The method of treatment of malnutrition

 

(57) Abstract:

The invention relates to medicine, namely to therapy, and can be used in the treatment of malnutrition. Diet therapy is carried out in 3 stages, in combination with physical therapy and drug therapy. The duration of phase 1 of 12 - 15 days, 2 stage 15 - 20 days, 3 phase 20 - 60 days. Calculation of food spend per kg should body mass. Energy value and caloric increase from stage to stage. Physiotherapy at stage 1 includes the total UFO, monitor purification and oxygenation to the gut. During the stage 2 hyperbaric oxygenation and oxygen baths. 3 stage - UFOs autologous blood. Drug therapy in all three stages includes a multienzyme preparations, solutions of electrolytes and 10 - 20% albumin. At stage 3 in addition enter retabolil at the rate of 1 injection per week, only 3 injections. The method allows to normalize metabolic processes in the body. This increases the effectiveness of treatment and reduce mortality. table 1.

The invention relates to medicine, in particular to the treatment of such diseases as malnutrition.

In modern conditions are becoming more frequent cases of extreme exhaustion l is okislennyh stressful situations, related to national conflicts, the revival of many prejudices, such as longer awkwardly held the posts not only adults but also children and adolescents. Plays a role the desire to get rid of excess weight, and also clear the body of toxins, which led to the spread of such "trendy" areas as "separation of power", an unbalanced chemical composition of vegetarianism, self without medical supervision starvation. All this often leads to the loss of body weight, up to the development of malnutrition.

Malnutrition is a disease that develops due to prolonged full or partial starvation that can occur when inadequate physiological needs of the flow of nutrients into the body. It is characterized by General exhaustion, progressive disorders of all kinds of organs and tissues, in violation of their duties. In severe cases, these effects can become irreversible.

For many years after world war II, taking into account the welfare of the population, almost until very recently, the issues of malnutrition adults was not given proper attention. Only in the work of L. is ACA students (Ed. Leningrad Institute of postgraduate medical education, Department of Pediatrics N2, L., 1987, S. 37). Was considered this problem. However, this work was only for infants (up to 1 year of life) age, which fundamentally limits the application of the recommendations of this report.

The closest to patent the way to destination, and the aggregate of the characteristics used, is a method of treatment described in the book: "the Experience of Soviet medicine in the great Patriotic war of 1941-45,," I. VIII "the violation of the General power" /Under the editorship of Gelstein M Medgiz 1951, S. 127-133. This method adopted by us for the prototype.

The essence of this method of treatment consists of measures including diet therapy, traditional food, enriched with hematogenous, eritromitinom, Baker's yeast and casein, and drug therapy are presented in vitamins a, b, C and PP.

- The essential disadvantages of this method are:

- slow recovery of body weight, physical and mental health;

- frequent complications such as dysentery, pneumonia, tuberculosis.

These deficiencies have reduced the effectiveness of treatment and often privateline short time clinical manifestations of malnutrition by a quick recovery of the body weight, metabolic processes, physical and mental health, minimize the mortality from this disease, prevention of complications.

This objective is achieved in that in the method of treatment of malnutrition, which includes diet therapy is based on the products of high nutritional value and medicinal therapy using vitamin preparations, the treatment process is carried out in three stages duration: 1st stage 12-15 days; 2nd stage 15 - 20 days and the 3rd stage 20-60 days, diet therapy at each stage is performed on the basis of the balance of nutrients and energy value per kg should body weight; increasing their number from stage to stage according to the scheme: proteins and fats 1.6-2.0 g/kg; 2.0 to 2.5 g/kg; 2.5-3.0 g/kg and carbohydrates - 4,5-6,5 g/kg; 6,5-8,0 g/kg; 8.0 to 8.5 g/kg, and the energy value of each phase should be 38,8 with 52.0 kcal/kg; with 52.0 64.5 kcal/kg and 64.5-73,0 kcal/kg, respectively, drug therapy at all three stages of treatment provided in addition to vitamins, the appointment of a multienzyme preparations, solutions of electrolyte and 10-20% solution of albumin, and on the 3rd stage injection retabolil one per week but not more than three, and, in addition, carry out physiotherapy proceduresis oxygenation and oxygen baths and on the 3rd stage ultraviolet autologous blood.

