Oedema malnutrition

Diet The diet should be evenly balanced and in accordance with the principles of present-day dietetics it must also be tolerated by the patient. There is no special diet for viral hepatitis patients. The water and electrolyte balance is often disrupted in cases of acute viral hepatitis, possibly with the occurrence of oedemas and ascites (so-called hepatitis oedematosa) (48, 77, 131) (s. p. 297) or impaired renal function (60, 120) - as is recognizable from the diuresis which normally develops at the onset of the convalescence phase. An even balance of water and electrolytes should be maintained - this is very much supported by the patient lying flat. In the event of inadequate nutrition or malnutrition, particularly when nausea and vomiting occur, substitution measures are advisable (e.g. vitamins, glucose and electrolyte infusions). 

If oedema is present, the malnutrition is termed kwashiorkor or marasmus-kwashiorkor if very severe. 

Credance was given to this formula from 6 whole body chemical analyses performed on adult cadavers where the mean water content of LBM was 72.5% (67.4-77.5%) [271]. That the use of this formula, even for subjects of normal body composition, may be an over-simplification leading to significant errors has been stressed [272]. Certainly it is inapplicable to individuals exhibiting oedema, malnutrition, obesity or during pregnancy. The study of obesity with respect to body composition, has prompted the development of a new model for calculating adipose tissue and adipose-free masses [261]. The model still requires the measurement of total body water and its application to 4 normal and 5 obese individuals has been presented [273]. 

Protein-energy malnutrition in children can therefore be classified by both the deficit in weight compared with what would be expected for age and also the presence or absence of oedema, as shown in Table 8.2. The most severely affected group, and therefore the priority group for intervention, are those suffering from marasmic kwashiorkor - they are both severely undernourished and also oedematous. 

Kwashiorkor A disease of protein—energy malnutrition in which there is oedema masking the severe muscle wastage, fatty infiltration of the liver and abnormalities of hair structure and hair and skin pigmentation. 

Five million children worldwide die every year from malnutrition. In the UK it is usually precipitated by severe illness, but in developing countries it is more likely to be caused by poor diet. Kwashiorkor is most common in rural Africa and is due to deficiency of both protein and foods providing calories (PEM). It is characterized by painless pitting oedema, skin lesions, muscle wasting and GI infections. The excess fluid retention (oedema) can often mask loss of body tissue. 

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