Lecture Summary

Malnutrition remains common in low- and middle income countries and is a major driver of child mortality. Mortality risk increases as anthropometric measurements are lower without a threshold effect. This is because of an increased risk of developing common infections such as pneumonia, sepsis and severe diarrhoea, and a much increased risk of death once those conditions are present. In higher-income settings, malnutrition also increases mortality, ventilator and ICU days and the risk of new infections. Besides treating medical conditions, cautious initial refeeding is done. This switches the child from a starvation metabolism where energy is generated from amino acids and fatty acids and poor ATP synthesis to a metabolism in which most energy is from carbohydrates. This is accompanied by substrate, hormonal, electrolyte and fluid changes that can have important clinical consequences. Decreased absorption, a different volume of distribution, low albumin, and impaired hepatic and renal metabolism can all affect exposure to pharmaceuticals. Post-discharge mortality remains a risk after discharge.

Target Audience

Critical Care Doctors
Experienced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

• Define commonly defined forms of malnutrition and associated mortality
• Describe the physiological and metabolic changes in malnutrition and during recovery
• Appreciate the nutritional and pharmacological considerations in managing critically ill malnourished children

None.