- Kwashiorkor : There is deficiency of protein with adequate energy intake.
- Marasmus : is due to severe and prolonged restriction of all food (energy sources + protein + other nutrients). It is seen in infants usually under one year.
Kwashiorkor
- It is mostly occurs in age of 2 when the child is shifted from breast milk to low protein diet or to a cereal that is refined and disputed.
Clinical features :
- Oedema generalised
- Growth retardation
- Poor appetite
- Hair become thin and sparse
- Hair colour changes from black to grey.
- Diarrhoea
- Liver is enlarged
Investigation :
Lab. finding is very low plasma albumin.
Marasmus
- It is childhood version of starvation (Starvation in infants).
- It usually occcurs after six months of age.
Cause :
Very Low diet in calories, protein and essential nutrients
Clinical Features :
- Muscle wasting
- Very thin child with no subcutaneous fat
- Limbs look like sticks
- Weight is reduced below 60% of standard weight
- No oedema
- No or mild skin and hair changes
Management :
Severe PEM both kwashiorkor and marasmus is dealt in three phases :-
I. Resuscitation :
Correction of dehydration, electrolyte imbalance, acidosis, hypoglycaemia and hypothermia.
II. Start of the cure :
- This consists of refeeding, gradually giving calories to 150 Kcal/kg with protein about 1.5g/kg.
- They are usually based on dried shimmed milk mixed with some flour or sugar and given 5-6 times a day.
- Potassium, magnesium and a multi-vitamin mixture are also needed.
III. Nutritional rehabilitation :
- After about 3 weeks, the child should be better.
- After this, mother should be educated about nutrition and helped to obtain extra food.
Main features of kwashiorkor and Marasmus –
| Kwashiorkor | Marasmus |
| Oedema Growth retardation Skin and hair changes Poor appetite | Wasting (muscle) Irritability Infections Good appetite |