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"code": "E46",
"name": "Белково-энергетическая недостаточность неуточненная",
"icd_name": "Белково-энергетическая недостаточность неуточненная",
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"lead": "Состояние питания, при котором дисбаланс энергии, белков и других питательных веществ ведет к измеримым нежелательным эффектам на ткани, функции и клинические исходы.",
"description": "При недостаточном поступлении белков и энергии уменьшаются безжировая масса тела и количество жировой ткани, причем одно из этих изменений может быть более выраженным.",
"etiology": "<p>Белково-энергетическая недостаточность может быть первичной или вторичной. Первичная белково-энергетическая недостаточность обусловлена неадекватным поступлением питательных веществ, а вторичная белково-энергетическая недостаточность является следствием различных расстройств или приема лекарственных препаратов, которые препятствуют использованию питательных веществ.</p>",
"pathogenesis": "",
"diagnostics": "",
"treatment": "<p>При легкой и умеренной белково-энергетической недостаточности следует устранить возможные причины этого состояния. Суточный приход белков и энергии увеличивают (в соответствии с идеальным весом) для ликвидации их дефицита. Всем больным назначают поливитамины. Проводят также лечение и профилактику дефицита минеральных веществ (в том числе микроэлементов) для предупреждения угрожающих жизни гипокалиемии, гипомагниемии, гипофосфатемии и т. д. Если больной способен принимать пищу и глотать, достаточно самостоятельного питания. При снижении аппетита или в отсутствие зубов дополнительно назначают жидкие питательные смеси для самостоятельного или зондового питания.</p>\r\n<full></full>\r\n<p>При тяжелой белково-энергетической недостаточности требуется более срочное вмешательство. Лечение таких больных затруднено по нескольким причинам:</p>\r\n<ul>\r\n<li>Заболевания, вызвавшие белково-энергетическую недостаточность, протекают тяжело, их труднее лечить. Иногда азотистый баланс можно восстановить только после излечения инфекции и устранения лихорадки.</li>\r\n<li>Белково-энергетическая недостаточность сама по себе может препятствовать излечению вызвавшего ее тяжелого заболевания. В таких случаях необходимо как можно раньше начать зондовое или парентеральное питание.</li>\r\n<li>Поступление пищи через ЖКТ способствует поносу из-за атрофии слизистой и дефицита ферментов кишечника и поджелудочной железы. При этом может быть показано полное парентеральное питание.</li>\r\n<li>Следует устранить сопутствующий дефицит других компонентов пищи (витаминов, незаменимых минеральных веществ, микроэлементов).</li>\r\n</ul>\r\n<p>У взрослых восстановление питательного статуса наступает медленно и не всегда полностью; у детей выздоровление происходит в течение 3-4 мес. Во всех случаях необходимы образовательные и реабилитационные программы, а также меры психологической и социальной поддержки.</p>",
"prevention": "",
"clinical_picture": "<p>Легкая и умеренная белково-энергетическая недостаточность. У детей отсутствует прибавка веса и роста. У взрослых отмечается снижение веса, хотя при отеках или ожирении оно может быть не столь заметным. Уменьшаются толщина кожной складки над трехглавой мышцей плеча и мышечная масса в области плеча.</p>\r\n<p>В отсутствие болезней почек чувствительным показателем белковой недостаточности служит отношение суточной экскреции креатинина к росту (показатель измеряют еженедельно). Снижаются уровни альбумина, трансферрина и транстиретина (преальбумина) в крови. Уровень Т3 снижается, а реверсивного Т3 - повышается. Замедляется метаболизм. Возможны лимфопения и нарушение толерантности к глюкозе . Размеры сердца уменьшены .</p>\r\n<p>Тяжелая белково-энергетическая недостаточность. Тяжелая белково- энергетическая недостаточность сопровождается более выраженными изменениями клинических и лабораторных показателей. При физикальном исследовании обнаруживают западение межреберий, атрофию височных мышц и атрофию мышц конечностей. Подкожная клетчатка атрофирована или отсутствует. Характерны <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>, быстрая <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>, чувство холода, депигментация кожи и депигментация волос, заострившиеся черты лица; кожа сухая, покрыта трещинами. В запущенных случаях образуются пролежни, кожа изъязвляется. АД снижено, также как и температура тела, пульс ослаблен. Нарушаются функции всех органов и систем.</p>",
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},
"code": "E53",
"name": "Недостаточность других витаминов группы B",
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3
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"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме и проявляющееся нарушениями преимущественно со стороны нервной системы, сердца и кишечника.",
