Marasmic kwashiorkor

Lesson 3: Protein calorie malnutrition

Marasmic kwashiorkor

The combined form of protein calorie malnutrition develops when the acute stress of illness or surgery is experienced by the chronically starved patient

Characteristic features of marasmus and kwashiorkor

Clinical setting
Marasmus Kwashiorkor
Decreased calories Decreased protein + stress
Time taken to develop
Months, years
  • Starved appearance
  • Weight/Height < 80% of standard
  • Triceps skin fold < 3mm
  • Midarm muscle circumference < 15cm
  • Creatinine Height index < 60%
  • Well nourished appearance
  • Hair –easily pluckable
  • Flag sign in children.
  • Edema
  • Hepatomegaly
  • Hyper pigmentation of skin
Laboratory findings
No changes
  • Serum albumin < 2.8g/100 ml
  • Serum transferring < 150mg /100ml
  • Lymphocytes <1200 cells / cu mm
  • Non reactive skin tests.
Clinical course
Reasonably preserved responsiveness to short term stress.
  • Wound healing.
  • Immunocompetence.
  • Infections and other complications.
Low(unless there is underlying disease)
Hepatomegaly is swelling of the liver beyond its normal size.
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Last modified: Wednesday, 2 November 2011, 9:49 AM