Kwashiorkor is a distressing condition characterized by the severe lack of protein in the diet and the resulting bilateral swelling of the extremities. This condition predominantly affects infants and young children, typically between the ages of weaning and five years old. Kwashiorkor is most prevalent in regions of extreme poverty and widespread malnutrition worldwide. During the 1950s, the World Health Organization recognized Kwashiorkor as a significant public health crisis.
However, there was initially a delay in understanding and addressing the condition due to misreporting of childhood deaths as digestive system disorders or infectious diseases. This misclassification hindered the accurate identification of Kwashiorkor cases and impeded effective intervention efforts. Since the recognition of Kwashiorkor as a distinct condition, numerous relief initiatives have been implemented to eradicate this debilitating disease.
These efforts have focused on providing nutritional support, education, and resources to affected regions, particularly those grappling with poverty and limited access to essential healthcare services. By addressing the root causes of malnutrition and promoting sustainable development, organizations and governments have strived to improve the well-being of affected children and prevent future occurrences of Kwashiorkor.
Epidemiology
Kwashiorkor is most commonly observed in regions facing extreme poverty, food insecurity, and inadequate access to healthcare. Sub-Saharan Africa, particularly countries in West and Central Africa, has historically reported a higher prevalence of Kwashiorkor. Other areas affected include parts of Asia, Southeast Asia, and certain regions in South America and the Caribbean.
Kwashiorkor primarily affects infants and young children, typically between the ages of weaning (around six months) and five years old. Although both genders can be affected, there is no significant variation in the occurrence of Kwashiorkor between males and females. Kwashiorkor is closely linked to poverty and socioeconomic disparities.
Vulnerable populations living in impoverished conditions, particularly in rural areas or urban slums, are at higher risk due to limited resources, insufficient healthcare infrastructure, and insufficient access to nutritious food. Social determinants of health, including low education levels, unemployment, and limited social support systems, further compound the risk of Kwashiorkor.
Anatomy
Pathophysiology
Kwashiorkor occurs when there is a severe deficiency of dietary protein, specifically essential amino acids required for proper growth and maintenance of body tissues. Inadequate protein intake disrupts normal cellular function, impairs tissue repair, and compromises the synthesis of essential molecules such as enzymes, hormones, and immune system components. Protein synthesis is essential for maintaining cells’ and tissues’ structural integrity and function.
In Kwashiorkor, the reduced availability of amino acids hampers protein synthesis, leading to the breakdown of body tissues, particularly in muscles and organs. This results in muscle wasting and organ dysfunction. Protein plays a crucial role in maintaining fluid balance within the body. Insufficient protein levels disrupt the oncotic pressure in the blood vessels, leading to a decrease in plasma proteins, mainly albumin.
Reduced oncotic pressure causes fluid to leak from the blood vessels into the surrounding tissues, leading to edema, especially in the extremities, abdomen, and face, a hallmark feature of Kwashiorkor. Protein malnutrition weakens the immune system, making individuals more susceptible to infections. The deficiency of specific amino acids, such as arginine and glutamine, compromises immune cell function and reduces antibody production, impairing the body’s ability to fight infections.
This further increases the risk of developing secondary infections and complicates the clinical course of Kwashiorkor. The liver plays a vital role in protein metabolism, including the synthesis of albumin, clotting factors, and transport proteins. In Kwashiorkor, liver dysfunction is commonly observed, with reduced albumin production and impaired detoxification capacity.
This contributes to the development of hypoalbuminemia (low levels of albumin in the blood) and coagulation abnormalities. Kwashiorkor is often associated with various micronutrient deficiencies, including vitamins (such as vitamin A, B complex, and vitamin C), minerals (such as iron, zinc, and magnesium), and essential fatty acids. These deficiencies further exacerbate the overall nutritional imbalance and contribute to the clinical manifestations of the disease.
Etiology
The exact etiology of kwashiorkor remains uncertain, although certain dietary factors have been frequently linked to the disease. Diets primarily reliant on cassava, maize, or rice have often been associated with kwashiorkor. While initial beliefs centered on protein deficiency, low levels of antioxidants, and aflatoxins as potential causes, attempts to address the disease through interventions aimed at increasing dietary protein and antioxidants have not yielded significant success.
