Голодание и мышечная дистрофия у детей раннего возраста
Отеки при голодании следует дифференцировать с отеками почечного происхождения (главным образом при нефрозах) и при заболевании печени или сердечной недостаточности.
При нефрозах в моче имеется больше альбуминов и часто наблюдается асцит.
Дерматоз при голодании можно перепутать с пеллагрой, но при голодании изменения кожи не ограничиваются только открытыми участками тела.
При поздно начатом лечении прогрессирующей стадии голодания смертность очень высокая. Смерть может наступить в связи с развитием коматозного состояния (печеночной комы, кахексии, интеркуррентных инфекций). При тяжелой форме голодания без значительно проявляющихся отеков летальный исход может наступить вследствие дегидратации, сопровождающейся водно-электролитными нарушениями и, прежде всего, нарушениями обмена калия. Внезапная смерть может быть обусловлена гипокалиемией.
При своевременно начатом больничном лечении и санировании очагов инфекций можно ожидать благоприятного исхода заболевания.
До недавного времени считалось, что при тяжелых формах голодание заканчивается циррозом печени. Многочисленные тщательные и углубленные исследования последних лет путем пункционной биопсии доказали возможность лечения печеночного стеатоза (жировой инфильтрации) и вероятную этиологическую роль афлатоксина в возникновении цирроза печени, а также первичной карциномы печени у детей с белково-энергетической недостаточностью, наблюдающейся а тропических странах.
Молочная дистрофия развивается иногда при искусственном вскармливании грудных детей, которым продолжительное время дается только неразведенное коровье молоко без добавления углеводов. Вопреки достаточному калорийному содержанию получаемой пищи, при мышечной дистрофии ребенок не прибавляет в массе тела достаточно, у него появляются запоры с характерными серовато-белыми, сухими крошкообразными испражнениями, содержащими кальциевые мыла, которые не пачкают пеленки. Серовато-белый цвет испражнений определяется бактериально-химическими процессами, которые способствуют редуцированию билирубина в стеркобилин, и большими количествами кальциевых мыл.
Секреция желчных кислот по данным medicalplanet.su понижена при мышечной дистрофии. Кишечная флора состоит из анаэробных и гнилостных бактерий. В моче содержится повышенное количество аммиака, который вызывает покраснение кожи в паховой области и заднепроходного отверстия. Общее состояние ребенка ухудшается, он бледнеет, много потеет, становится раздражительным, сон его нарушается. При мышечной дистрофии по данным медицинского сайта medicalplanet.su развивается алиментарная железодефицитная анемия, лишь отчасти связанная с низким содержанием железа в молоке. Этому способствует высокое содержание фосфатов в молоке, которые нарушают резорбцию железа, а также и пониженная кислотность желудочного сока (в связи с буферными свойствами казеина молока), которая имеет значение для ионизации железа.
Так как общая устойчивость организма таких детей понижена, они болеют различными инфекционными заболеваниями и получают гнилостные диспепсии. Проявляется подчеркнутая склонность к развитию рахита и спазмофилии.
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