Kwashiorkar and Marasmus

Kwashiorkor:

• It is a disease marked by severe protein malnutrition and bilateral extremity swelling.
• Usually affects infants and children around the age of weaning to age 5.
• Seen in severe cases of starvation and poverty-stricken areas.
• Major symptoms: pitting edema (edematous), anorexia, skin change.
• Diet based on maize, cassava or rice mainly is associated with this disease.
• Main factors that contribute are recent weaning, recent infection (measles), and disruptions to childhood.

Pathophysiology:

Characterized by peripheral edema which results from loss of fluid balance between hydrostatic and oncotic pressure across capillary blood vessels walls. Due to the low level of albumin, they became intravascularly depleted. Subsequently, ADH increases resulting in edema. Plasma renin also responds and cause sodium retention. This also contributes to edema.

Kwashiorkor is also marked by low glutathione (antioxidant ) levels. And thus high oxidant levels cause chronic inflammation.

Symptoms or clinical manifestations:

• peripheral pitting edema
• marked muscle atrophy
• abdominal distention
• round or "moon face"
• thin, dry peeling skin with areas of scaling and hyperpigmentation
• dry, hypopigmented hair with weak roots
• hepatomegaly
• growth retardation 
• anorexia, apathy
• skin lesions/ dermatitis
• subcutaneous fat retention with loose skin folds.

Treatment and Management:

• Treating and preventing hypocalcemia, hypothermia, dehydration, infection.
• correcting electrolyte imbalance 
• correcting micronutrient deficiencies
• ReSolMal (Rehydration Solution of Malnutrition) is a customized solution that can be given orally or via nasogastric tubes that contain the exact amount of mineral/ electrolyte, sugar, and water that WHO recommends.

Complications:

• Cardiovascular system collapse/ hypovolemic shock.
• Urinary tract infections
• Abnormalities of GI tract like atrophy of pancreas, glucose intolerance, bacterial overgrowth etc.
• Loss of immune function, antioxidant function septic shock, and death.
• Endocrinopathies (low insulin, high GH) this leads to insulin intolerance
• metabolic disturbances and hypothermia 
• endothelial dysfunction
• electrolyte abnormalities.
• hepatomegaly.

MARASMUS:

It is the chronic state of malnutrition.

Causes:

• improper feeding
• infection (e.g., pyelitis, syphilis, tuberculosis)
• congenital weakness of disease (prematurity, congenital heart disease)
• defective hygiene
• poor environment and constitutional weakness

Features:

• variable appetite
• abnormal body temperature
• pulse is small and slow
• blood is thin and pale
• the rigidity of muscles, opisthotonos also develops

Treatment;

• skimmed milk
• whey
• fresh milk and water mixtures (equal parts)
• prolonged cooked milk improves digestibility
• mixture of carbohydrates
• acidification of milk

Symptoms;

Marasmus is known as the wasting syndrome (malnutrition without edema). Children have depleted fat stores, low height and weight, thin, dry skin, the head appear large relative to the body, weak appearance, bradycardia, hypotension, hypothermia, thin shrunken arms, thighs, and buttocks with redundant skin folds.

Differences between Kwashiorkor and Marasmus:

Kwashiorkor:

1. It is the state of chronic protein deficiency.
2. Usually seen in 1-5 years of the child.
3. Subcutaneous fat is less affected
4. 'Moonface' (puffy edema)
5. Skin is smooth and has edema with dermatosis, pigmentation/depigmentation, and deep cracks.
6. Discolored hair with weak roots
7. Not a happy child, irritable, apathetic.

Marasmus:

1. Extreme deficiency of protein and calorie.
2. generally, occur before the age of 1.
3. marked wasting of muscles and subcutaneous fat
4. thin face
5. skin can be lifted off like folds, giving the 'skin & bone' appearance
6. hairs are not affected.
7. Alert child, less indifferent.