DISEASE SUMMARY PAGE

Carbohydrate and Protein Malnutrition in Bonobos

Summary Information

Diseases / List of Micronutrient (Vitamin / Mineral) Diseases / Disease summary
Alternative Names Marasmus
Disease Agents Inadequate protein and carbohydrate in the diet. (D386.4.3.w4c)
Infectious Agent(s) --
Non-infectious Agent(s) --
Physical Agent(s) --
General Description Clinical signs
  • Extreme emaciation. (D386.4.3.w4c)
  • Unlike bonobos with kwashiorkor (Protein Malnutrition), the abdomen is not swollen with ascites. (D386.4.3.w4c)
Further Information
Treatment

The following information is from the PASA Primate Veterinary Healthcare Manual Second Edition - Full text included

  • Severely malnourished primates usually have infections, impaired function of the intestines and liver, and electrolyte imbalances when they arrive at a Sanctuary. They are unable to tolerate the amounts of protein, fat and sodium found in a normal diet and must initially be given a diet low in these nutrients and higher in carbohydrates. (D425.3.7.w3g)
  • Diets are available for severely malnourished human children, and can be obtained as powders to be added to water. Alternatively, they can be mixed from basic components.  (D425.3.7.w3g)
  • The F-75 diet provides 315 kJ per 100 mL and is used initially, with the F-100 diet (420kJ per 100 mL) used after the infant's appetite has returned. (D425.3.7.w3g)
    • F-75: dried skimmed milk 25g, sugar 70 g, cereal flour 35g, vegetable oil 27 g, mineral mix 20 mL, vitamin mix 140 mg: add water to make one litre.
    • F-100: dried skimmed milk 80g, sugar 50 g, vegetable oil 60 g, mineral mix 20 mL, vitamin mix 140 mg: add water to make one litre.
    • To prepare, add all the ingredients except the minerals and vitamins to some of the water, mix, boil for 5 - 7 minutes, allow to cool, then add the minerals and vitamins and mix again, then add the rest of the water to reach one litre.
    • Standard proprietary multivitamin supplements can be given if the preparation of small quantities means that using the vitamin mix is not practical.
    • The F-75 diet provides, per 100 mL: Energy 75 kcal (315 kJ), protein 0.9 g, lactose 1.3 g, potassium 3.6 mmol, sodium 0.6 mmol, magnesium 0.43 mmol, zinc 2.0 mg, copper 0.25 mg with 53% of the energy coming from fat and 12% from protein. Osmolarity is 333 mOsmol/L.
    • The F-100 diet provides, per 100 mL: Energy 100 kcal (420 kJ), protein 2.9 g, lactose 4.2 g, potassium 5.9 mmol, sodium 1.9 mmol, magnesium 0.73 mmol, zinc 2.3 mg, copper 0.25 mg with 32% of the energy coming from fat and 5% from protein. Osmolarity is 419 mOsmol/L.

    (D425.3.7.w3g)

  • The diet is given little and often, to avoid overloading the gastrointestinal tract, liver and kidneys: every 2-4 hours day and night. (D425.3.7.w3g)
    • If the infant vomits, the amount given per feed is reduced, with the time between feeds also reduced. (D425.3.7.w3g)
    • If the infant will not take the diet voluntarily then it is given via nasogastric tube. (D425.3.7.w3g)
  • Initially give at least 80 kcak (315 kJ) per kg bodyweight per day but no more than 100 kcal (420 kJ) per kg bodyweight per day, to prevent further tissue breakdown while avoiding metabolic imbalance.
  • Feed using a cup and spoon or for very weak individuals a dropper or syringe, but not a feeding bottle, as these carry a greater risk of transmitting infection.
  • Initially give 130 mL of F-75 per kg bodyweight per day, divided between the feeds, so an infant weighing 7 kg and fed every two hours (12 feeds per day) would be given 75 mL per feed; if fed every three hours (eight feeds per day) this would be 115 mL per feed, and if fed every four hours (six feeds per day), 155 mL per feed. (D425.3.7.w3g)
  • Use coaxing and be patient to encourage the infant to take its full allotment of food at each feed. (D425.3.7.w3g)
  • If the infant will not take enough food orally (e.g. due to weakness, poor appetite or severe stomatitis), then a nasogastric tube must be passed to give the diet.
    • The tube should be properly fixed so that it cannot move from the oesophagus into the trachea.
    • NOTE: ALWAYS aspirate the nasogastric tube before administering anything through the tube.
    • At each feed, offer food by mouth. Once the infant stops taking the diet, give the rest of the ration via the nasogastric tube.
    • Once the infant takes the whole of two consecutive feeds by mouth, or is regularly taking more than 75% orally, the tube can be removed, but it must be replaced if the infant does not take at least the minimum 80 kcal/kg (336 kJ/kg) daily.
    • If abdominal distension develops, give 2 mL of 50% magnesium sulphate solution by intramuscular injection; this enhances potassium uptake.

    (D425.3.7.w3g)

  • Improvement of the infant's appetite, which usually occurs after two to seven days, indicates improvement in its general condition: the liver able to metabolise the nutrients, infections under control and metabolic abnormalities reducing. At this stage a gradual transition to the F-100 diet can be carried out: first replace the -75 diet with a similar amount of the F-100 diet for two days, then gradually increase the volume given per feed. (D425.3.7.w3g)
  • MONITORING:
    • The quantities of food offered and taken, type of food, and the date and time of each feed should be recorded accurately.
    • If vomiting occurs, the amount of feed lost should be estimated.
    • Once daily, the amount of energy the individual has taken in should be calculated and the quantities to be offered the next day should be confirmed or recalculated to ensure the appropriate intake (80-100 kcal/ 336-420 kJ) per day. (D425.3.7.w3g)
  • Additional treatment
    • An anthelmintic should be given e.g. Mebendazole or Ivermectin. (D425.3.7.w3g)
    • Broad-spectrum antibiotic treatment should be given initially, because severely malnourished individuals oftern have infections and may show few signs of such infection (e.g. only drowsiness or lethargy rather than evident fever and inflammation). The standard first-line antibiotic to be given should be standard at a given facility, based on local patterns of important bacteria; pathogens, and cost/availability. Suggestions include: (D425.3.7.w3g)
      • Cotrimoxazole (25 mg sulfamethoxazole (Sulphonamides) plus 5 mg Trimethoprim) orally twice daily for five days. (D425.3.7.w3g)
      • For individuals with evidence of infection: (D425.3.7.w3g)
        • Ampicillin 50 mg/kg intramuscularly or intravenously every six hours for two days, then Amoxycillin 15 m/kg orally every eight hours for five days (or ampicillin 25 mg/kg orally every six hours). (D425.3.7.w3g)
        • Gentamicin 7.5 mg/kg intramuscularly or intravenously once daily for seven days. (D425.3.7.w3g)
    • If the infant fails to respond to the first-line antibiotic, then in addition, Chloramphenicol 25 mg/kg intramuscularly or intravenously every eight hours (every six hours for suspected meningitis) for five days. (D425.3.7.w3g)
    • If the infant has a fever (>39.5 C or >103 F) give an antipyretic. (D425.3.7.w3g)
Associated Techniques
Host taxa groups /species
Author Dr Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referees  

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