A child with marasmus having diarrhea and no appetite. what will be preferred food that give energy to the br… - PGIMER NO - 2020

PGIMER NO - 2020

Pediatric Nursing

Medium

Appeared in: PGIMER NO - 2020

Explanation

Glucose is the primary and most readily metabolized source of energy for the brain.
In severe acute malnutrition (SAM), such as marasmus, preventing and treating hypoglycemia is the first priority.
Children with marasmus have depleted glycogen stores, making them unable to maintain blood glucose levels without an external source.
Administering glucose (e.g., as a 10% solution orally or IV) is a critical first step in the WHO's 10-step management plan for SAM.

Option A: Ketone bodies are an alternative, not primary, fuel for the brain. They are produced during prolonged starvation from fat breakdown. In an acute setting, providing direct glucose is faster and more effective.
Option C: Fatty foods cannot be directly used by the brain for energy. Furthermore, a malnourished child with diarrhea has a compromised digestive system and will not tolerate fatty foods well; it could worsen the diarrhea.
Option D: This is not a medical or therapeutic food. It is a processed snack high in salt and unhealthy fats, with no nutritional benefit for a critically ill child. It is an entirely inappropriate option.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Nutritional management in severe acute malnutrition (marasmus) and brain metabolism as background academic context rather than a clinical decision trigger.
A core nursing responsibility in managing a child with SAM is the frequent monitoring of blood glucose levels. Any reading below 54 mg/dL (3 mmol/L) is a medical emergency requiring immediate glucose administration.
Hypoglycemia, hypothermia, and infection often occur together in a deadly triad in malnourished children. Nurses must assess for all three simultaneously.
What if the child was unconscious? If the child is symptomatic (lethargic, unconscious, or having seizures), the correct action is to give intravenous (IV) 10% dextrose, as oral administration would be unsafe and too slow.

How to Approach the Question

First, identify the patient's condition: a child with marasmus, a form of severe acute malnutrition (SAM).
Next, identify the critical problem: the child is sick (diarrhea, no appetite) and needs energy specifically for the brain.
Recall the basic physiology of brain metabolism. The brain's primary and preferred fuel is glucose.
Evaluate the options based on this physiological principle. Glucose is a direct energy source.
Consider the other options: Ketone bodies are a secondary/adaptive fuel. Fatty foods are not a direct brain fuel and are poorly tolerated. 'Cold chips' is a non-medical, nonsensical option.
Conclude that providing glucose is the most direct, rapid, and appropriate intervention to fuel the brain and prevent life-threatening hypoglycemia in this clinical scenario.

Concept Tested & Keywords

Concept Tested: Nutritional management in severe acute malnutrition (marasmus) and brain metabolism.
Stem keywords: marasmus, diarrhea, no appetite, energy to the brain
Lead-in keywords: preferred food
Clinical cues: The child's diagnosis of marasmus indicates severe protein-energy malnutrition, making them highly susceptible to hypoglycemia.
Clinical cues: The presence of diarrhea and no appetite complicates oral feeding and points to a fragile metabolic state.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 90-92

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 94-96