Diseases, Disorders information » Nutrition in Children

Copper deficiency

Disorders — Tue, 30 Jun 2009 18:01:31 +0000

The only one I didn’t include is copper. Copper deficiency, as you know, can be associated with a couple of things. One, it can be associated with a microcytic anemia. Just remember that copper and iron are very closely related to each other and that copper is necessary for the reduction of ferric to ferrous iron. So you will see a microcytic anemia in patients who are copper deficient. You will also see, in copper deficiency, that the patients tend to have leukopenia. That’s another blood manifestation of the condition, and the patients with copper deficiency will have changes in their hair as a manifestation of the condition.
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Now we’ll talk a little about kwashiorkor and marasmus, because that is something that is very typically asked on the Board. Not that I know it’s going to be on, but it’s been on enough times that I know that you probably should be able to separate the two. Kwashiorkor results from a severe deficiency of protein, and less than adequate caloric intake. So patients with kwashiorkor more often than not will tend to look a bit fat or plump, because they are retaining a lot of fluid because of their hypoproteinemia, and often they have gotten a diet that seems to be more than adequate in fat and carbohydrate. Clinical presentation; patients with kwashiorkor usually are lethargic, they are apathetic, they are irritable, they are anorectic, they have poor growth, they have loss of muscular tissue and they are usually immunodeficient because of their hypoproteinemia. Their lymphocyte count is usually depressed because that is very much linked with the fact that they don’t have sufficient proteins. Having a sufficient protein mass is really very important in terms of lymphocyte function. Edema may mask muscle loss, and this is why patients with kwashiorkor sometimes, unless you look very closely at them and you check them for edema, you may not recognize what you are dealing with. Kamagra Oral Jelly online. They have dry hair, they may have alopecia. Because they may have other nutritional deficiencies, again patients who tend to have inadequate protein in their diet tend to be patients who have inadequate trace metals in their diet. So there can be an overlap between this and zinc deficiency and selenium deficiency. You see it when you look at the skin manifestations because they have dermatitis and these patients often can have a combination of nutritional deficiencies at the same time. It’s unusual to have a pure protein deficiency as you might have in a pure kwashiorkor.
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Zinc deficiency. Selenium deficiency

Disorders — Mon, 29 Jun 2009 16:33:13 +0000

Now a little bit about the trace metals. Zinc deficiency; there is a congenital syndrome we’ll talk about in a minute. How do you get zinc deficiency? Well zinc deficiency is usually associated with diarrhea. Patients who have chronic diarrhea with mucosal malabsorption are very prone to get zinc deficient. Viagra super active make your penis rock-hard and adds to your pleasures. Patients with short bowel syndrome who are not managed effectively are prone to get it because they are likely to have diarrhea and malabsorption. The presentation of zinc deficiency; the first or earliest manifestations are usually loss of hair. Patients may just complain that their hair is beginning to fall out or thin. You don’t really see very much, but that’s just the complaint that the parent may have. Then if you don’t pick up on that then the next thing they start to get is usually a rash. And the rash that they usually get is usually around the mouth, the nose, the ears, around the anus and the perineum. It looks like seborrheic dermatitis when it first becomes manifest. Wound healing is not something typically that I’ve seen. These other things, impaired cellular immunity, if you test the patient you will find it. Anorexia is another manifestation. Patients who are zinc deficient will also have decreased appetite. Zinc deficiency has been recognized to be seen in patients with cystic fibrosis, but I do not think it is associated with the anorexia in that condition. And it will also affect growth failure. The congenital condition that people can be born with is called tacra-dermatitis enteropathica. It’s an autosomal recessive disorder in which there is a defect in zinc absorption. These patients will present, usually in the first six months of life, first with chronic diarrhea, then with hair loss and then will break out in this eruption as described here. Before it is bullous and pustular, it’s seborrheic-like. Female pink viagra. It’s usually yellow and crusting and then they start to get these bullae that break. And they occur in all the acral portions of the body and around the extremities. The other things that one sees with it is they have ophthalmologic problems and they cannot stand bright light, and will therefore have photophobia. They can get corneal opacities because of the fact that they have defects in the regeneration of their corneas. So the full-blown picture is hair loss, skin changes as described, diarrhea and the ophthalmologic findings. Interestingly, you can treat these patients if you give them large doses of zinc. You can treat it even orally in these patients. They have difficulty with absorbing the standard amounts of zinc that are found in formulas, but if you give them therapeutic amounts, enough is able to cross the mucosa to bring about the reversal of these changes.
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Selenium deficiency. Selenium is another important trace element. Again, when do we see selenium deficiency? It’s seen in patients with chronic diarrhea, because it, like zinc, is typically absorbed in the duodenum and jejunum. So if you have someone where the mucosa in those areas is substantially injured or you’ve had a major intestinal resection, they may have substantial losses of this trace element. The manifestations are; they can myositis, cardiomyopathy and macrocytic anemia. There is a disease that’s seen in China where they get the pure cardiomyopathy. There’s an area in mainland China where the soil lacks selenium and the infants and children that used to be born in that area would get a cardiomyopathy that would be fatal. Now, because they’ve recognized it, of course they supplement the diet in that particular area of the world. But again, you can see it manifested in patients with chronic diarrheal syndromes. Amoxicillin pharmacy – order cheap canadian medications. The other interesting thing is they get a macrocytic anemia. Their red blood cells become quite large in this condition. Sometimes they don’t become anemic, the red cells enlarge. The other thing that it is associated with is a change in the hair color. Patients with selenium deficiency often have a lightening of their skin color, a lightening of their hair color. We’ve seen one youngster with short bowel syndrome who went from being actually dark brown to very white, and her hair went from being very brunet to becoming yellow before we figured out what was wrong with her. So you should know what the manifestations are.