Additionally, aflatoxin, once considered a primary etiological factor, does not consistently correlate with the occurrence of kwashiorkor in specific populations. However, certain factors consistently demonstrate an association with the development of kwashiorkor. These include recent weaning practices, recent infections, particularly measles, and disruptions in childhood, such as parental death, temporary home environments, and poverty. These factors have been identified as potential contributors to the increased vulnerability of children to kwashiorkor.
Genetics
Prognostic Factors
The mortality rate in kwashiorkor tends to decrease as the age at which the disease manifests increase. Children affected by kwashiorkor may experience stunted growth and abnormal development. Without early initiation of treatment, severe complications can arise, including shock, coma, and permanent physical and mental disabilities. It is crucial to recognize that kwashiorkor can be life-threatening if not promptly and adequately treated.
Clinical History
Clinical History
A detailed assessment of the patient’s nutritional history is essential. It involves gathering information about the individual’s dietary patterns, including the types of foods consumed, the frequency of meals, and any significant dietary restrictions or deficiencies. Kwashiorkor predominantly affects infants and young children, typically between the age of weaning and five years old.
The patient’s age and growth patterns, including weight and height measurements, are assessed to identify signs of growth faltering, stunting, or failure to thrive. The clinical features observed in the patient play a crucial role in diagnosing kwashiorkor. These include the presence of bilateral extremity swelling (edema), which is a characteristic sign of the condition. Other signs may include skin changes (such as depigmentation, flaky skin, or changes in hair color and texture), poor wound healing, muscle wasting, and changes in hair and nail appearance.
Understanding the patient’s socioeconomic background and living conditions is crucial, as Kwashiorkor is closely associated with poverty, inadequate access to healthcare, and poor sanitation. Factors such as parental death, temporary home environments, and limited resources are also considered, as they contribute to the vulnerability of children to kwashiorkor.
Physical Examination
Physical Examination
One of the hallmark signs of kwashiorkor is peripheral pitting edema, which initially presents in dependent regions, such as the feet and ankles, and gradually progresses cranially. Edema is characterized by swelling that leaves an indentation or pit when pressure is applied and can involve the extremities, abdomen, and face. Kwashiorkor leads to marked muscle wasting and atrophy, resulting in a loss of muscle mass and reduced muscle tone. This can be observed as thin limbs and decreased muscle bulk, particularly in the upper arms and thighs. Patients with kwashiorkor often exhibit abdominal distension, which the presence of dilated bowel loops may accompany.
Hepatomegaly can also be observed due to fatty liver infiltrates resulting from the metabolic derangements associated with severe malnutrition. A patient’s face with kwashiorkor may exhibit a characteristic round appearance, with a prominence of the cheeks, often referred to as moon facies. This is a result of subcutaneous fat loss in certain facial areas. The skin in kwashiorkor shows distinct characteristics. It tends to be thin, dry and may peel, with areas of scaling and hyperpigmentation.
Additionally, patches of hypopigmentation may be observed. These skin changes are often prominent in the perineum, groin, limbs, ears, and armpits. The hair is typically dry, thin, and easily plucked. It may appear dull and lack luster. Hair loss or patchy hair growth can also occur. Nail abnormalities, such as brittle nails or ridges, may be present. Children with kwashiorkor commonly exhibit growth retardation in terms of height and weight.
Stunted growth and failure to thrive are observed due to the overall impact of severe malnutrition on the body’s growth and development. Kwashiorkor can cause psychic changes in affected individuals. Common manifestations include anorexia and apathy, which may be attributed to severe malnutrition’s physiological and psychological effects. Kwashiorkor can result in the retention of subcutaneous fat in certain body areas, leading to loose inner inguinal skin folds. This finding is often observed in the groin region.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Actinic prurigo
Acrodermatitis enteropathica
Atopic dermatitis
Cirrhosis
Nephrotic syndrome
Chronic kidney disease
Inflammatory bowel disease
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment
The treatment of kwashiorkor involves a comprehensive approach to addressing nutritional deficiencies, managing complications, and promoting overall recovery and growth. The primary goals of treatment are to restore the patient’s nutritional status, correct fluid and electrolyte imbalances, manage infections and provide supportive care. The cornerstone of treatment involves providing a well-balanced and nutrient-rich diet to correct severe protein and energy deficiencies. This typically includes therapeutic feeding with specialized milk formulas, ready-to-use therapeutic foods, or fortified feeds.
