finger nails Slow growth, brittle and fragile.
5. Digestive dysfunction Absorption dysfunction, appetite is getting worse and worse, even completely refused to eat, poor tolerance to food, poor tolerance to fat and sugar, tolerance to protein, frequent diarrhea, vomiting, and heavier Malnutrition, low blood sugar, prone to hypoglycemia and shock.
6. Other systems change heart rate slowly, heart sound is low and blunt, blood pressure is low, ECG leads are low voltage, T wave is low or inverted, malignant malnutrition is harmful to early development of brain tissue, patient head circumference is smaller than Normal, mental retardation, cognitive, language, thinking, socialization are worse than their peers, early nutritional nutrition brain development can be quickly improved, missed the critical period of brain development, will leave the sequela of mental retardation.
Examine
Examination of dystrophic edema in children
1. Plasma protein reduction, especially plasma albumin reduction, has diagnostic value. When edema is severe, the total plasma protein content is below 45g/L (4.5g/dl), and plasma albumin is mostly below 20g/L (2g/dl). When the edema completely disappears, the total plasma protein is 55g/L (5.5g/dl), and the plasma albumin is mostly at 25g/L (2.5g/dl), which can be called the "critical level" of edema. The globulin changes very much, and the diagnosis by this test alone is of little significance.
2. Urine routine urine test is more normal.
3. Anemia when dystrophic edema, accompanied by nutritional anemia.
4. Anthropometric measurement of height, weight, upper arm circumference, upper arm circumference, head circumference, chest circumference, abdominal circumference; determination of the thickness of the skin fold of a specific part, in order to judge the growth and development of children, significantly lower than their peers.
5. Creatinine/Height Index Creatinine is a breakdown product of whole body muscles. Normally, the daily discharge is relatively constant. When protein storage decreases, muscle atrophy leads to a decrease in creatinine production. Therefore, the creatinine/height index decreases, and 24 hours of urine can be used for evaluation. The creatinine discharge is divided by the ideal creatinine discharge of the medium-sized body corresponding to the height, and the actual discharge is calculated as the percentage of the ideal discharge. The diagnostic criteria are: >90% normal; 80%-90% is mild nutritional deficiency; 60% ~80% is moderate nutritional deficiency; <60% is severe nutritional deficiency.
6. Radiological examination routines are not required, but X-ray examination is necessary if rickets, osteomalacia, infantile scurvy or protein thermal malnutrition are found.
7. ECG examination of beriberi, potassium deficiency, selenium deficiency (Keshan disease) involve the heart, ECG examination is helpful for diagnosis and treatment.
8. Dark adaptation check with vitamin A deficiency, prolonged adaptation time.
9. Nutritional Assessment Index (NAI) NAI can also predict mortality. When NAI 60, the prognosis is good, 40 complications and mortality are high, and 60 to 40 are moderate.
Calculation formula: NAI=2.64(AC) 0.6(PA) 3.76(RBP) 0.017(PPD)-53.8
Where AC is the arm circumference (cm), PA is the prealbumin (mg/L), RBP is the retinol binding protein (mg/L) and PPD is the purified protein derivative intradermal reaction circle (long diameter × short diameter) , cm2).
Diagnosis
Diagnosis and diagnosis of dystrophic edema in children
Diagnostic criteria
1. History: There is insufficient protein intake or consumption of food, etc. The minimum physiological safety requirement for infants and young children can be used as a reference for evaluation.
2. Clinical features: The main manifestations of edema and related clinical symptoms and signs, anthropometric results.
3. Characteristics of biochemical examination: The most characteristic of plasma protein reduction, the rest is similar to malnutrition wasting.
4. Therapeutic response: A high-protein diet can be diagnosed quickly and effectively.
Differential diagnosis
1. Cardiac edema is mainly the manifestation of right heart failure. The characteristic of edema is that it first appears in the sagging part of the body. Those who can get up are the first to appear on the inside of the sputum. After walking, they are obvious. After the break, they will alleviate or disappear. The lumbosacral region is obvious, the face is generally not swollen, and the edema is symmetrical and concave.
2. Nephrogenic edema can be seen in various types of nephritis and nephropathy. The edema is characterized by eyelids and facial edema in the early morning when the disease is up, and later develops into systemic edema.
3. Hepatic edema caused by decompensated cirrhosis, mainly manifested as ascites, but also the first edema of the ankle, gradually spread upward, and the head and face and upper limbs often edema.
Malnutrition edema is characterized by edema often caused by weight loss, weight loss, subcutaneous fat loss caused by tissue relaxation, decreased tissue pressure, increased retention of edema fluid, edema often spread from the foot to the whole body.