Vitamin E deficiency

Disorders — Mon, 22 Jun 2009 18:22:14 +0000

Vitamin E deficiency. The clinical presentation here is hemolytic anemia in the premature infants, loss of neural integrity, neurological changes. These patients usually get problems, if you follow them, they have decreased reflexes if they get vitamin E deficiency. They then may have problems with sensory changes and have problems with positional sense, have difficulty sometimes even with their balance. They can get muscle lesions and have weakening of their muscles. The characteristic is for them to get scleroid pigmented deposition in their muscle tissue.
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Now what about toxicity states? They are more likely to ask a question about vitamin A toxicity. What are the characteristics of it? Increased CSF pressure with pseudotumor, an enlarged liver – they usually get a fatty kind of liver with vitamin A toxicity, carotinemia is another characteristic of it, and the skin of patients with vitamin A toxicity tends to be very very thickened and they get what looks like fatty deposits in the skin. Other things that the patient may experience, vomiting is usually associated with the pseudotumor, alopecia is one of the skin manifestations that one sees as well as the dry and cracking skin. Some parents think that vitamin A is very important. How many units does it take to get it? If you take 25,000 units of vitamin A a day for probably six or more months and you absorb it normally, you are very likely to get vitamin A toxicity. You have to give large doses in order for it to occur. Fosamax online without prescription.

Vitamin D toxicity

These are the characteristics of it; hypercalcemia, anorexia, vomiting and poor growth. Again, that is a pretty unusual occurrence in the general population. Most parents don’t usually give that.
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Biotin deficiency

Disorders — Sat, 07 Mar 2009 21:15:55 +0000

Now, biotin deficiency is one of the rarer types. Again, there is the overlap between this and the other vitamin B2, B6 deficiencies. Just be aware that they share some similar features.
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What about toxicity states? Can you get vitamin poisoning? Would you be able to recognize vitamin poisoning if you saw it? There are only three water soluble vitamins which cause toxicity when given in excess; niacin, vitamin B6 and vitamin C. Know that. How would you know niacin toxicity? These are its characteristics. It became apparent, one of the ways that they treat some adults who have problems with cholesterol and they try to increase, those who are able, their HDL production is by giving those individuals large amounts of niacin. One of the characteristics that these people talk to you about is the skin flushing. They get very very red and they get tingling. It’s not a very pleasant experience, and sometimes they stop the niacin because the toxic effects are really too much for them to tolerate.
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Vitamin B6 toxicity. These are basically all neurological manifestations that are seen with it. Again, it would be an unusual phenomenon to see but it does occur. Probably vitamin C toxicity would be the commonest vitamin toxicity we might see, of the water soluble vitamins, in children because a lot of parents believe that vitamin C taken in high doses will prevent viral infections, will stimulate the immunity. Maybe it does, I don’t know, but there are considerable side effects from it; nausea, diarrhea, cramps, kidney stones. What kind of dosage will produce this? If you give vitamin C at a dosage that is greater than 10 times what the RDA’s are, this is when you start to see this phenomenon begin to become manifest.
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There are four fat soluble vitamins, A,D,E and K. What are the signs of deficiency? The characteristics that you see with vitamin A deficiency, clinical presentation, night blindness. And the other thing is xerophthalmia where they get problems like scaly-ness of the eyelids is one of the characteristics of it because it affects the skin and affects the cornea of the patient. So the cornea tends to become irregular. They also have a general problem with their skin as a result of it. Photophobia, conjunctivitis, so-called Bitot’s spots, keratomalacia, again because in vitamin A deficiency you have failure to regenerate the epithelium of the eye as well as the conjunctiva. They also get hyperkeratosis in the sun, on the skin. Poor growth, impaired resistance to infection. Vitamin D deficiency, the clinical presentation is most likely going to be rickets and it is very common – and I’ve seen this so repeatedly – that they will show you an x-ray and have you try to make a diagnosis of rickets. Here you see some of the classical features. You see splaying of the ends of the long bones in this patient. That’s the other thing that you see, this is before and this is after. This is the normal, this is the abnormal. And they will ask you, “What is this characteristic of?” and they will show you some vitamins, but they usually show this. Again, this is a patient who turned out to have vitamin C deficiency and one of the things that this patient has is very osteopenic bone. But they are probably not going to ask you that.