The diet should be gradually introduced to allow the body to adjust and minimize the risk of refeeding syndrome. Essential vitamins and minerals supplementation is administered to address any underlying micronutrient deficiencies. This includes vitamin A, vitamin B complex, vitamin C, iron, zinc, and others, as indicated based on specific deficiencies. Patients with kwashiorkor often have imbalances in fluid and electrolyte levels. Rehydration therapy is initiated to correct dehydration and electrolyte disturbances. This may involve the administration of oral rehydration solutions or, in severe cases, intravenous fluids.
Prompt identification and management of infections are vital. Antibiotics are administered when there is evidence of bacterial infection, and supportive care is provided to manage complications such as pneumonia, sepsis, or skin infections. Psychological and emotional support is essential for both the child and their caregivers. Nutritional education, counseling, and guidance on proper feeding practices are provided to ensure long-term sustainable improvements in the child’s nutritional status.
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Kwashiorkor is a distressing condition characterized by the severe lack of protein in the diet and the resulting bilateral swelling of the extremities. This condition predominantly affects infants and young children, typically between the ages of weaning and five years old. Kwashiorkor is most prevalent in regions of extreme poverty and widespread malnutrition worldwide. During the 1950s, the World Health Organization recognized Kwashiorkor as a significant public health crisis.
However, there was initially a delay in understanding and addressing the condition due to misreporting of childhood deaths as digestive system disorders or infectious diseases. This misclassification hindered the accurate identification of Kwashiorkor cases and impeded effective intervention efforts. Since the recognition of Kwashiorkor as a distinct condition, numerous relief initiatives have been implemented to eradicate this debilitating disease.
These efforts have focused on providing nutritional support, education, and resources to affected regions, particularly those grappling with poverty and limited access to essential healthcare services. By addressing the root causes of malnutrition and promoting sustainable development, organizations and governments have strived to improve the well-being of affected children and prevent future occurrences of Kwashiorkor.
Kwashiorkor is most commonly observed in regions facing extreme poverty, food insecurity, and inadequate access to healthcare. Sub-Saharan Africa, particularly countries in West and Central Africa, has historically reported a higher prevalence of Kwashiorkor. Other areas affected include parts of Asia, Southeast Asia, and certain regions in South America and the Caribbean.
Kwashiorkor primarily affects infants and young children, typically between the ages of weaning (around six months) and five years old. Although both genders can be affected, there is no significant variation in the occurrence of Kwashiorkor between males and females. Kwashiorkor is closely linked to poverty and socioeconomic disparities.
Vulnerable populations living in impoverished conditions, particularly in rural areas or urban slums, are at higher risk due to limited resources, insufficient healthcare infrastructure, and insufficient access to nutritious food. Social determinants of health, including low education levels, unemployment, and limited social support systems, further compound the risk of Kwashiorkor.
Kwashiorkor occurs when there is a severe deficiency of dietary protein, specifically essential amino acids required for proper growth and maintenance of body tissues. Inadequate protein intake disrupts normal cellular function, impairs tissue repair, and compromises the synthesis of essential molecules such as enzymes, hormones, and immune system components. Protein synthesis is essential for maintaining cells’ and tissues’ structural integrity and function.
In Kwashiorkor, the reduced availability of amino acids hampers protein synthesis, leading to the breakdown of body tissues, particularly in muscles and organs. This results in muscle wasting and organ dysfunction. Protein plays a crucial role in maintaining fluid balance within the body. Insufficient protein levels disrupt the oncotic pressure in the blood vessels, leading to a decrease in plasma proteins, mainly albumin.
