The particularities of metabolism in children. Clinical semiotics

Содержание

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Plan of lecture: Basal metabolism Fluid and electrolyte balance Protein metabolism,

Plan of lecture:

Basal metabolism
Fluid and electrolyte balance
Protein metabolism, protein-energy

malnutrition
Carbohydrate metabolism.
Fat metabolism.
Vitamins.
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This set of processes of transformation of matter and energy that

This set of processes of transformation of matter and energy that

occur in living organisms, and the exchange of matter and energy between the organism and the environment.
In children, unlike adults, much of the energy consumed for the growth and plastic processes, which are especially large infants and children in the first three years of life.

Metabolism and energy

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For the child's body is characterized by: High tension power and

For the child's body is characterized by:

High tension power and oxidation

processes.
Intensive basic metabolism in all age groups.
Significant energy consumption for processes of assimilation and growth.
Imperfection of the regulation of metabolism, which determines its instability and the development of lung violations.
Uniqueness of each of the main types of exchange - protein, carbohydrate and fat.
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Basal metabolism in children The primary metabolism in children varies depending

Basal metabolism in children

The primary metabolism in children varies depending

on the child's age and the type of food.
In the infant and in the first years of life there is the maximum intensity of metabolism and energy, and then there is a slight decline in basal metabolism.
Compared with the first days of life, to eighteen months metabolism increases by more than half.
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Water-salt metabolism in children Features water-salt metabolism in children. Role in

Water-salt metabolism in children

Features water-salt metabolism in children.
Role in maintaining

homeostasis of electrolytes.
Causes of dehydration in infants.
Forms of the dehydration.
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Water in the body of the child is: Neonates - 75%

Water in the body of the child is:

Neonates - 75% of

total body weight
With age, it gradually decreases and is completed in the period of growth of 65%
In the body of water is distributed among several sectors of liquid.
In the cells (intercellular space) is 60% of the total
Extracellular water in the intercellular space and plasma, as well as part of the so-called transcellular fluid (in the spinal canal, the camera eye, gastrointestinal tract, exocrine glands, renal tubules and urinary ducts).
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Water balance Water enters a child's body with food and drink,

Water balance

Water enters a child's body with food and drink, as

well as formed by oxidation of fats.
Displayed through the water:
- Kidneys – 49%
- Evaporation of sweat, feces, urine – 49%
- Through breathing – 2%
       Regulation of water and ion exchange is carried out complex neuroendocrine responses aimed at maintaining a constant volume and osmotic pressure of the extracellular sector, primarily blood plasma.
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Homeostasis - A set of physical and chemical constants characterizing the

Homeostasis

- A set of physical and chemical constants characterizing

the internal environment of the body and especially the constancy of exchange and qualitative composition of body fluids.
An important indicator of homeostasis in children, is the concentration of hydrogen ions in blood and extracellular fluids.
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Depot body fluid In humans, there are three fluid depot: 1)

Depot body fluid

In humans, there are three fluid depot:
1) bloodstream

to the volume of circulating blood
2) intercellular space with a certain amount of intercellular or interstitial, liquid
Note: The blood plasma and interstitial fluid together form a so-called extracellular depot, or extracellular, the liquid.
3) intracellular liquid.
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Plasma electrolytes Sodium cations - 137 to 145 mmol / L

Plasma electrolytes

Sodium cations - 137 to 145 mmol / L and

varies little with the age of the child. Sodium determines the magnitude of the osmotic pressure of blood plasma.
Chlorine anions - 92-107 mmol / L as determined by the osmotic pressure of the extracellular fluid.
Calcium - 5 mmol / L plasma .
Sodium bicarbonate - blood pH 7.35-7.45.
Electrolytes cytoplasm
Potassium - 120-140 mmol / L potassium in the cells.
Phosphate ions.
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Semiotics water and electrolyte metabolism All violations of water exchange can

Semiotics water and electrolyte metabolism

All violations of water exchange can

be grouped into two forms:
hyperhydration characterized by excess fluid in the body content;
dehydration - is to reduce the total volume of liquid.
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Children are vulnerable to loss of fluid (water) in connection with:

Children are vulnerable to loss of fluid (water) in connection with:

Significant

loss of water in children with breathing and possible evaporation from the skin surface.
Especially easy to create water shortages in the body of the child in the stomach and intestine diseases (acute gastroenteritis).
Under normal conditions, a large number of children fluid released into the gastrointestinal tract from digestive juices (saliva, gastric, pancreatic and intestinal secretions).
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The main causes of the syndrome of dehydration are: Incoming water

