| Affected organ or system | Effects | Treatment |
| Cardiovascular system | - Cardiac output and stroke volume are reduced
- Infusion of saline may cause an increase in venous pressure
- Any increase in blood volume can easily produce acute heart failure; any decrease will further compromise tissue perfusion
- Blood pressure is low
- Renal perfusion and circulation time are reduced
- Plasma volume is usually normal and red cell volume is reduced
| - If the child appears dehydrated, give ReSoMal or F-75 diet; do not give fluids intravenously unless the child is in shock
- If there is evidence of congestive heart failure, restrict blood transfusion to 10 mL/kg and give a diuretic*
|
| Liver | - Synthesis of all proteins is reduced
- Abnormal metabolites of amino acids are produced
- Capacity of liver to take up, metabolize, and excrete toxins is severely reduced
- Energy production from substrates such as galactose and fructose is much slower than normal
- Gluconeogenesis is reduced, which increases the risk of hypoglycemia during infection
- Bile secretion is reduced
| - Do not give the child large meals
- Ensure that the amount of protein given does not exceed the metabolic capacity of the liver but is sufficient to support synthesis of proteins (1 to 2 g/kg per day)
- Reduce the dosage of drugs that depend on hepatic disposal or are hepatotoxic
- Ensure that sufficient carbohydrate is given to avoid the need for gluconeogenesis
- Do not give iron supplements, which may be dangerous because transferrin levels are reduced
|
| Genitourinary system | - Glomerular filtration is reduced
- Capacity of kidney to excrete excess acid or a water load is greatly reduced
- Urinary phosphate output is low
- Sodium excretion is reduced
- Urinary tract infection is common
| - Prevent further tissue breakdown by treating any infections and providing adequate energy (80 to 100 kcal/kg or 336 to 420 kJ/kg per day)
- Do not give the child more protein than is required to maintain tissues
- Ensure that high-quality proteins are given, with balanced amino acids
- Avoid nutrients that give an acid load, such as magnesium chloride
- Restrict dietary sodium
- Ensure that water intake is sufficient but not excessive
|
| Gastrointestinal system | - Production of gastric acid is reduced
- Intestinal motility is reduced
- Pancreas is atrophied and production of digestive enzymes is reduced
- Small intestinal mucosa is atrophied; activities of digestive enzymes are reduced
- Absorption of nutrients is reduced when large amounts of food are eaten
| - Give the child small, frequent feeds
- If absorption is poor, increase the frequency and reduce the size of each feed
- If there is malabsorption of fat, treatment with pancreatic enzymes may be useful
|
| Immune system | - All aspects of immunity are diminished
- Lymph glands, tonsils, and the thymus are atrophied
- Cell-mediated (T cell) immunity is severely depressed
- IgA levels in secretions are reduced
- Complement components are low
- Phagocytes do not kill ingested bacteria efficiently
- Tissue damage does not result in inflammation or migration of white cells to the affected area
- Acute phase immune response is diminished
- Typical signs of infection, such as an increased white cell count and fever, are frequently absent
- Hypoglycemia and hypothermia are both signs of severe infection and are usually associated with septic shock
| - Treat all children with broad-spectrum antimicrobials
- Because of the risk of transmission of infection, ensure that newly admitted children are kept apart from children who are recovering from infection
|
| Endocrine system | - Insulin levels are reduced, and the child has impaired glucose tolerance
- IGF-1 levels are reduced, although growth hormone levels are increased
- Cortisol levels are usually increased
| - Give the child small, frequent feeds
- Do not give steroids
|
| Circulatory system | - Basic metabolic rate is reduced by approximately 30%
- Energy expenditure due to activity is very low
| - Keep the child warm to prevent hypothermia; dry the child quickly and properly after washing and cover with clothes and blankets; ensure that windows are kept closed at night and keep the temperature of the living environment at 25 to 30ºC
|
- Both heat generation and heat loss are impaired; the child becomes hypothermic in a cold environment and hyperthermic in a hot environment
| - If a child has fever, cool the child by sponging with tepid (not cold) water (never alcohol rubs)
|
| Cellular function | - Sodium pump activity is reduced and cell membranes are more permeable than normal, which leads to an increase in intracellular sodium and a decrease in intracellular potassium and magnesium
- Protein synthesis is reduced
| - Give large doses of potassium and magnesium to all children
- Restrict sodium intake
|
| Skin, muscles, and glands | - The skin and subcutaneous fat are atrophied, which leads to loose folds of skin
- Many signs of dehydration are unreliable; eyes may be sunken because of loss of subcutaneous fat in the orbit
- Many glands, including the sweat, tear, and salivary glands, are atrophied; the child has dryness of the mouth and eyes and sweat production is reduced
- Respiratory muscles are easily fatigued; the child is lacking in energy
| - Rehydrate the child with ReSoMal, ORS, or F-75 diet
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