Kwashiorkor

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Kwashiorkor

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Chapter 47 Malnutrition TREATMENT World Health Organisation (WHO) 10 steps for severe malnutrition management ▪ Treat/prevent hypoglycemia (blood glucose < 3mmol/L) ▫ Prevention: urgent small frequent feeds ▫ Treatment: dextrose water ▪ Treat/prevent hypothermia (rectal/oral temperature < 35.5°C/95.9°F) ▪ Treat/prevent dehydration ▫ Prevention: oral rehydration (sunken eyes, no urine passed for 12 hours, thirst) ▫ Treatment: intravenous ﬂuid infusion (lethargy/consciousness loss) ▪ Correct electrolyte imbalances ▫ Total-body sodium excess (likely in severe malnourishment) avoid high sodium solutions, feeds ▫ Specialized refeeding milk feeds contain ▪ ▪ ▪ ▪ ▪ ▪ necessary electrolytes Treat infection ▫ Broad-spectrum antibiotics ▫ In endemic regions: children < one year of age, assume presence of parasitic infection → mebendazole Correct micronutrient deﬁciencies ▫ Supplements: multivitamin, vitamin A, potassium, magnesium, iron, folic acid, zinc, copper Start cautious feeding ▫ WHO recommended starter formula “F-75” Achieve catch-up growth ▫ WHO recommended catch-up formula “F-100” ▫ Reintroduce normal meals Provide sensory stimulation, emotional support Prepare for discharge, post-recovery follow-up KWASHIORKOR osms.it/kwashiorkor PATHOLOGY & CAUSES SIGNS & SYMPTOMS ▪ Sufﬁcient calorie intake, severely inadequate protein intake ▪ AKA “the sickness the baby gets when the new baby comes” ▫ Older children in food-scarce environments weaned off breast milk → carbohydrate rich diet ▪ Characterization ▫ Inadequate adaptation; insufﬁcient dietary nutrient intake ▫ Extreme protein deﬁciency → ↓ liver protein synthesis → osmotic imbalance → edema, abdominal distension ▫ ↓ lymphatic function → ↓ ﬂuid recovery, low lipid absorption → further abdominal distension ▪ Bilateral pitting edema, distended abdomen (rarely ascites; typically weak abdominal musculature, hepatomegaly) ▪ Hepatomegaly (with fatty inﬁltration) ▪ Muscle wasting ▪ Integumentary change (thinning hair, skin/ hair depigmentation, dermatitis) ▪ Irritability, listless affect DIAGNOSIS DIAGNOSTIC IMAGING Chest X-ray ▪ Infection workup: respiratory distress OSMOSIS.ORG 277

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Kwashiorkor

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A 5-year old girl presents to the clinic for a well-child check. She was recently adopted from a refugee camp in Southeast Asia, and her biological family history is unknown. Her parents are concerned that she appears very thin but has a large protuberant abdomen. Temperature is 37°C (98.6°F), pulse is 90/min, respirations are 14/min and blood pressure is 110/70 mmHg. On physical exam, she appears irritable and minimally consolable by her mother. Examination reveals a distended abdomen, bilateral pitting edema, and muscle wasting. Laboratory results are significant for hypoalbuminemia, anemia, and hypophosphatemia. What is the most likely cause of edema seen in this patient’s condition?

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