B12 deficiency

Disorders — Fri, 23 Jan 2009 18:43:45 +0000

B12 deficiency; extremely unusual unless you have someone who has a congenital defect in absorption of B12. There’s a syndrome called Imerslund syndrome which is a congenital failure to be able to absorb vitamin B12 in the terminal ileum because they lack the binding sites in the terminal ileum for the B12. They typically present at about one year of age with these characteristics, as well as they get posterior column diseases and mental changes because of the B12 deficiency. When else can you see it? If an infant has the ileum resected and the physician is not aware of it, or it has not been tested for, they can become B12 deficient. Remember, you are born with B12 stores for up to a year at birth. Obviously after later on in childhood if the ileum is resected, most people have 3-5 years worth of stores of vitamin B12 present in the body.
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Ascorbic acid deficiency, or scurvy. Again, these are the characteristics of it; poor wound healing, which is very similar to what you see in essential fatty acid deficiency. Be aware that bleeding problems, which also can be seen in essential fatty acid deficiency, are characteristic of it. Easy fracture of bones. Bleeding gingiva with loose teeth perhaps in the older child. So many of these conditions have overlaps between them and sometimes you are asked to show the similarities or the differences between them.
Niacin deficiency is probably the easiest; dermatitis, diarrhea and dementia. And the dermatitis is typically in areas where there has been exposure to the sun. So I used to have a picture of a child with pellagra and it’s disappeared, but it basically showed a youngster who had what looked like a necklace in the neck area and also on the wrist. This patient had sort of a reddish-magenta kind of eruption and that was due to niacin deficiency.
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Folate deficiency. These patients get a macrocytic anemia. They are very much like patients with B12 deficiency. So they get big red blood cells, but different than patients with B12 deficiency syndrome, they get leukopenic, poor growth and gliacitis. Again, they have overlap with patients who have vitamin B and B2 deficiency, and also pyridoxine deficiency. Diarrhea is another characteristic of folate deficiency. The folate is very important for the integrity of the intestinal mucosa. If you get folate deficient, patients are very likely to have leakage from their mucosa and failure to regenerate normal epithelium. The only formula that is deficient in folate normally is goats milk, but if you feed … most of the preparations that are available for children who are fed goats milk are folate-supplemented because we recognize that deficiency.