The main causes of the syndrome of dehydration are:

Incoming water deficit

(inability to eat and drink, defects in the care and treatment)
pathological loss (vomiting, diarrhea, excessive sweating with fever, the evaporation of water at rapid breathing, rapid diuresis in diabetes, bleeding).
a combination of reasons.
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If vomiting occurs a significant loss of water from the gastric

If vomiting occurs a significant loss of water from the gastric

juice and the contents of the upper small intestine. Together with vomiting are also lost sodium, potassium and chloride ions is particularly significant (hydrochloric acid).
When diarrhea occurs hypotonic fluid loss due to increased secretion of digestive juice with a significant loss of water and ions, potassium, sodium, magnesium, bicarbonate.

Causes of dehydration

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Dehydration - Sunken fontanel large skull - Sunken "hollow eyes“ -

Dehydration - Sunken fontanel large skull - Sunken "hollow eyes“ - Dry tongue -

Loss of skin turgor and weight loss - Child listless, inactive
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Proteins This is one of the basic and vital products in

Proteins

This is one of the basic and vital products in

the body of the child. For normal growth it needs a protein which can not be replaced either fats or carbohydrates.
The biological value protein is determined by amino acid composition and their ability to hydrolysis by the enzymes of the digestive tract.
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Essential amino acids for children: Methionine Threonine Tryptophan Phenylalanine Valine Arginine Histidine Isoleucine Leucine Lysine

Essential amino acids for children:

Methionine
Threonine
Tryptophan
Phenylalanine
Valine

Arginine
Histidine
Isoleucine
Leucine
Lysine

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Proteins are synthesized from amino acids that enter the body with

Proteins are synthesized from amino acids that enter the body with

food.
In the body breaks down protein synthesis, amino acids are not essential if ingested in the diet.
In the absence of essential amino acids in the diet, they can be synthesized from the essential.
For example, the lack of lysine in the diet leads to stunted growth, depletion of the muscular system, the lack of valine - balance disorders in children.
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On the number of entering the body and destroyed it proteins

On the number of entering the body and destroyed it proteins

judged by the value of nitrogen balance, ie the ratio of the nitrogen that enters the body through food and output from the body through urine, sweat and other bodily secretions.
       The younger the body, the higher the positive balance and the ability to detain food nitrogen.

1 year - 4.8 g
1-3 years - 4-4.5 g
6-10 years - 2.5-3 g
12 or more - 2.5 g
adults - 1.5-1.8 g

The daily requirement of protein per 1 kg of body weight of the child:

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40% of the demand for amino acids should be borne by

40% of the demand for amino acids should be borne by

the essential amino acids. Of particular importance for the child's body has a ratio of certain amino acids. During the period of the most favorable ratio is:
tryptophan : lysine (methionine + cysteine) = 1: 3: 3
Children need more than adults, the protein of animal origin.
As insufficient and excessive protein intake in the diet of children adversely affects their growth and psychomotor development.
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Protein-energy malnutrition Clinical outcomes in children with chronic malnutrition typically include

Protein-energy malnutrition

Clinical outcomes in children with chronic malnutrition typically include short

stature, poor weight gain or weight deficit and subcutaneous fat.
And also: reduced physical activity,
mental apathy,
 psychomotor delay and mental development
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Kwashiorkor Severe malnutrition

Kwashiorkor

Severe malnutrition

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Nutritional marasmus Marasmus – in Greek - depletion, extinction. It is

Nutritional marasmus

Marasmus – in Greek - depletion, extinction. It is a

form of protein-energy malnutrition, usually in children under 1 year of age.
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Phenylketonuria - disrupted synthesis of phenylalanine to tyrosine

Phenylketonuria - disrupted synthesis of phenylalanine to tyrosine

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Gomotsistinemiya - homocysteine ​​is an intermediate degradation product of methionine and

Gomotsistinemiya - homocysteine ​​is an intermediate degradation product of methionine and

are not normally found in plasma and urine
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- congenital disorder caused by deficiency of enzymes that break down

- congenital disorder caused by deficiency of enzymes that break

down the gluten protein cereal to amino acids.

Celiac Disease

The disease manifests itself more with the introduction of semolina porridge and oatmeal. The child says:
copious frothy stools, anorexia, vomiting, symptoms of dehydration, a false picture of ascites. Develop severe dystrophy.

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Celiac Disease

Celiac Disease

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Carbohydrates - the main source of energy. Carbohydrates enter the body

Carbohydrates - the main source of energy.
Carbohydrates enter the body

in the form of complex polysaccharides - starch, disaccharides and monosaccharides.
Plastic material, carbohydrates are included in the ground substance of connective tissue in the form of mucopolysaccharides forming cell membrane.

