Kwashiorkor

A form of malnutrition; kwashiorkor is a condition resultingfrom inadequate protein intake. Causes, incidence, and risk factors Kwashiorkor occurs most commonly in areas of famine, limitedfood supply, and low levels of education leading to inadequate knowledge of dietand feeding techniques. Early symptoms of any type of malnutrition are very general and include fatigue,irritability, and lethargy. As protein deprivation continues, one sees growthfailure, loss of muscle mass, generalized swelling (edema), and decreasedimmunity. A large, protuberant belly is common. Skin conditions such asdermatitis, changes in pigmentation, thinning of hair, and vitiligo are seenfrequently. Shock and coma precede death. The incidence of kwashiorkor in children in the U.S. is extremely small and onlyrare isolated cases are seen. This is typically a disease of impoverishedcountries often seen in the midst of drought or political turmoil. However, onegovernment estimate suggests that as many as 50 percent of elderly persons inrest homes in the U.S. suffer from protein-calorie malnutrition. Improving calorie and protein intake will correct kwashiorkor provided thattreatment is not started too late. However, full height and growth potentialwill never be achieved. Severe kwashiorkor, may leave a child with permanentmental and physical disabilities. There is good statistical evidence thatmalnutrition early in life permanently decreases IQ. Risk factors include livingin impoverished countries, countries in political unrest and countries affectedby frequent natural disasters such as drought. These conditions are directly orindirectly responsible for scarcity of food which leads to malnutrition. Symptoms * unavailability of adequate food and quality protein * failure to gain weight and failure of linear growth * irritability * lethargy or apathy * decreased muscle mass * edema * large protuberant belly * diarrhea * dermatitis * changes in skin pigment; may lose pigment where the skin has peeled away(desquamated) and the skin may darken where it has been irritated ortraumatized * hair changes; hair color may change often lightening or becoming reddish.The hair thins and becomes brittle. * increased numbers of infections and increased severity of normally mildinfection as a result of damaged immune system * shock (late stage) * coma (late stage) Signs and tests The physical examination may show an enlarged liver(hepatomegaly) and generalized edema. Decreased renal function as shown by changes in: * urinalysis * serum creatinine * creatinine clearance * BUN * serum potassium * arterial blood gas Total protein levels (from a chemistry profile) showinsufficient amounts of albumin proteins (hypoalbuminemia). CBC demonstratespresence of anemia Treatment Treatment varies depending on the severity of the condition.Shock requires immediate treatment with restoration of blood volume andmaintenance of blood pressure. Calories are given early in the form of carbohydrates, simple sugars, and fats.Proteins are given after other caloric sources have already provided increasedenergy. Vitamin and mineral supplements are essential. Since the child will havebeen without much food for a long period of time, starting oral feedings,especially if the caloric density is too high at first, can presents problems.Food must be reintroduced slowly, carbohydrates first to supply energy followedby protein foods. Many children will have developed intolerance to milk sugar (lactoseintolerance) and will need to be supplemented with the enzyme lactase if theyare to benefit from milk products. Expectations (prognosis) Treatment early in the course of kwashiorkor produces goodresults. Treatment of kwashiorkor in its late stages will improve the child'sgeneral health but the child may be left with permanent physical problems andintellectual disabilities. Complications * shock * coma * death * permanent disability Calling your health care provider Although very unlikely to be seen in industrializedcountries, the signs and symptoms of kwashiorkor may suggest child abuse. Prevention Adequate diet with appropriate amounts of carbohydrate, fat(minimum of 10 percent of total calories), and protein (12 percent of totalcalories) will prevent kwashiorkor.