Reduced oncotic pressure causes fluid to leak from the blood vessels into the surrounding tissues, leading to edema, especially in the extremities, abdomen, and face, a hallmark feature of Kwashiorkor. Protein malnutrition weakens the immune system, making individuals more susceptible to infections. The deficiency of specific amino acids, such as arginine and glutamine, compromises immune cell function and reduces antibody production, impairing the body’s ability to fight infections.
This further increases the risk of developing secondary infections and complicates the clinical course of Kwashiorkor. The liver plays a vital role in protein metabolism, including the synthesis of albumin, clotting factors, and transport proteins. In Kwashiorkor, liver dysfunction is commonly observed, with reduced albumin production and impaired detoxification capacity.
This contributes to the development of hypoalbuminemia (low levels of albumin in the blood) and coagulation abnormalities. Kwashiorkor is often associated with various micronutrient deficiencies, including vitamins (such as vitamin A, B complex, and vitamin C), minerals (such as iron, zinc, and magnesium), and essential fatty acids. These deficiencies further exacerbate the overall nutritional imbalance and contribute to the clinical manifestations of the disease.
The exact etiology of kwashiorkor remains uncertain, although certain dietary factors have been frequently linked to the disease. Diets primarily reliant on cassava, maize, or rice have often been associated with kwashiorkor. While initial beliefs centered on protein deficiency, low levels of antioxidants, and aflatoxins as potential causes, attempts to address the disease through interventions aimed at increasing dietary protein and antioxidants have not yielded significant success.
Additionally, aflatoxin, once considered a primary etiological factor, does not consistently correlate with the occurrence of kwashiorkor in specific populations. However, certain factors consistently demonstrate an association with the development of kwashiorkor. These include recent weaning practices, recent infections, particularly measles, and disruptions in childhood, such as parental death, temporary home environments, and poverty. These factors have been identified as potential contributors to the increased vulnerability of children to kwashiorkor.
The mortality rate in kwashiorkor tends to decrease as the age at which the disease manifests increase. Children affected by kwashiorkor may experience stunted growth and abnormal development. Without early initiation of treatment, severe complications can arise, including shock, coma, and permanent physical and mental disabilities. It is crucial to recognize that kwashiorkor can be life-threatening if not promptly and adequately treated.
Clinical History
A detailed assessment of the patient’s nutritional history is essential. It involves gathering information about the individual’s dietary patterns, including the types of foods consumed, the frequency of meals, and any significant dietary restrictions or deficiencies. Kwashiorkor predominantly affects infants and young children, typically between the age of weaning and five years old.
The patient’s age and growth patterns, including weight and height measurements, are assessed to identify signs of growth faltering, stunting, or failure to thrive. The clinical features observed in the patient play a crucial role in diagnosing kwashiorkor. These include the presence of bilateral extremity swelling (edema), which is a characteristic sign of the condition. Other signs may include skin changes (such as depigmentation, flaky skin, or changes in hair color and texture), poor wound healing, muscle wasting, and changes in hair and nail appearance.
Understanding the patient’s socioeconomic background and living conditions is crucial, as Kwashiorkor is closely associated with poverty, inadequate access to healthcare, and poor sanitation. Factors such as parental death, temporary home environments, and limited resources are also considered, as they contribute to the vulnerability of children to kwashiorkor.
Physical Examination
One of the hallmark signs of kwashiorkor is peripheral pitting edema, which initially presents in dependent regions, such as the feet and ankles, and gradually progresses cranially. Edema is characterized by swelling that leaves an indentation or pit when pressure is applied and can involve the extremities, abdomen, and face. Kwashiorkor leads to marked muscle wasting and atrophy, resulting in a loss of muscle mass and reduced muscle tone. This can be observed as thin limbs and decreased muscle bulk, particularly in the upper arms and thighs. Patients with kwashiorkor often exhibit abdominal distension, which the presence of dilated bowel loops may accompany.
