Malnutrition Pregnancy

Co-trimoxazole should not be given to patients with malnutrition, pregnancy, severe liver damage, megaloblastic anemia, agranulocytosis, or bone marrow failure (12,14,87). 

In historical terms, folates are among the most recently identified of the vitamins. Wills was the first to describe a form of anaemia associated with pregnancy and malnutrition which could be cured by yeast or liver extract (Wills, 1933 Wills et al, 1937). The active constituent of these dietary... 

Hyperemesis gravidarum A rare disorder of severe and persistent nausea and vomiting during pregnancy that can result in dehydration, malnutrition, weight loss, and hospitalization. 

AED pharmacokinetic data are summarized in Table 52-3. For populations known to have altered plasma protein binding, free rather than total serum concentrations should be measured if the AED is highly protein bound. Conditions altering AED protein binding include chronic renal failure, liver disease, hypoalbuminemia, burns, pregnancy, malnutrition, displac-... 

Risk factors for deficiency Pregnancy (neural tube defects in fetus may result) Alcoholism Severe malnutrition Risk fiictors for deficiency Pernicious anemia Gastric resection Chronic pancreatitis Severe malnutrition Vegan Infection with D. latum... 

There are many excellent texts on nutrition. This chapter, therefore, focuses not on nutrition per se but on how biochemistry helps us understand well established and less well established aspects of nutrition and how such knowledge fits in with other subjects discussed in this text. There is now considerable medical and lay interest in what is meant by healthy and unhealthy diets. Nutrition has become a major issue in the medical sciences and in clinical practice. It is also of concern to politicians, particularly in the link between nutrition and Western diseases such as cardiovascular disease, obesity, cancer and neurological problems. In this chapter an attempt is made to provide a biochemical basis for discussion of nutrition and development of these conditions. To this end, biochemical explanations for nutritional advice and the recommendations from national bodies are provided. Similarly, explanations for the recommendations designed for different populations, different conditions and activities (physical and mental activity, the elderly, the young, during pregnancy and space flight) are discussed. Finally, the biochemistry of malnutrition, undemutrition and ovemutrition is discussed. 

In severe malnutrition where circulating protein concentrations are very low, in uraemia and in pregnancy, the distribution of the drug (e.g., anticonvulsants) between bound and free forms may alter, and when monitoring treatment it may be necessary to get the laboratory to measure free concentrations of the drug. However this can only be done in specialised centres, even in developed countries, and is not usually available elsewhere. 

L In most instances, dental plaque can cause erythema and gingival bleeding, but the gingival response can also be exacerbated by a variety of systemic conditions, including diabetes mellitus, leukemia, malnutrition, puberty and pregnancy. 

An examination by the dentist should eliminate many of the potential systemic issues that can affect the periodontium of this patient. For example, the age of the patient, her appearance, and questions about her diet should be enough to rule in or out issues concerning puberty and malnutrition. However, if systemic conditions cannot be ruled out, an additional physical examination by a physician may be necessary. Additional tests to be requested could include oral glucose tolerance test for diabetes mellitus, human chorionic gonadotropin levels for pregnancy, and/or qualitative and quantitative evaluation of bone marrow cells and blood cells for leukemia. 

Hypoglycemia can also be induced by concomitant diseases, for example renal disease, hepatic disease (cirrhosis), hypopituitarism, hypoadrenocorticalism, hypoglucagonism, hypothyroidism, malnutrition, anorexia nervosa, pregnancy, termination of pregnancy, recovery from infections, operations, or stress. 

Differential diagnosis Palmar erythema is also found in pregnancy, in hyperthyroidism, collagen diseases, endocarditis, long-standing feverish conditions, tuberculosis, diabetes mellitus, malignant tumours, chronic polyarthritis and in cases of malnutrition — as well as in healthy people. 

Variable factors are coexisting diseases (diabetes, liver or renal disease, endocrinopathies), overweight, malnutrition (e.g. lack of protein), alcohol, additional medication, tobacco smoke particles, heavy metals and pregnancy as well as drug-related overdose, longterm intake or application form, etc. (s. tab. 3.18)... 

Like oral iron, parenteral iron is used too widely. When iron is truly needed, oral administration is generally preferable (9). Intractable gastrointestinal intolerance to oral formulations, hyperemesis in pregnancy, very severe blood loss, and possibly ulcerative colitis are some of the few valid indications for parenteral iron. A low ironbinding capacity (for example due to prior saturating iron therapy or malnutrition), folic acid deficiency, and an allergic constitution predispose the patient to adverse reactions to parenteral iron. Iron injections have been reported to provoke hemolytic anemia in cases of paroxysmal nocturnal hemoglobinuria. 

Bipolar disorder has a lifetime prevalence of approximately 1%. During pregnancy, untreated bipolar disorder may result in hospitalization, suicidal ideation, violence, loss of employment, malnutrition, and an increased risk of postpartum psychosis. It does not appear that pregnancy provides protection for the risk of recurrence of symptoms. Women who discontinue the use of mood stabilizing drugs abruptly before conception or who have had four or more episodes of recurrence of symptoms have a substantial risk for recurrence during pregnancy. Risk for recurrence in the first 3 to 6 months postpartum has been estimated at 20% up to 80%. Postpartum psychosis may occur in 10% to 20% of women with bipolar disorder. 

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