Introduction to malnutrition: Malnutrition is a chronic nutritional deficiency caused by long-term insufficient protein and/or total calories. It is more common in infants and young children under 3 years old.

The main manifestations are progressive weight loss, weight loss or edema. In severe cases, internal organ dysfunction often affects the function of the heart, liver, kidneys and other organs.

Treatment in the emergency period

( ) Anti-infection The relationship between malnutrition and infection is inseparable. The most common ones are gastrointestinal respiratory and/or skin infections. Sepsis is also common and requires appropriate antibiotic treatment.

() Correct water and Electrolyte balance imbalance In the emergency treatment of malnutrition, the treatment of dehydration and electrolyte imbalance is particularly important, especially in children with diarrhea and malnutrition. The following points need to be noted:

① Pay attention to the entry of fluids To prevent heart failure

②Adjust and maintain the electrolyte balance in the body: Malnourished children are often severely deficient in potassium. When urine output is normal, potassium can be given ~mmol/(kg·d) to at least maintain Tian also has calcium, magnesium, zinc and phosphorus deficiencies. If not treated in time, it will worsen when given high-calorie, hypertonic parenteral nutrition solutions. Supplement magnesium ~ mmol/(kg·d), zinc ~ mmol/( kg · d), calcium should be given in regular amounts, and a small amount of sodium should be supplemented to avoid heart failure, about ~ mmol/(kg · d)

() Nutritional support After the fluid and electrolyte imbalance is corrected, malnourished patients Treatment depends on the degree of damage to the intestinal absorption function. If the intestinal absorption function is poor, central venous nutrition or peripheral intravenous nutrition can be used as needed. The former has a longer retention time and the concentration of the input nutrient solution is higher, while the latter cannot exceed d parenteral nutrition. The composition and amount of nutrient solution should be based on maintaining the fluid needs of children. Generally, ml/(kg·d) protein and g/(kg·d) fat are the main sources of heat energy and can provide % of the total heat energy when applied parenterally. During intravenous nutrition, serum glucose should be monitored every hour to prevent the occurrence of hyperglycemia and liver function should be followed up every week

. Treatment of complications

() Hypoglycemia, especially in weight loss Types are more common. Generally, glucose ml can be injected intravenously after blood collection at the hospital for treatment. In the future, %~% glucose solution can be used in rehydration.

() Hypothermia is associated with severe weight loss and low body temperature. The body temperature mortality rate is high, mainly due to insufficient heat energy. Pay attention to the ambient temperature (~℃), and use hot water bottles or other methods to keep warm (be careful of burns) and monitor the body temperature at the same time. If necessary, you can do it every minute.

() Anemia Severe anemia If Hb is less than g/L, blood transfusion can be used. The weight loss type is usually ~ ml/kg. The edema type generally does not require blood transfusion except for collapse or heart failure due to anemia. Mild to moderate anemia can be treated with iron, ~ mg/(kg·d). Lasts for months

. Recovery period treatment

() It is extremely important to provide sufficient heat energy and protein. When calculating heat energy and protein needs, the average weight (or P) of the corresponding age should be used Calculate, rather than the actual weight of the child, the calories and protein required per kilogram of body weight are shown in the table -, and then multiply by the ideal weight to get the daily intake

() Choose food that is suitable for the child’s digestive ability And foods that meet nutritional needs, try to choose foods with high protein and high energy, such as dairy products and animal proteins such as eggs, fish, meat, poultry, soy products, and fresh vegetables and fruits

Table - Energy and protein requirements< /p>

Age (months) kcal/kg protein g/kg

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*Excerpted from: Gellis CS and kagan BM: Current Pediatric Therapy .

（）Promote digestion and improve metabolic function

①Medical therapy is given Various digestive enzymes such as pepsin and pancreatic enzymes can be used to aid digestion. Appropriate application of anabolic steroids such as nandrolone phenylpropionate, intramuscular injection of ~mg each time, ~ times a week, for ~ weeks, can promote protein synthesis in the body and increase appetite. However, sufficient heat energy and protein should be supplied during the medication period

. Cause treatment

Treatment of primary diseases such as chronic digestive system diseases and consumptive diseases such as tuberculosis and heart, liver and kidney diseases should be provided to parents Promote scientific feeding knowledge, encourage breastfeeding, add complementary foods appropriately, and wean in time to change bad eating habits such as picky eaters and partial eclipses