Hepatomegaly can also be observed due to fatty liver infiltrates resulting from the metabolic derangements associated with severe malnutrition. A patient’s face with kwashiorkor may exhibit a characteristic round appearance, with a prominence of the cheeks, often referred to as moon facies. This is a result of subcutaneous fat loss in certain facial areas. The skin in kwashiorkor shows distinct characteristics. It tends to be thin, dry and may peel, with areas of scaling and hyperpigmentation.
Additionally, patches of hypopigmentation may be observed. These skin changes are often prominent in the perineum, groin, limbs, ears, and armpits. The hair is typically dry, thin, and easily plucked. It may appear dull and lack luster. Hair loss or patchy hair growth can also occur. Nail abnormalities, such as brittle nails or ridges, may be present. Children with kwashiorkor commonly exhibit growth retardation in terms of height and weight.
Stunted growth and failure to thrive are observed due to the overall impact of severe malnutrition on the body’s growth and development. Kwashiorkor can cause psychic changes in affected individuals. Common manifestations include anorexia and apathy, which may be attributed to severe malnutrition’s physiological and psychological effects. Kwashiorkor can result in the retention of subcutaneous fat in certain body areas, leading to loose inner inguinal skin folds. This finding is often observed in the groin region.
Differential Diagnoses
Actinic prurigo
Acrodermatitis enteropathica
Atopic dermatitis
Cirrhosis
Nephrotic syndrome
Chronic kidney disease
Inflammatory bowel disease
Treatment
The treatment of kwashiorkor involves a comprehensive approach to addressing nutritional deficiencies, managing complications, and promoting overall recovery and growth. The primary goals of treatment are to restore the patient’s nutritional status, correct fluid and electrolyte imbalances, manage infections and provide supportive care. The cornerstone of treatment involves providing a well-balanced and nutrient-rich diet to correct severe protein and energy deficiencies. This typically includes therapeutic feeding with specialized milk formulas, ready-to-use therapeutic foods, or fortified feeds.
The diet should be gradually introduced to allow the body to adjust and minimize the risk of refeeding syndrome. Essential vitamins and minerals supplementation is administered to address any underlying micronutrient deficiencies. This includes vitamin A, vitamin B complex, vitamin C, iron, zinc, and others, as indicated based on specific deficiencies. Patients with kwashiorkor often have imbalances in fluid and electrolyte levels. Rehydration therapy is initiated to correct dehydration and electrolyte disturbances. This may involve the administration of oral rehydration solutions or, in severe cases, intravenous fluids.
Prompt identification and management of infections are vital. Antibiotics are administered when there is evidence of bacterial infection, and supportive care is provided to manage complications such as pneumonia, sepsis, or skin infections. Psychological and emotional support is essential for both the child and their caregivers. Nutritional education, counseling, and guidance on proper feeding practices are provided to ensure long-term sustainable improvements in the child’s nutritional status.
medtigo
Kwashiorkor Disease
Updated :
September 4, 2023
Kwashiorkor is a distressing condition characterized by the severe lack of protein in the diet and the resulting bilateral swelling of the extremities. This condition predominantly affects infants and young children, typically between the ages of weaning and five years old. Kwashiorkor is most prevalent in regions of extreme poverty and widespread malnutrition worldwide. During the 1950s, the World Health Organization recognized Kwashiorkor as a significant public health crisis.
However, there was initially a delay in understanding and addressing the condition due to misreporting of childhood deaths as digestive system disorders or infectious diseases. This misclassification hindered the accurate identification of Kwashiorkor cases and impeded effective intervention efforts. Since the recognition of Kwashiorkor as a distinct condition, numerous relief initiatives have been implemented to eradicate this debilitating disease.
These efforts have focused on providing nutritional support, education, and resources to affected regions, particularly those grappling with poverty and limited access to essential healthcare services. By addressing the root causes of malnutrition and promoting sustainable development, organizations and governments have strived to improve the well-being of affected children and prevent future occurrences of Kwashiorkor.
Kwashiorkor is most commonly observed in regions facing extreme poverty, food insecurity, and inadequate access to healthcare. Sub-Saharan Africa, particularly countries in West and Central Africa, has historically reported a higher prevalence of Kwashiorkor. Other areas affected include parts of Asia, Southeast Asia, and certain regions in South America and the Caribbean.
