PEDIATRIC MALNUTRITION INDICATORS


MICRONUTRIENT EXAM: CLINICAL INTERPRETATION OF NUTRITION FOCUSED PHYSICAL EXAM FINDINGS SIGNS/SYMPTOMS


SKIN (continued)


Pellagra thick, dry, scaly pigmented skin on sun exposed areas; Casal necklace; photosensitive; hyperpigmentation over bony prominences


Bilateral edema Poor skin turgor


Carotenemia yellow to orange pigmentation


Flushing Deficiency: Niacin and/or Tryptophan


Additional information: Can be compounded by vitamin B6 deficiency


Risk of deficiency: Malnutrition • Homelessness • Anorexia nervosa • Carcinoid syndrome • HIV • Malabsorption • Chronic alcoholism • Medications • Hartnup disease


Deficiency: Thiamin • Vitamin C • Riboflavin Other: Malnutrition^


Other: Dehydration Other: Excessive beta carotene Toxicity: Niacin


Possible non–nutrition-related causes: Edema related to medical conditions (eg, congestive heart failure, kidney or liver disease)


Additional information: Decreased skin turgor may be normal finding in elderly


Possible non–nutrition-related causes: Diabetes mellitus • Anorexia nervosa • Hypothyroidism • Liver and kidney conditions


Possible non–nutrition-related causes: Medullary thyroid cancer • High fever • Rosacea • Medications • Neuroendocrine tumors • Renal cell carcinoma • Carcinoid syndrome • Cushing syndrome


Psoriasis Atopic dermatitis (eczema)


Jaundice yellowing of skin, sclera


N/A N/A N/A


Additional information: Vitamin D deficiency can worsen condition


Additional information: Zinc deficiency may worsen condition


Possible non–nutrition-related causes: Hepatitis • Alcoholic liver disease • Bile duct obstruction • Medication reaction


39 POSSIBLE NUTRITION-RELATED CAUSES ADDITIONAL INFORMATION


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