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"etiology": "<p>Гиповитаминоз B1 в развитых странах встречается нередко и наблюдается в основном у больных с хроническими заболеваниями желудочно-кишечного тракта, хроническим алкоголизмом, полиневритами, эндокринными заболеваниями (сахарный диабет, токсический зоб) и др. Недостаточность тиамина часто сочетается с дефицитом других витаминов группы В.</p>",
"pathogenesis": "<p>Витамин B1 хорошо растворяется в воде; кофермент тиаминдифосфат (кокарбоксилаза) играет существенную роль в углеводном обмене. Наряду с этим тиамин участвует в обмене аминокислот, нуклеотидов, ацетилхолина и холинэстеразы. При дефиците витамина В1 в тканях и крови накапливаются недоокисленные продукты: пировиноградная кислота, молочная кислота и др. При этом нарушается деятельность различных отделов нервной системы (особенно периферической нервной системы), скелетных мышц и миокарда, а также функция желудочно-кишечного тракта.</p>",
"diagnostics": "<p>Диагноз гиповитаминоза B1 подтверждается уменьшением содержания тиамина в крови (в сыворотке ниже 5 мкг/л, в эритроцитах ниже 30 мкг/л), резким повышением концентрации пировиноградной кислоты в крови (выше 0,01 г/л) и моче (выше 30 мг/сут), повышением содержания в крови молочной кислоты (выше 200 мг/л). В последнее время с этой целью используют также ряд более сложных современных методов.</p>",
"treatment": "<p>Лечение больных обычно проводится амбулаторно. Рекомендуется диета, богатая тиамином, в сочетании с препаратами тиамина внутрь (50-100 мг/сут) или парентерально (30-60 мг/сут).</p>\r\n<p>Больные с выраженными формами болезни часто нуждаются в стационарном лечении. Парентерально вводят тиамин по 1 мл и кокарбоксилазу. Одновременно назначают другие витамины группы В (рибоксин, пиридоксин, никотиновая кислота) и аскорбиновую кислоту.</p>",
"prevention": "",
"clinical_picture": "<p>Характерны ухудшение аппетита, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, наклонность к запорам, парестезии в ногах, боль в икроножных мышцах при ходьбе, ухудшение сна, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, плаксивость, снижение физической и психической работоспособности. Иногда умеренное похудание, лабильность пульса на фоне общей психоэмоциональной лабильности. Язык суховат, живот нерезко вздут, умеренно снижена болевая и глубокая чувствительность в области стоп и голеней, нерезко ослаблены сухожильные рефлексы (больше на ногах).</p>",
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},
"code": "E54",
"name": "Недостаточность аскорбиновой кислоты",
"icd_name": "Недостаточность аскорбиновой кислоты",
"gender": 1,
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0
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"periodicity": 4,
"slug": "e54_nedostatochnost_askorbinovoy_kisloty",
"lead": "Гиповитаминоз С",
"description": "Недостаточность аскорбиновой кислоты (гиповитаминоз С) обусловлена дефицитом ее в организме. Тяжелый дефицит ее приводит к развитию цинги.",
"etiology": "<p>Гиповитаминоз С может развиваться при приеме ацетилсалициловой кислоты, эстрогенов, пероральных контрацептивов, а также при алкоголизме, гипертиреозе, проведении гемодиализа.</p>",
"pathogenesis": "<p>Аскорбиновая кислота играет важную роль в окислительно-восстановительных процессах, углеводном обмене, оказывает универсальное влияние на проницаемость сосудистой стенки, развитие и функцию костной, хрящевой ткани, кожи, надпочечников и других органов. Недостаток аскорбиновой кислоты со временем приводит к угнетению Т-системы иммунитета, что способствует развитию инфекционных осложнений.</p>",
"diagnostics": "<p>Важное значение особенно в I стадии заболевания имеет определение экскреции аскорбиновой кислоты с мочой.</p>\r\n<p>Во II и III стадиях цинги клиническая симптоматика (гингивит, стоматит, выпадение зубов, распространенные петехиальные сыпи и кровоизлияния под кожу в мышцы, суставы, остеопороз и др.) в сочетании с анамнестическими данными о неполноценном питании дает возможность установить правильный диагноз.</p>",
"treatment": "<p>Лечение больных цингой в I стадии можно проводить амбулаторно. Назначают аскорбиновую кислоту по 0,1 г 3—5 раз в сутки. При ухудшенном всасывании витамина С его вводят внутримышечно по 1—2 мл 5% раствора. Одновременно назначают витамин Р (рутин, кверцетин и др.) 100—150 мг/сут. <br />Больные с II и III стадиями цинги должны лечиться в стационаре. Им показана диета, богатая белками (до 120—150 г/сут). При цинге II стадии суточная доза аскорбиновой кислоты должна быть не менее 500 мг, при III стадии — 1000 мг, при этом не менее 1/3 дозы следует вводить парентерально.</p>\r\n<p>Эффективно введение в вену 1—2 мл 5% раствора аскорбината натрия вместе с глюкозой. Назначают также витамины Р (150—300 мг), B1 (20 мг), рибофлавин (10 мг). Активную витаминотерапию проводят не менее месяца, затем дозы постепенно снижают.</p>",
"prevention": "",
