Malnutrition and diarrheal disease.

Malnutrition and diarrheal disease interact with each other in a vicious cycle. Diarrhea contributes to and aggravates malnutrition while malnutrition interferes with the hosts intestinal absorption and defense mechanisms. The evironmental factors responsible for malnutritioin also enhance diarrheal disease. The structural and functional changes in the gastrointestinal tract of the malnourished child result in impaired absorption of substances such as glucose lactose d-xylose and fat. Thus the malnourished child with diarrhea presents a serious problem to the physician. Sings of dehydration are more difficult to assess and impaired renal function requires cautious observation of intravenous fluid administration. Secondary infections and disseminated intravascular coagulation are frequent complications of diarrheal disease associated with malnutrition. All severly malnourished children with diarrhea should be hospitalized. Solid food withdrawal to control diarrhea should be minimized and early feeding of a rich calorie-protein formual with moderate fat content and low lactose content should be gradually introduced. This formula should be continued until the child can tolerate lactors (10-12 weeks) at which point milk feeding can be resumed. In cases with severe anorexia vomiting and malabsorption parenteral alimentation may be necessary.