As can be seen from the above entity patentable method for the treatment of malnutrition, nutritional therapy, as an integral part of this method, presents a balanced chemical composition and energy value of diets with the inclusion of easily digestible foods of high biological value of animal and vegetable origin (entity, isolated soy protein, enriched with mineral and vitamin complex). Calculation of dietary intake should be per kilogram should body mass index, calculated by the known formula Brock:

Body weight (in kg) = height in cm - 100

The desired balance is achieved by the introduction of gradually increasing quantities of nutrients, with a corresponding energy value (see table)

Drug therapy along with the use of vitamin preparations: oil solution of vitamin a capsules of AEVIT and intravenous drip of water-soluble vitamins by 5% glucose solution, provides for the appointment at all stages of the multienzyme preparations based 1-2 drops in each meal, solutions of electrolyte and 10-20% solution of albumin, depending on the severity of dysproteinemia with hypoalbuminemia, and increase of body weight not less than 3.5-4.5 kg prescribe anabolic steroids (retabolil 1,0 - im) once in 7 days, but no more than three injections.

Of course, at the discretion of the attending physician may use intravenous drip complex drugs: cocarboxylase, ascorbic acid and Panangin on saline or glucose and other types of conventional symptomatic treatment.

At the same time apply physiotherapy, which is the 1st stage includes General ultraviolet light, oxygen and monitor the bowel clean. The last procedure is the intestinal monitor dialysis, reaching intestinal lavage using the device to monitor bowel cleansing (AIOC-1), first proposed for the treatment of other categories of patients in 1995 in the manual "Pathological detoxification and metabolic adjustments, St. Petersburg maps., 1995, 20 S. - authors M. C. A., N. Belyakov.A., Miroshnichenko, A., and others

Procedure carry out the introduction of the 4-channel probe into the anal hole to rectosigmoidal channel section of the large intestine with subsequent excretion of bacterial toxins and hydrodynamical massage the walls of the intestines, vozdeistviy channel probe impose a decoction of chamomile or lignosol at a rate of 5 g/kg of body weight of the patient. The procedure lasts 30-35 minutes and is administered daily in the morning. At the 2nd stage of the conduct of hyperbaric oxygenation and appoint oxygen baths, and on the 3rd stage - ultraviolet autologous blood.

The above combination of diet, medication and physical therapy makes the proposed method a new and very positive feature is the rapid restoration of physical and mental health on the background normalization of body weight. This sverhsummarny effect contributes practically to the exclusion of deaths and rapid rehabilitation.

Patent-pending method for the treatment of malnutrition allows the physician on the basis of continuous monitoring of the patient's condition and correction phases of the complex of activities, including the calculation of the chemical composition of proteins, fats, carbohydrates and energy value of diets, vitamin therapy and medication symptomatic therapy and physiotherapy, to achieve the main goal: to stop the development of dystrophic phenomena, to restore body weight and the normal course of metabolic processes in the body, to restore rabota the aja E., 54 years was admitted to the hospital with a deficit of body weight more than 50% (when the height is 158 cm weight 24 kg). Diagnosis at admission - malnutrition 3 severity. The patient complained of severe weakness, almost not allowing to move, lack of appetite and an independent chair, discomfort in the stomach, resulting in food and persisting after eating about an hour, bleeding gums when brushing your teeth. For the first time began to follow a diet two years ago, when body weight was 56 kg Diet was observed due to occasional dyspeptic disorders, first from the diet excluding meat, then milk and dairy products, bakery products, gradually reducing and the number of meals and amount eaten portions. So for 2 years loss of body weight was 30 kg Last month the daily diet of the patient consisted of 3 berries, dried apricots and 4 berries, prunes, nastennych in a glass of boiling water, after which the patient has lost 4 kg

At objective examination, attention pronounced manifestations multivitamin deficiency - eating at the corners of the mouth, peeling skin with hyperkeratosis on the elbows with subcutaneous hemorrhages around materialno pressure 60/25 mm RT. Art. On electrocardiogram signs of cardiomyopathy. Despite repeated conversations with the patient, she flatly refused to include in the diet foods of high biological value and traditional products, despite the observance of the principles of mechanical and chemical sparing preparation, continued to cause the patient discomfort in the stomach that is not contributed to the expansion of food. From physiotherapy patient also refused. The patient was only symptomatic therapy. After 5 days from the moment of admission to the hospital has come to be lethal. On the section of the deaths were from cardiovascular disease, developed on the background of severe malnutrition.

The method is tested.

Example 2. Patient B., age 17, was admitted to the hospital with a deficit of body weight more than 50% (when the height is 168 cm weight 30 kg). The diagnosis of malnutrition.

