15 months old child feeding on cow milk with water wih severe wasting and bipedal edema with poor appetite -
Ans. is 'a' i.e., Kwashiorkar o Kwashiorkar and marasmus are manifestations of protein energy malnutrition (PEM).o Marasmus represents the compensated phase of PEM.o Kwashiorkar represents the uncompensated phase of PEM.Kwashiorkaro It is characterized by following three essential features -EdemaEdema starts in lower extreities and later involves upper limbs and the face.Face appears moon shaped and puffy.Edema is caused by -Hypoalbuminemia Major factorIncreased capillary permeability due to infection.Free radical injury to cell membrane.Markedly retarded growthMuscles of the upper limb are wasted, but the lower extremities appear swollen due to edema.Muscle wasting is masked by edema.Psychomotor (mental) changesChild is lethargic, listless and apathetic (in contrast to marasmus, where the child is alert and irritable).Appetite is impaired (in contrast to marasmus, where children show voracious appetite).Other features of kwashiorkorHepatomegalyDue to fatty infiltrationHair changes in KwashiorkarHair is thin, dry- and brittle, easily pluckableStraight and hypopigmentedFlag sign (Alternate bands of Hypo and hyperpigmented hair corresponding to the period of under and proper nutrition).Skin changes in KwashiorkarLarge areas of skin show erythema followed by hyperpigmentationFlaky paint dermatosis Hyperpigmentation patches desquamate to expose raw hypopigmented areas. Ii gives the appearance of paint flaking off the surface of the wood.InfectionsThese children suffer from recurrent episodes of diarrhoea, respiratory and skin infections.Hepatomegaly is seen in kwashiorkor (not in marasmus).Marasmuso It is characterized by gross wasting of muscle and subcutaneous tissues resulting in emaciation and marked stunting.o There is no edema.o Body weight is less then 60% of expected.o Fat in adipose tissues is severely depleted. However the buccal pad of fat is preserved till the malnutrition becomes extreme because a higher proportion of saturated fatty acids is stored there and the saturated fat is the last to be depleted.o Skin is dry, scaly and inelastic with wrinkles,o The hair is hypopigmented.o Abdomen is distended due to wasting and hypotonia of abdominal wall muscles.o The child is alert but irritable,o Child may show voracious appetite.FeaturesMarasmusKwashiorkorIncidenceMore commonLess commonStage in PEMCompensated phaseUncompensated phaseActivityActiveApathicMuscle wastingObviousSometimes hidden by edema and fatFat wastingSevere loss of subcutaneous fatFat often retained but not firmEdemaNonePresentWeight for heightVery lowLow but may be masked by edemaAppetititeVocarious (good) appetitePoorSkin changesNoneDiffuse pigmentations, flaky paint dermatosisHair changesNoneSparse, silky, easily pulled outAnemiaUncommonCommonHepatomegalyAbsentPresentLiver biopsyNormal or atrophicFatty changesInfectionLess proneMore proneSerum albuminNormal or slightly decreasedLow (< 3g/100 ml)Insulin levelNormalLowOthersMonkey facies Baggy pant appearanceSugar baby appearance Flag sign of hairRecoveryEarlyLong timeMortalityLess than kwashiorkorHigh in early stage
Kwashiorkar
Marasmus
Both
None
Nutrition