Kwashiorkor

Causes and Risks:

Kwashiorkor occurs most commonly in areas of famine, limited food supply, and low levels of education leading to inadequate knowledge of diet and feeding techniques.

Early symptoms of any type of malnutrition are very general and include fatigue , irritability , and lethargy . As protein deprivation continues, one sees growth failure , loss of muscle mass, generalized swelling ( edema ), and decreased immunity . A large, protuberant belly is common. Skin conditions such as dermatitis , changes in pigmentation, thinning of hair, and vitiligo are seen frequently. Shock and coma precede death.
The incidence of kwashiorkor in children in the U.S. is extremely small and only rare isolated cases are seen. This is typically a disease of impoverished countries often seen in the midst of drought or political turmoil. However, one government estimate suggests that as many as 50 percent of elderly persons in rest homes in the U.S. suffer from protein-calorie malnutrition.

Improving calorie and protein intake will correct kwashiorkor provided that treatment is not started too late. However, full height and growth potential will never be achieved. Severe kwashiorkor, may leave a child with permanent mental and physical disabilities. There is good statistical evidence that malnutrition early in life permanently decreases IQ ( intelligence quotient ). Risk factors include living in impoverished countries, countries in political unrest and countries affected by frequent natural disasters such as drought. These conditions are directly or indirectly responsible for scarcity of food which leads to malnutrition.

Prevention:

Adequate diet with appropriate amounts of carbohydrate , fat (minimum of 10 percent of total calories), and protein (12 percent of total calories) will prevent kwashiorkor.

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 or traumatized
  • 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 mild infection 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:

Total protein levels (from a chemistry profile) show insufficient amounts of albumin proteins (hypoalbuminemia).
CBC demonstrates presence of anemia

Treatment:

Treatment varies depending on the severity of the condition. Shock requires immediate treatment with restoration of blood volume and maintenance 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 increased energy. Vitamin and mineral supplements are essential. Since the child will have been 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 followed by protein foods.

Many children will have developed intolerance to milk sugar ( lactose intolerance ) and will need to be supplemented with the enzyme lactase if they are to benefit from milk products.

Prognosis:

Treatment early in the course of kwashiorkor produces good results. Treatment of kwashiorkor in its late stages will improve the child's general health but the child may be left with permanent physical problems and intellectual disabilities.

Complications:



Call Your Healthcare Provider:
Although very unlikely to be seen in industrialized countries, the signs and symptoms of kwashiorkor may suggest child abuse .