At admission the patient complained of severe weakness, amenorrhea in the last year, the practical absence of an independent chair, heaviness in the abdomen and discomfort after each meal, edema of the lower extremities. Its a disease of the light is) and the transition to a vegetarian lifestyle, the reason for which the patient is not explained. On physical examination, multiple manifestations polyvitamine failure: brittle hair and nails, hair loss, dry flaky skin, "eating" in the corners of the mouth, bleeding gums, bright red lips and shiny crimson language, manifestation Pellegrini changes on the limbs in the form of "red gloves and socks", oedema of the lower extremities. Clinical and biochemical tests for admission: decreased hemoglobin and erythrocytes, as well as reducing the overall level of protein due to the albumen fractions and increased globulin fractions. Fluoroscopy of the stomach with screening 1,5; 2; 8; 12 and 24 hours showed a sharp decline of motor-evacuation function of the gastrointestinal tract.

Starting from the 1st day of treatment, the patient began to receive a balanced diet of 1-th stage with the inclusion of products of high biological value, with the amount of protein in the diet was 1.8 g, fat 1.8 g and carbohydrate 4.7g / kg recommended body weight. Of physiotherapeutic procedures, in addition to the overall UV exposure, the patient received monitor the colon cleansing and oxygenation of the gut. Vitamin therapy included a reception mass trevenna drip. Medical therapy included receiving panziera to 1 tablet 6 times a day during meals and intravenous drip 3 times a week 10% solution of albumin in 100 ml. Duration of the 1st stage was 12 days. The rehabilitation unit patient was 30 days. Thus, treatment of 3-phase amounted to 31 days. The patient was discharged in satisfactory condition with increase of body weight of 25 kg from the beginning of treatment. After 4 months of starting treatment, the body weight of the patient was 58 kg After 8 months, the patient recovered monthly on the background of reduced body mass. On the 2nd stage of the diet of the patient included: protein 2.2 g, fat 2.2 g, carbohydrates 6,7, physical therapy includes hyperbaric oxygenation and oxygen baths. Of fat-soluble vitamins the patient received AEVIT 1 capsule 3 times a day, water-soluble vitamins were introduced on 5% glucose solution parenteral drip. Medication the patient continued receiving panziera. The duration of the 2nd stage was 18 days. On the 3rd stage, the patient received: 2.7 g protein, 2.7 g fat and 8.2 g of carbohydrates per kilogram of body weight. Physiotherapy treatment was presented by ultraviolet irradiation of autologous blood. B. the rehabilitation Department.

Example 3. Patient 44 years old, was admitted to the hospital unconscious with a deficit of body weight more than 50% (a growth of 170 sm, weight 29 kg). Diagnosis at admission malnutrition III severity. After the necessary resuscitation the patient regained consciousness. The patient complained of severe weakness, chilliness, drowsiness, absence of menstrual periods for 2.5 years, lack of appetite and an independent chair, edema of the lower extremities. From the anamnesis of the disease found that the last 3 years the patient themselves "medical" starvation for the treatment of headache and 2 years loss of body weight was 25 kg Last 40-day fasting, which the patient read in a popular magazine, observed with the purpose of "cleaning" of the organism, resulted in the loss of 11 kg of body weight, then the patient's condition deteriorated and unconscious, she was taken to the hospital.

At objective inspection pay attention to the signs of polyvitamins: pellagrini manifestations in the form of a red "gloves and socks", flaky skin, brittle nails, hair loss, teeth prints on the side surfaces of the language is systematic analyses of changes have been identified. In biochemical analyses were decreased level of potassium and glucose in the serum. When conducting fibrogastroduodenoscopy and rektoromanoskopii the patient revealed the diffusion of atrophic changes in the oral mucosa of the esophagus, stomach and duodenum, as well as mucous direct and primary Department of the sigmoid colon.

Diet therapy 1-th stage, in addition to traditional foods include protein inpit and soy milk (products of high biological value), the amount of protein in the diet was 1.9 g, fat - 1.9 grams, carbohydrates 4.8 g, which accounted for 43 kcal per kilogram of body weight. Physiotherapy was presented to monitor colon cleansing and oxygenation of the gut conducted on the background of overall UV exposure. The patient received fat-soluble vitamins and water-soluble, administered intravenously. The duration of the 1st stage was 13 days. On the 2nd stage, the amount of protein, fat, carbohydrates in the diet were, respectively, 2 g, 2 g, 6.5 g (52 kcal) per kilogram of body weight. Physiotherapy treatment was presented hyperbaric oxygenation and oxygen baths. The patient received festal 1 bean 5-6 times a day during meals, and RA was 16 days. On the 3rd stage of the dietary treatment was represented by a combination of traditional foods and products of high biological value protein, fat and carbohydrate respectively 2.5 g, 2.5 g and 8 g, which was 64 kcal per kilogram of body weight. Physiotherapy treatment was presented by ultraviolet irradiation of autologous blood. 30 day from the beginning of treatment the patient was discharged and continued outpatient treatment. The duration of the 3rd stage was 45 days. For a specified period of time, the patient fully recovered mental and physical performance, body weight has reached the reference value, the patient started to work. After 8 months recovered monthly.

