ICD-10 Version:2010

Maintenance of homeostasis

Malnutrition: Quantifying the health impact at national and local levels
COPD typically has two components which may be present to varying degrees: Checklists for collecting and analysing data are also suggested, and a step-by-step example of how to quantify the health impact associated with malnutrition is given for Nepal, a country in the WHO SEAR D subregion. Candies and chewing gums containing zinc have also been used. Formosulfathiazole is another excellent coccidiostatic drug at rates of 0. However, zinc does not seem to improve attention span.

Side Effects & Safety

Malnutrition in India

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These responses are initiated through negative feedback regulatory mechanisms similar to those described above. Not only is the concentration of each individual electrolyte maintained through homeostasis , but the total concentration of all of the electrolytes per unit of fluid osmolality is maintained as well. If this were not the case, an increase in extracellular osmolality an increase in the concentrations of electrolytes outside of cells would result in the movement of intracellular fluid across the cell membrane into the extracellular fluid.

Because the kidneys would excrete much of the fluid from the expanded extracellular volume, dehydration would occur. Conversely, decreased serum osmolality a decrease in the concentrations of electrolytes outside of cells would lead to a buildup of fluid within the cells.

Another homeostatic mechanism involves the maintenance of plasma volume. If the total volume of fluid within the circulation increases overhydration , the pressure against the walls of the blood vessels and the heart increases, stimulating sensitive areas in heart and vessel walls to release hormones. These hormones, called natriuretic hormones, increase the excretion of water and electrolytes by the kidney , thus reducing the plasma volume to normal.

Hormonal systems also provide for the homeostasis of nutrients and fuels that are needed for body metabolism. For example, the blood glucose concentration is closely regulated by several hormones to ensure that glucose is available when needed and stored when in abundance.

After food is ingested, increased blood glucose concentrations stimulate the secretion of insulin. Insulin then stimulates the uptake of glucose by muscle tissue and adipose tissue and inhibits the production of glucose by the liver.

In contrast, during fasting, blood glucose concentrations and insulin secretion decrease, thereby increasing glucose production by the liver and decreasing glucose uptake by muscle tissue and adipose tissue and preventing greater reductions in blood glucose concentrations. Despite the many mechanisms designed to maintain a constant internal environment , the organism itself is subject to change: These changes are accompanied by many changes in the composition of body fluids and tissues.

For example, the serum phosphate concentration in healthy children ranges from about 4 to 7 mg per ml 1. These and other more striking changes are part of a second major function of the endocrine system—namely, the control of growth and development. The mammalian fetus develops in the uterus of the mother in a system known as the fetoplacental unit. In this system the fetus is under the powerful influence of hormones from its own endocrine glands and hormones produced by the mother and the placenta.

Maternal endocrine glands assure that a proper mixture of nutrients is transferred by way of the placenta to the growing fetus. Sexual differentiation of the fetus into a male or a female is also controlled by delicately timed hormonal changes. Following birth and a period of steady growth in infancy and childhood, the changes associated with puberty and adolescence take place. This dramatic transformation of an adolescent into a physically mature adult is also initiated and controlled by the endocrine system.

In addition, the process of aging and senescence in adults is associated with endocrine-related changes. Throughout life the endocrine system and the hormones it secretes enhance the ability of the body to respond to stressful internal and external stimuli. The endocrine system allows not only the individual organism but also the species to survive. Acutely threatened animals and humans respond to stress with multiple physical changes, including endocrine changes, that prepare them to react or retreat.

Endocrine changes associated with this response include increased secretion of cortisol by the adrenal cortex, increased secretion of glucagon by the islet cells of the pancreas , and increased secretion of epinephrine and norepinephrine by the adrenal medulla. Adaptive responses to more prolonged stresses also occur. The prevention and treatment of hospital malnutrition offers a tremendous opportunity to optimize the overall quality of patient care, improve clinical outcomes, and reduce costs.

Unfortunately, malnutrition continues to go unrecognized and untreated in many hospitalized patients. This article represents a call to action from the interdisciplinary Alliance to Advance Patient Nutrition to highlight the critical role of nutrition intervention in clinical care and to suggest practical ways to promptly diagnose and treat malnourished patients and those at risk for malnutrition. We underscore the importance of an interdisciplinary approach to addressing malnutrition both in the hospital and in the acute post-hospital phase.

It is well recognized that malnutrition is associated with adverse clinical outcomes. Although data vary across studies, available evidence shows that early nutrition intervention can reduce complication rates, length of hospital stay, readmission rates, mortality, and cost of care.

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