CLINICAL NUTRITION

Lesson 4: Vitamin A deficiency

Cardiovascular and renal functions in PEM

• There is lowering of blood pressure, heart rate and cardiac output in PEM. A diminished venous return and postural hypotension along with tachycardia are observed.
  
  
• There is a decrease in renal glomerular filteration rate.
  
  
• Total body potassium decreases in PEM due to a reduction in muscle protein. Total intracellular sodium increases leading to overhydration. Changes in these electrolytes tend to increase the fatigueability of skeletal muscles and decrease their strength.
  
  
• Atrophy of cells with greater cell turnover rates occurs as seen in the intestinal mucosa where villi are flattened. Red bone marrow, testicular epithetical cells and skeletal muscles also get atrophied due to lack of proteins.
  
  
• Severe protein deficiency leads to a decreased production of gastric juice, pancreatic secretions and bile. Gastric enzymes are low and there is lowering in intestinal absorption of lipids and disaccharides. Irregular intestinal motility leads to diarrhoea.