Carbohydrate metabolism

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Carbohydrate metabolism In children, there is a physiological tendency to ketosis,

Carbohydrate metabolism

In children, there is a physiological tendency to ketosis, in

the occurrence of which may play a role minor glycogen. The water content in the tissues and the child is higher in infants 3/4 weight and decreases with age.
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Carbohydrate metabolism By the time of puberty, the energy consumption for

Carbohydrate metabolism

By the time of puberty, the energy consumption for basal

metabolism is reduced by 300 kcal / cubic meter. While boys energy costs on a major exchange in terms of one kilogram higher than in girls. With increasing energy costs increased muscle activity.
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Carbohydrate in the body in a free state and in connection

Carbohydrate in the body in a free state and in connection

with proteins, fats as glycoproteins, glycosaminoglycans (mucopolysaccharides).
A significant role is played in the biosynthesis of carbohydrates nucleic acids, formation of blood group specificity, immunological and other processes

Carbohydrate metabolism

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Insufficient amount of carbohydrates in the diet leads to impaired child

Insufficient amount of carbohydrates in the diet leads to impaired child

digestibility of individual food ingredients worsen digestive processes.
If excessive use of carbohydrates occurs increased formation of fat that is deposited in the subcutaneous tissue. With increased amounts of carbohydrates lowers your resistance to infectious agents child, there is a possibility of developing diabetes.

Disturbed carbohydrate intake with food:

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Disaccharidase deficiency in children lactose intolerance (lactase deficiency) Clinical symptoms: -

Disaccharidase deficiency in children

lactose intolerance (lactase deficiency)

Clinical symptoms:
- flatulence
-

watery stools with sour smell
- development of malnutrition
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Galactosemia disrupted conversion of galactose to glucose

Galactosemia disrupted conversion of galactose to glucose

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Fats - complex organic compounds differ from each other in structure

Fats - complex organic compounds differ from each other in structure

and functional significance.
The body provides a simple fat - triglycerides or neutral fats, and their derivatives, fatty acids, sterols (cholesterol), steroids, vitamins E, D, K
Complex lipids - phospholipids, cerebrosides, sphingomyelin. Functions of fats:
Energy
Construction
Support
Protective

Lipids

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1) In childhood, fat synthesis is most intense. 2) Fat formed

1) In childhood, fat synthesis is most intense.
2) Fat formed

from carbohydrates, edible fats inferior quality, since it does not contain essential fatty acids - linoleic, linolenic and arachidonic.
3) In terms of lack carbohydrate fat splitting is accompanied by formation of excessive amounts of ketone bodies as well as the complete combustion of fat is only possible in the presence of carbohydrates.

Lipogenesis and lipolysis in children

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Fatty acid Polyunsaturated fatty acids. Value vegetable fats due to their

Fatty acid

Polyunsaturated fatty acids. Value vegetable fats due to their content

of phosphatides ( lecithin ) , have a profound influence on the activity of the liver , the nervous tissue. Lecithin also rich buckwheat , peas, eggs, dairy products . Source PUFA vegetable oils - sunflower, corn , cottonseed .
Saturated fatty acids. This animal fats entering the body of butter, eggs, meat and dairy products . Their results in excess accumulation of excess weight, but is essential for absorption of fat soluble vitamins.
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Lack of fat in the diet of the child adversely affects

Lack of fat in the diet of the child adversely affects

its growth and development, leading to a decrease in the body's defenses, the development of disorders of the skin and mucous membranes.
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Impairs digestion processes due to oppression activity of digestive glands, decreased

Impairs digestion processes due to oppression activity of digestive glands, decreased

body resistance,
interfere with the absorption of protein.

Excess fat

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- This is a large group of inherited or acquired disorders

- This is a large group of inherited or acquired disorders

of lipid metabolism in the pathogenesis of which is the accumulation of (inherited pathology caused by enzymatic disturbances in lipid metabolism).

Lipidoses

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Niemann-Pick disease sphingomyelin storage disease Skin grayish-yellow color, hepatosplenomegaly, child lags

Niemann-Pick disease sphingomyelin storage disease

Skin grayish-yellow color,
hepatosplenomegaly,
child lags behind in

mental development

The symptom of "cherry-red“
in the ocular fundus

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Gaucher disease characterized by excessive deposition of abnormal cerebrosides Neurological symptoms: Strabismus, Spastic paralysis, Ataxia, Convulsions

Gaucher disease characterized by excessive deposition of abnormal cerebrosides

Neurological symptoms:
Strabismus,
Spastic paralysis,


Ataxia,
Convulsions
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Vitamins - biologically active organic compounds of various chemical nature. Have

Vitamins - biologically active organic compounds of various chemical nature.
Have

a significant effect on the reactivity and the metabolic processes of the child's growing body in small amounts (milligrams).
Child's need for most vitamins increased the tensions metabolism.

