1.Carbohydrate

• Patient develop hypoglycemia d/t

decrease glycogen storage in liver

and muscle.

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2.Fat

• Cholesterol content of body

decreases.

3.Protein

• Protein content of body also

decreases.

• (A)albumin-there is mainly fall in

albumin

• Patient develop edema if it is below

2.5g

• (B)globulin-normal

• (C)transferrin-markedly reduced in

severe P.E.M.

• (D)urinary urea excretion decreases

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(E)Blood urea :- decreases

(F)Serum Pre albumin :-

It is a sensitive indicator of protein

status in body.

At the beginning of nutritional

therapy it returns to normal.

(G)All essential amino acid:-

Decreases

Non essential amino acid level

normal or decreases .

RATIO of essential and non

essential amino acid increases.

(H)24hr urinary 3-methyl Histidine

excretion dercreased.

.

(i)Urinary Creatinine Height

Index (C.H.I):-

It is equal to 24hr Urine

Creatinine of affected child

divided by 24hr Urine

creatinine of normal child of

same height.

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P.E.M C.H.I

kwashiorkar 0.25-0.75

Marasmus 0.33-0.85

Recovered child ~1

Electrolyte level

• Water content of body

decreases

• Hyponatremia

• Hypokalemia

• Mg , Zn, Mn, ceruloplasmin

decreases

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Vitamins and

minerals deficiency

• Deficiency in Vit A, Vit K

• Deficiency in Zn ,Cu , Fe

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Endocrine

• Insulin- impaired serum insulin

level

• Glucagon- increased

• Cortisol – increased

• Growth hormone-increased

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