Example 4. Patient C., 50 years old, was admitted to the gastroenterology Department in the state of moderate severity with a diagnosis of a Disease of the operated stomach (a year ago underwent resection of the stomach Billroth II regarding gastrointestinal bleeding), afferent loop syndrome. Complications: malnutrition II severity. Complaints at admission: sudden weakness, loss of body weight 19 kg in the last 6 months, heaviness and discomfort in the epigastric region, more to the right, associated with food intake, Gore is the absence of an independent chair (chair only with enemas). The underweight and above gastrointestinal manifestations the patient associates with limiting myself to eat because of fear of occurrence of the above clinical picture.

At objective inspection draws attention to the lack of subcutaneous fat, some atrophy of skeletal muscles and signs of polyvitamins: dry skin, "geographic" tongue with teeth prints on the side.

In clinical, biochemical indicators of the patient revealed a decrease in the total protein 60 g/l at the expense of albumen fractions, which amounted to 41% and a slight decrease in hemoglobin and red blood cells. Otherwise, without features. Given the shortage of body weight, the basis of treatment was physiologically adequate nutrition fractional portions up to 6-8 times a day, with the inclusion of products of high biological value, with a gradual increase of the chemical composition and bringing it to 1 kg of body weight for protein to 2.0 g, fat 2.0 g, carbohydrate 5.0 g with a total energy value of 46 kcal.

Of physiotherapy patient with 1-day received a total ultraviolet radiation and monitor the bowel clean, oxygenation kiseon the ins on 5% glucose solution. For normalization of protein synthesis 10% albumin, 2 times a week for 100 ml digestion patient were assigned multienzyme preparations. The duration of the 1st stage was 12 days. Diet therapy of the 2nd stage was represented 2.4 g protein, 2.4 g fat, 7.9 g of carbohydrates per kilogram should weight the total energy value of 61 kcal per kilogram of body weight. Physiotherapy in this period was presented hyperbaric oxygenation and oxygen baths. To improve intestinal biocenosis patient received chelators and lactic acid drink soy-based. The duration of the 2nd stage was 15 days. Diet therapy 3 phase contained the different food products with the inclusion of products of high biological value, protein content, fat, carbohydrates, respectively, 2.1 g, 2.1 g, 6,9 g per kilogram of body weight with a total energy value of 53 kcal per kilogram of body weight. To improve microcirculation and restore the immune status of the patient was obtained by ultraviolet irradiation of autologous blood (5 sessions). On the 32nd day from the beginning of treatment the patient was discharged to outpatient treatment. The duration of the 3rd stage was 25 days. After 6 months of starting treatment, the pain is After 8 months the patient returned to his workplace.

The method of treatment of malnutrition, including diet therapy and vitamin therapy, characterized in that diet therapy is carried out in 3 stages, in combination with physical therapy and medication therapy, duration of stage 1 - 12-15 days, 2 stages - 15-20 days, 3 stages - 20-60 days; calculation of food spend per kg should body mass, where stage 1 is injected 1.6 - 2.0 g/kg protein and fat, and 4.5 - 6.5 g/kg of carbohydrates energy value 38,8 with 52.0 kcal; in phase 2 2.0 - 2.5 g/kg protein and fat, 6,5 - 8,0 g/kg of carbohydrates energy value is 52.0 64.5 kcal; 3 phase 2.5 - 3.0 g/kg protein and fat, 8,0 - 8,5 g/kg of carbohydrates energy value of 64.5 - 73,0 kcal; physiotherapy patients carried out during the stage 1 total UFOs, monitor purification and oxygenation to the gut, on the stage 2 of hyperbaric oxygenation and oxygen baths, 3 phase - UFOs autologous blood; during all three stages of the prescribed medication in the form of a multienzyme preparations, solutions of electrolytes and 10 - 20% solution of albumin, and 3 stage further added retabolil at the rate of 1 injection per week, not more than 3 injections.

 

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