Vitamins

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Functions of vitamins Contribute to the normal course of metabolic processes.

Functions of vitamins

Contribute to the normal course of metabolic processes.
Are

part of many enzymes and coenzymes body.
Bookmark affect organs and systems, child growth and development, the activities of the blood, the nervous system, immune status, and more.
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Vitamins classification according to their functions in the body: Involved in

Vitamins classification according to their functions in the body:

Involved in energy

and carbohydrate metabolism. This group is represented by B vitamins, pantothenic, folic acid, vitamin PP, biotin.
Possess antioxidant activity, counteract the damaging effects of free radicals. This vitamin C (ascorbic acid), vitamin E,
carotenoids (vitamin A).
Precursors of hormones.
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Vitamins based on solubility are divided into groups: 1) Fat-soluble -

Vitamins based on solubility are divided into groups:

1) Fat-soluble - A,

D, E and K.
2) Water soluble - C, P, B, etc.
3) Vitamin-compound - bioflavonoids, choline, inositol, lipoic acid, and others.
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Water soluble vitamins Vitamin B1 Vitamin B2 Vitamin PP Vitamin B6 Pantothenic Biotin (vitamin H) Inositol

Water soluble vitamins

Vitamin B1
Vitamin B2
Vitamin PP
Vitamin B6
Pantothenic


Biotin (vitamin H)
Inositol
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Water soluble vitamins Para-aminobenzoic acid (bacterial growth factor and factor pigmentation)

Water soluble vitamins

Para-aminobenzoic acid (bacterial growth factor and factor pigmentation)
Folic

acid (vitamin antianemic vitamin growth for chickens and bacteria)
Vitamin B12 (vitamin antianemic)
Vitamin B15 (pangamic acid)
Vitamin C (antiskorbut)
Vitamin P (vitamin permeability)
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Fat-soluble vitamins Vitamin A Vitamin D Vitamin E Vitamin K

Fat-soluble vitamins

Vitamin A
Vitamin D
Vitamin E
Vitamin K

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Scurvy - vitamin C deficiency Generalized weakness Bleeding gums, Distortion of

Scurvy - vitamin C deficiency

Generalized weakness
Bleeding gums,
Distortion of the

structure of cartilage and bone.
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Beri-beri – a deficiency of vitamin B 1 Reduced physical and

Beri-beri – a deficiency of vitamin B 1

Reduced physical and mental

stability of the child,
muscle weakness,
reduced intestinal motility - constipation,
polyneuritis.
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Pellagra - a deficiency of vitamin B, nicotinic acid Dermatitis on

Pellagra - a deficiency of vitamin B, nicotinic acid

Dermatitis on exposed

skin (face, neck, back of hands)
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Rickets - vitamin D deficiency

Rickets - vitamin D deficiency

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Hemorrhagic syndrome - a deficiency of vitamin K

Hemorrhagic syndrome - a deficiency of vitamin K

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Hemorrhagic syndrome - a deficiency of vitamin K

Hemorrhagic syndrome - a deficiency of vitamin K

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Minerals Macronutrients (which is really a lot) Trace elements in it

Minerals

Macronutrients (which is really a lot)
Trace elements in it which

only 0,04 - 0, 06%.
Content and those and other man has continuously replenished.
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Macronutrients Micronutrients Calcium -- Ca Phosphorus – P Magnesium --- Mg

Macronutrients Micronutrients

Calcium -- Ca
Phosphorus – P
Magnesium --- Mg
Potassium ---

K
Sodium --- Na
Chlorine --- Cl
Sulphur --- S
Need: 2 - 3 grams per day

- Iron – Fe
- Copper - Cu
- Manganese - Mn
- Zinc - Zn
- Cobalt - Co
- Iodine - I
- Fluoro - F
- Chrome - Cr
- Molybdenum - Mo
Requirement per day: several milligrams

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- Rapid growth and development high physical activity child active communication

- Rapid growth and development
high physical activity
child active communication

with the outside world
In childhood, formed food stereotype laid typological features of adult metabolism.

Children's bodies are different from adults:

- Предыдущая
Материалы используемые для фасада
Следующая -
Понятие о лечебно-охранительном режиме

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