Kwashiorkor

INTRODUCTION:
  • A dietary history of a monotonous single cereal-based diet with inclusion of animal-source foods less than once per week will raise suspicion of kwashiorkor. Diets based on corn, cassava, and rice are those most commonly associated with kwashiorkor.
  • In Kwashiorkor, the letter 'K' is post-fixed to denote edema
  • Cessation of breast-feeding in the few months before presentation is a common finding. 
  • There may be a history of preceding diarrhea or measles infection. 
  • Kwashiorkor edema starts in the feet and develops over a few days.
  • Alternative Names:Protein malnutrition; Protein-calorie malnutrition; Malignant malnutrition
SIGNS & TESTS:
  • Early signs of kwashiorkor present as general symptoms of malnutrition and include fatigue, irritability and lethargy. 
  • In malnourished subjects, secretory IgA is generally reduced. Therefore infections tend to be severe and recovery delayed. 
  • Flag sign is seen :
  1. In Kwashiorkor hair is thin, dry, brittle, easily pluckable, sparse & devoid of their normal sheen.
  2. It becomes straight and hypopigmented.
  3. The colour of the hair that grows during the period of nutritional deprivation appears reddish brown.
  4. During the phase of better nutrition, the growing part of the hair gets appropriately pigmented.
  5. This gives appearance of alternate bands of hypopigmented & normally pigmented hair. This is called Flag sign.
  • As protein deprivation continues the following abnormalities become apparent.
  1. Failure to thrive (failure to put on height and weight)
  2. Loss of muscle mass
  3. Pitting oedema- This is the main sign(due to low albumin level)
  4. Poor appetite
  5. Large protuberant belly (pot belly)
  6. Fatty liver
  7. Failing immune system so prone to infections and increased severity of normally mild infections
  8. Skin and hair changes:
  • Apathy, 
  • Flaky paint dermatosis
  • Retarded growth
  • Psychomotor changes
  • Tests may include:
  1. Arterial Blood Gas
  2. BUN(Blood Urea Nitrogen)
  3. Complete Blood Count(CBC)
  4. Creatinine Clearance
  5. Serum Creatinine
  6. Serum Potassium
  7. Total Protein Levels
  8. Urinalysis
TREATMENT:
  • Antibiotics to treat infections
  • Gradual increases in dietary calories from carbohydrates, sugars and fats
  • Gradual increases in dietary protein
  • Intravenous fluids to correct fluid and electrolyte imbalances
  • Lactase to assist in digestion of dairy products
  • Vitamin and mineral supplements to treat deficiencies
COMPLICATIONS:
  • Anemia (low red blood cell count)
  • Coma
  • Frequent infections
  • Intellectual disability
  • Physical disability
  • Poor wound healing
  • Shock
  • Short stature
  • Skin pigmentation changes
  • Fatty liver
PREVENTION:
  • Kwashiorkor can be prevented by including foods in your diet that are rich in proteins, such as 
  1. Meat, 
  2. Fish, 
  3. Dairy products, 
  4. Eggs, 
  5. Soya, and beans.
  • Treatment involves slow increases in calories from carbohydrates, sugars, and fats, followed by protein. 
  • Vitamin and mineral supplements and enzymes to help digest dairy products are often needed
Exam Question
  • Flag sign is seen in kwashiorkor 
  • Kwashiorkor is characterised by Markedly retarded growth, psychomotor changes,Dermatitis,Edema,Flag sign
  • Apathy, Flaky paint dermatosis, Poor appetite & low albumin level is seen in Kwashiorkor 
  • In malnourished subjects, secretory IgA is generally reduced. 
  • In Kwashiorkor
  • , the letter 'K' is post-fixed to denote Edema
Don't Forget to Solve all the previous Year Question asked on Kwashiorkor