The content of linoleic acid is different in different milks

Disorders — Wed, 17 Dec 2008 16:28:34 +0000

Now the content of linoleic acid is different in different milks. Human milks contain 3-7% of the calories from linoleic acid. Common formulas contain 10%. Cows milk … see, this is human milk, this is one of the reasons why the cows milk formulas are supplemented. So if you just look at cows milk and fed that to a baby from the very beginning, you would get a baby that would be linoleic acid deficient. They would also be linolenic deficient. That’s why the formulas, which are based on cows milk, have taken and added linoleic acid but they outdo what even the humans, what the mothers produce. They’ve tried to make it a little bit better in this way and give 10% of the calories coming from linoleic acid. But human milk is 3-7%. Again, it’s the kind of thing you might be asked about.
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Recommendation of expert panel on blood cholesterol in children and adults. Greater than two-year-olds, no more than 30% of the total calories should come from fat. Saturated fat, less than 10% of the total calories should come from this. Intake of dietary cholesterol is not to exceed 300 mg per day. I mean, this is what the American Academy of Pediatrics, their panel of experts, says. So they are trying to … I don’t know how many children are following this but this is considered to be a relatively low fat diet. But really it’s quite a decent diet but it doesn’t allow for a lot of junk foods that contain fat.
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Let’s talk about the vitamins. Water soluble vitamins. These are the ones that are considered to be water soluble. So again it’s important to at least recognize them. The deficiency states with the water soluble vitamins; again, one of the typical things to recognize is that thiamin is associated with beriberi. And this is congestive heart failure, tachycardia, and peripheral edema. And the peripheral edema is believed to be associated with the congestive heart failure. So the main manifestation is by heart failure and its consequences. There is a so-called dry beriberi which also can be seen as a manifestation of B1 deficiency, which mainly has neurological manifestations associated with it and is more likely to be a complaint that one would see some of these things in the older children or adults. Again, it’s so uncommon. There are very few youngsters, at least in this country, who have ever experienced this state. But anything is possible. Riboflavin deficiency, clinical presentation; seborrheic dermatitis, hyalosis, photophobia. Be aware that some of these features can overlap with other nutritional deficiencies and you need to be able to separate them out or to show which conditions overlap, as you will see. Pyridoxine deficiency, again vitamin B6 deficiency. In newborns it can present as convulsions. In older children, skin manifestations as well as neurological manifestations, so there is overlap of some of these conditions and you need to be able to separate them out.

Nutrition in Children

Disorders — Mon, 08 Dec 2008 18:14:02 +0000

There are five basic food groups, vegetables, fruits, grains, dairy products and the protein groups. What is an RDA? It won’t be uncalled for to see a question where they define it and you have to pick out the answer. “Levels for intakes for the central nutrients that, on the basis of scientific knowledge, are judged by the Food and Nutrition Board to be adequate to meet the known nutrition needs of practically all healthy persons.” It’s pretty vague, isn’t it? What’s an essential nutrient? Cheap generic medications at online canadian pharmacy: generic viagra, cialis, kamagra etc. That’s something that’s got to be provided exogenously usually from your diet because our bodies cannot synthesize it at a sufficient rate to meet the needs of our body. There are some things that we can make but we can’t make enough of and we need to get them from our foods in order to avoid having a deficiency.

What are the eight major categories of nutrients? All of these are considered nutrients, so there are eight that our body needs that are really essential. You can’t have a normally functioning body without all of them. Be aware that when we are born we are mostly water. But when we are young adults we become more and more fat. And when we are elderly, you are 70% fat. Total body water is affected, of course, by our age, our sex, our body composition and the total body water decreases with age and changes in body fat. All pretty obvious. The consequences of providing adequate amounts of nutrients without adequate amounts of fluid, dehydration, excessive renal solid load and an inefficient use and waste of calories. What are our daily maintenance fluid requirements for infants and children? Again, it’s not uncommon to ask really simple things about how much water infants or children at different ages might require per day. Again, you should be able to figure that out. There often are questions like, 10 kg infants should be given so much fluid per day and they’ll list a number, various numbers, and you’ll have to figure out what the water requirements are. Seems sort of simple but surprisingly some people don’t know it. Reasons why infants are more susceptible to dehydration? Large body surface area, obviously because they have a higher body content of water and they require more. And again because the kidneys have limited capacity to handle a solid load, it takes more water to basically excrete the solid load. Again, why the infants are more likely get dehydrated? Well because they can’t tell us they are thirsty. I guess they can cry and that’s an indication to us that they are hungry or that they are thirsty, but until a youngster can really vocalize we don’t often know. But that’s not too common. We also want to show you that oxidation of food stuffs produces water as an end product. It’s interesting that from fat you get more grams of water than you start with, but with carbohydrates you get less and from protein.
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Breast milk or infant formulas provide the majority of fluid requirements. Human milk, 89% of it is water. Oxidation of ingested milk results in approximately 90% of volume available as free water so you often have pediatricians and family wanting to give their children additional water. Well, if there’s a question about their nutrition, if they are certainly borderline, you either let them take more breast milk or more formula because again most of it is water anyway and when the nutrients get metabolized it forms even more water. Energy is provided by food, it is chemical energy obtained after digestion. I don’t know if you remember this, but the unit of measuring energy is joule or the calorie in what a joule is equal to, and the difference between a kilo calorie and the little calorie. It’s the amount of heat energy to raise 1 kg of water 1 degree centigrade. That’s a kilo calorie.