"clinical_picture": "<p>К I стадии цинги относят случаи, характеризующиеся умеренной слабостью, болью в ногах, повышенной кровоточивостью, цинготной пурпурой, нерезким гингивитом; трудоспособность снижена умеренно.</p>\r\n<p>Во II стадии геморрагии приобретают распространенный характер. Отмечается геморрагический <a href=\"/symptom/vypot/\" title=\"Перейти на страницу симптома Выпот\">выпот</a> в суставы, плевру. Гингивит и стоматит резко выражены; у больных повышается температура. Они нуждаются в стационарном лечении.</p>\r\n<p>Стадия III характеризуется тяжелым общим состоянием больных, резким исхуданием, дальнейшим нарастанием кровоточивости, анемизации, возникновением долго незаживающих язв конечностей, развитием инфекционных осложнений (пневмонии, туберкулез, дизентерия, <a href=\"/symptom/sistemnoe_vospalenie/\" title=\"Перейти на страницу симптома Системное воспаление\">сепсис</a> одонтогенный и др.).</p>",
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"etiology": "<p>Дефицит цинка может быть вызван нарушением деятельности щитовидной железы, болезнями печени, плохим усвоением, недостатком этого минерала в воде, пище, а также слишком большим количеством фитина в продуктах питания, так как фитин \"связывает\" цинк, затрудняет его усвоение (кстати, нельзя принимать цинк вместе с селеном, так как два этих элемента взаимоисключают друг друга.). Если в пище слишком много белка, это тоже может быть причиной недостатка цинка в организме. При болезнях: рак бронхов, воспалении или раке предстательной железы, других раковых опухолях, лейкозах также происходит перерасход цинка, который необходим для роста клеток.</p>\r\n<p>Добавки кальция и богатый кальцием рацион (молочные продукты) способны снижать усвоение цинка почти на 50%, а кофеин и алкоголь усиленно выводят его из организма.<br /> <br /> Содержание цинка снижается при приеме внутрь противозачаточных средств (пероральных контрацептивов). Кортикостероиды (кортизон, преднизолон), назначаемые при ряде заболеваний (артрит, бронхиальная астма и др.), также снижают уровень цинка.<br /> <br /> Цинк быстро выводится из организма при стрессах, а также под действием ядовитых металлов, пестицидов и др.<br /> <br /> Уровень цинка в организме значительно снижается с возрастом, следовательно, пожилые люди в той или иной мере испытывают дефицит цинка.</p>",
"pathogenesis": "<p>Незаменимость цинка для течения кардинальных процессов жизнедеятельности явно проявляется при возникновении его дефицита. Классическим примером дефицита цинка является энтеропатический акродерматит. Он относится к редким, наследуемым по аутосомно-рецессивному типу заболеваниям. Манифестирует в грудном возрасте и без лечения приводит к смертельному исходу. Полагают, что в результате генетического дефекта в клетках Панета нарушается всасывание цинка в кишечнике. Клинически акродерматит проявляется типичными признаками дефицита цинка. На первый план выступают поражения кожи в виде хронического эритематозно-буллезного дерматита на конечностях и вокруг естественных отверстий тела, частое присоединением вторичного инфицирования, патологией роста ногтей и волос, аллопецией. Характерны тяжелые желудочно-кишечные расстройства с синдромом нарушенного всасывания, глазные симптомы (блефарит, конъюнктивит, <a href=\"/symptom/svetoboyazn/\" title=\"Перейти на страницу симптома Светобоязнь\">фотофобия</a>, помутнение роговицы), нервно-психические нарушения, замедление роста, гипогонадизм, анемия, гепатоспленомегалия, снижение остроты вкуса и обоняния. Дефицит цинка, испытываемый женщиной во время беременности, приводит к широкому спектру врожденных уродств у плода - расщеплению верхней челюсти, верхнего неба, микроцефалии.</p>",
"diagnostics": "<p>Диагностика дефицита цинка основывается на определении уровня цинка в сыворотке крови, эритроцитах, моче, волосах. Наиболее информативным по мнению многих авторов является исследование цинка в сыворотке крови. По данным Карлинского М. В. концентрацию цинка в крови менее 13 мкмоль/л можно расценивать как цинк-дефицитное состояние, а содержание цинка менее 8,2 мкмоль/л является неблагоприятным прогностическим признаком. Однако необходимо учитывать, что не всегда уровень цинка в крови коррелирует с клиническими проявлениями. Так, концентрация цинка в крови может изменяться в течение дня в зависимости от приема пищи, стресса, перенесенной инфекции, при нарушениях забора и хранения крови. Поэтому при диагностике дефицита цинка необходимо учитывать не только концентрацию цинка в сыворотке крови, но и положительную динамику клинических симптомов, а также повышение концентрации цинка в ответ на терапию цинксодержащими препаратами.</p>",
"treatment": "<p>Восполнить дефицит можно с помощью продуктов питания, таких как морепродукты (устрицы, креветки), печень, нежирная говядина, твердые сыры, бобовые, орехи, грибы и ягоды (черника, малина). Кроме того, большинство пищевых добавок и витаминно-минеральных комплексов содержат цинк.</p>",
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