Makindo Medical Notes

Famously occurs when a child is weaned from breast milk, which contains essential protein, to a sugar-rich diet deficient in protein.

About

• Kwashiorkor: A form of malnutrition characterized by a severe deficiency in protein intake despite sufficient overall calorie consumption.

Aetiology

• Primarily caused by protein malnutrition, often seen in areas where diets are predominantly carbohydrate-based and lack adequate protein.
• Commonly occurs in children after weaning when they switch to a diet low in protein but high in carbohydrates.

Clinical Features

• Oedema: Swelling of the skin due to fluid retention, often noticeable in the legs and feet.
• Hyperkeratosis and pigmentation changes: Thickened skin with areas of pigmentation or depigmentation.
• Ascites: Fluid accumulation in the abdomen, contributing to the characteristic swollen belly.
• Fatty liver: The liver becomes enlarged and infiltrated with fat due to protein deficiency.
• Gut oedema: Swelling of the intestines, leading to poor nutrient absorption and digestion.
• In severe cases, intellectual impairment, increased susceptibility to infections, and death may occur.

Differentials

• Marasmus: Another form of malnutrition caused by overall calorie deficiency, in contrast to the protein deficiency seen in kwashiorkor.

Investigations

• Low serum protein levels: Indicative of protein malnutrition.
• Anaemia: Often seen due to a lack of essential nutrients required for red blood cell production.

Management

• Dietary intervention: The primary treatment is to reintroduce adequate amounts of protein into the diet, often through therapeutic feeding programs.
• Supplementation: Vitamin and mineral supplements may be necessary to address any additional deficiencies.
• Close monitoring: Careful refeeding is necessary to prevent complications such as refeeding syndrome, which can occur when nutrients are reintroduced too quickly.

References

• WHO - Malnutrition

Revisions

• Ensure that management protocols for protein refeeding are followed to prevent complications.