Kwashiorkor primarily affects infants and young children, typically between the ages of weaning (around six months) and five years old. Although both genders can be affected, there is no significant variation in the occurrence of Kwashiorkor between males and females. Kwashiorkor is closely linked to poverty and socioeconomic disparities.
Vulnerable populations living in impoverished conditions, particularly in rural areas or urban slums, are at higher risk due to limited resources, insufficient healthcare infrastructure, and insufficient access to nutritious food. Social determinants of health, including low education levels, unemployment, and limited social support systems, further compound the risk of Kwashiorkor.
Kwashiorkor occurs when there is a severe deficiency of dietary protein, specifically essential amino acids required for proper growth and maintenance of body tissues. Inadequate protein intake disrupts normal cellular function, impairs tissue repair, and compromises the synthesis of essential molecules such as enzymes, hormones, and immune system components. Protein synthesis is essential for maintaining cells’ and tissues’ structural integrity and function.
In Kwashiorkor, the reduced availability of amino acids hampers protein synthesis, leading to the breakdown of body tissues, particularly in muscles and organs. This results in muscle wasting and organ dysfunction. Protein plays a crucial role in maintaining fluid balance within the body. Insufficient protein levels disrupt the oncotic pressure in the blood vessels, leading to a decrease in plasma proteins, mainly albumin.
Reduced oncotic pressure causes fluid to leak from the blood vessels into the surrounding tissues, leading to edema, especially in the extremities, abdomen, and face, a hallmark feature of Kwashiorkor. Protein malnutrition weakens the immune system, making individuals more susceptible to infections. The deficiency of specific amino acids, such as arginine and glutamine, compromises immune cell function and reduces antibody production, impairing the body’s ability to fight infections.
This further increases the risk of developing secondary infections and complicates the clinical course of Kwashiorkor. The liver plays a vital role in protein metabolism, including the synthesis of albumin, clotting factors, and transport proteins. In Kwashiorkor, liver dysfunction is commonly observed, with reduced albumin production and impaired detoxification capacity.
This contributes to the development of hypoalbuminemia (low levels of albumin in the blood) and coagulation abnormalities. Kwashiorkor is often associated with various micronutrient deficiencies, including vitamins (such as vitamin A, B complex, and vitamin C), minerals (such as iron, zinc, and magnesium), and essential fatty acids. These deficiencies further exacerbate the overall nutritional imbalance and contribute to the clinical manifestations of the disease.
The exact etiology of kwashiorkor remains uncertain, although certain dietary factors have been frequently linked to the disease. Diets primarily reliant on cassava, maize, or rice have often been associated with kwashiorkor. While initial beliefs centered on protein deficiency, low levels of antioxidants, and aflatoxins as potential causes, attempts to address the disease through interventions aimed at increasing dietary protein and antioxidants have not yielded significant success.
Additionally, aflatoxin, once considered a primary etiological factor, does not consistently correlate with the occurrence of kwashiorkor in specific populations. However, certain factors consistently demonstrate an association with the development of kwashiorkor. These include recent weaning practices, recent infections, particularly measles, and disruptions in childhood, such as parental death, temporary home environments, and poverty. These factors have been identified as potential contributors to the increased vulnerability of children to kwashiorkor.
The mortality rate in kwashiorkor tends to decrease as the age at which the disease manifests increase. Children affected by kwashiorkor may experience stunted growth and abnormal development. Without early initiation of treatment, severe complications can arise, including shock, coma, and permanent physical and mental disabilities. It is crucial to recognize that kwashiorkor can be life-threatening if not promptly and adequately treated.
Clinical History
A detailed assessment of the patient’s nutritional history is essential. It involves gathering information about the individual’s dietary patterns, including the types of foods consumed, the frequency of meals, and any significant dietary restrictions or deficiencies. Kwashiorkor predominantly affects infants and young children, typically between the age of weaning and five years old.
