eMedicine Specialties > Dermatology > Metabolic Diseases

Protein-Energy Malnutrition: Treatment & Medication

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Coauthor(s): Anusuya Mokashi, MS, MD, Radiology Resident, Staten Island University Hospital; Andrew Lin, MD, FRCPC, Associate Professor, Department of Internal Medicine, Division of Dermatology, University of Alberta
Contributor Information and Disclosures

Updated: Jan 8, 2010

Treatment

Medical Care

In both children and adults, the first step in the treatment of protein-energy malnutrition (PEM) is to correct fluid and electrolyte abnormalities and to treat any infections. The most common electrolyte abnormalities are hypokalemia, hypocalcemia, hypophosphatemia, and hypomagnesemia. Macronutrient repletion should be commenced within 48 hours under the supervision of nutrition specialists.

A 1980 double-blind study of 8 children with kwashiorkor and skin ulceration found that topical zinc paste was more effective than placebo in healing areas of skin breakdown. Oral zinc supplements were also found to be effective.

The second step in the treatment of protein-energy malnutrition (which may be delayed 24-48 h in children) is to supply macronutrients by dietary therapy. Milk-based formulas are the treatment of choice. At the beginning of dietary treatment, patients should be fed ad libitum. After 1 week, intake rates should approach 175 kcal/kg and 4 g/kg of protein for children and 60 kcal/kg and 2 g/kg of protein for adults. A daily multivitamin should also be added.

For most of the cutaneous manifestations of inflammatory bowel disease, the primary therapy remains treatment of the bowel.

Chung et al,11 in discussing that protein-energy malnutrition is highly prevalent among peritoneal dialysis patients, noted that although nutritional status assessments are better now than they were a decade ago, no definitive single test is available to assess nutritional status. Instead, they propose that several different markers of nutrition must be used to understand nutritional status. Thus, the treatment for peritoneal dialysis patients with malnutrition must be multifaceted, and they suggest using nontraditional strategies such as appetite stimulants, anti-inflammatory diets, and anti-inflammatory pharmacologic agents combined with more traditional forms of nutritional support to abate the protein-energy malnutrition.

The clinical guideline summary, Dietary guidelines for Americans, 2005, from the US Department of Health and Human Services and US Department of Agriculture, may be helpful.12

Consultations

  • Any patient at risk for nutritional deficiency should be referred to a registered dietitian or other nutritional professional for a complete nutritional assessment and dietary counseling.
  • Other subspecialty referrals should be considered if findings from the initial evaluation indicate that the underlying cause is not poor nutritional intake. If signs indicate malabsorption, a gastroenterologist should be consulted. Further, in pediatric cases, a pediatrician, preferably one with experience in the management of protein-energy malnutrition (PEM), should oversee care of the patient. Any patient with significant laboratory abnormalities, as discussed above, may benefit from consultation with the appropriate subspecialty (eg, endocrinology, hematology).
  • Children with poor nutrition secondary to inadequate intake and/or neglect should be referred to the appropriate social agencies to assist the family in obtaining resources and providing ongoing care for the child.

Diet

See Medical Care.

More on Protein-Energy Malnutrition

Overview: Protein-Energy Malnutrition
Differential Diagnoses & Workup: Protein-Energy Malnutrition
Treatment & Medication: Protein-Energy Malnutrition
Follow-up: Protein-Energy Malnutrition
References
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References

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Further Reading

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Keywords

protein-energy malnutrition, PEM, kwashiorkor, malignant malnutrition and infantile pellagra, marasmus

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Anusuya Mokashi, MS, MD, Radiology Resident, Staten Island University Hospital
Disclosure: Nothing to disclose.

Andrew Lin, MD, FRCPC, Associate Professor, Department of Internal Medicine, Division of Dermatology, University of Alberta
Andrew Lin, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Michelle Pelle, MD, Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California at San Diego
Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn State Milton S Hershey Medical Center
Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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