| Affected organ or system | Effects | Treatment |
| Cardiovascular system | Cardiac output and stroke volume are reduced Infusion of saline may cause an increase in venous pressure Any increase in blood volume can easily produce acute heart failure; any decrease will further compromise tissue perfusion Blood pressure is low Renal perfusion and circulation time are reduced Plasma volume is usually normal and red cell volume is reduced | If the child appears dehydrated, give ReSoMal or F-75 diet; do not give fluids intravenously unless the child is in shock If there is evidence of congestive heart failure, restrict blood transfusion to 10 mL/kg and give a diuretic* |
| Liver | Synthesis of all proteins is reduced Abnormal metabolites of amino acids are produced Capacity of liver to take up, metabolize, and excrete toxins is severely reduced Energy production from substrates such as galactose and fructose is much slower than normal Gluconeogenesis is reduced, which increases the risk of hypoglycemia during infection Bile secretion is reduced | Do not give the child large meals Ensure that the amount of protein given does not exceed the metabolic capacity of the liver but is sufficient to support synthesis of proteins (1 to 2 g/kg per day) Reduce the dosage of drugs that depend on hepatic disposal or are hepatotoxic Ensure that sufficient carbohydrate is given to avoid the need for gluconeogenesis Do not give iron supplements, which may be dangerous because transferrin levels are reduced |
| Genitourinary system | Glomerular filtration is reduced Capacity of kidney to excrete excess acid or a water load is greatly reduced Urinary phosphate output is low Sodium excretion is reduced Urinary tract infection is common | Prevent further tissue breakdown by treating any infections and providing adequate energy (80 to 100 kcal/kg or 336 to 420 kJ/kg per day) Do not give the child more protein than is required to maintain tissues Ensure that high-quality proteins are given, with balanced amino acids Avoid nutrients that give an acid load, such as magnesium chloride Restrict dietary sodium Ensure that water intake is sufficient but not excessive |
| Gastrointestinal system | Production of gastric acid is reduced Intestinal motility is reduced Pancreas is atrophied and production of digestive enzymes is reduced Small intestinal mucosa is atrophied; activities of digestive enzymes are reduced Absorption of nutrients is reduced when large amounts of food are eaten | Give the child small, frequent feeds If absorption is poor, increase the frequency and reduce the size of each feed If there is malabsorption of fat, treatment with pancreatic enzymes may be useful |