The patient’s age and growth patterns, including weight and height measurements, are assessed to identify signs of growth faltering, stunting, or failure to thrive. The clinical features observed in the patient play a crucial role in diagnosing kwashiorkor. These include the presence of bilateral extremity swelling (edema), which is a characteristic sign of the condition. Other signs may include skin changes (such as depigmentation, flaky skin, or changes in hair color and texture), poor wound healing, muscle wasting, and changes in hair and nail appearance.
Understanding the patient’s socioeconomic background and living conditions is crucial, as Kwashiorkor is closely associated with poverty, inadequate access to healthcare, and poor sanitation. Factors such as parental death, temporary home environments, and limited resources are also considered, as they contribute to the vulnerability of children to kwashiorkor.
Physical Examination
One of the hallmark signs of kwashiorkor is peripheral pitting edema, which initially presents in dependent regions, such as the feet and ankles, and gradually progresses cranially. Edema is characterized by swelling that leaves an indentation or pit when pressure is applied and can involve the extremities, abdomen, and face. Kwashiorkor leads to marked muscle wasting and atrophy, resulting in a loss of muscle mass and reduced muscle tone. This can be observed as thin limbs and decreased muscle bulk, particularly in the upper arms and thighs. Patients with kwashiorkor often exhibit abdominal distension, which the presence of dilated bowel loops may accompany.
Hepatomegaly can also be observed due to fatty liver infiltrates resulting from the metabolic derangements associated with severe malnutrition. A patient’s face with kwashiorkor may exhibit a characteristic round appearance, with a prominence of the cheeks, often referred to as moon facies. This is a result of subcutaneous fat loss in certain facial areas. The skin in kwashiorkor shows distinct characteristics. It tends to be thin, dry and may peel, with areas of scaling and hyperpigmentation.
Additionally, patches of hypopigmentation may be observed. These skin changes are often prominent in the perineum, groin, limbs, ears, and armpits. The hair is typically dry, thin, and easily plucked. It may appear dull and lack luster. Hair loss or patchy hair growth can also occur. Nail abnormalities, such as brittle nails or ridges, may be present. Children with kwashiorkor commonly exhibit growth retardation in terms of height and weight.
Stunted growth and failure to thrive are observed due to the overall impact of severe malnutrition on the body’s growth and development. Kwashiorkor can cause psychic changes in affected individuals. Common manifestations include anorexia and apathy, which may be attributed to severe malnutrition’s physiological and psychological effects. Kwashiorkor can result in the retention of subcutaneous fat in certain body areas, leading to loose inner inguinal skin folds. This finding is often observed in the groin region.
Differential Diagnoses
Actinic prurigo
Acrodermatitis enteropathica
Atopic dermatitis
Cirrhosis
Nephrotic syndrome
Chronic kidney disease
Inflammatory bowel disease
Treatment
The treatment of kwashiorkor involves a comprehensive approach to addressing nutritional deficiencies, managing complications, and promoting overall recovery and growth. The primary goals of treatment are to restore the patient’s nutritional status, correct fluid and electrolyte imbalances, manage infections and provide supportive care. The cornerstone of treatment involves providing a well-balanced and nutrient-rich diet to correct severe protein and energy deficiencies. This typically includes therapeutic feeding with specialized milk formulas, ready-to-use therapeutic foods, or fortified feeds.
The diet should be gradually introduced to allow the body to adjust and minimize the risk of refeeding syndrome. Essential vitamins and minerals supplementation is administered to address any underlying micronutrient deficiencies. This includes vitamin A, vitamin B complex, vitamin C, iron, zinc, and others, as indicated based on specific deficiencies. Patients with kwashiorkor often have imbalances in fluid and electrolyte levels. Rehydration therapy is initiated to correct dehydration and electrolyte disturbances. This may involve the administration of oral rehydration solutions or, in severe cases, intravenous fluids.
Prompt identification and management of infections are vital. Antibiotics are administered when there is evidence of bacterial infection, and supportive care is provided to manage complications such as pneumonia, sepsis, or skin infections. Psychological and emotional support is essential for both the child and their caregivers. Nutritional education, counseling, and guidance on proper feeding practices are provided to ensure long-term sustainable improvements in the child’s nutritional status.
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