Clinical Nutrition

Lesson 3: Protein calorie malnutrition

Kwashiorkor

Unlike marasmus, kwashiorkor is diagnosed based on laboratory indices. In children kwashiorkor is often the result of a low protein, starchy diet during stress periods of growth. In a hospitalized patient under stress and being supported by 50% dextrose solution, kwashiorkor is often seen within as short a period as two weeks. Fat reserves and muscle mass tend to be normal giving a deceptive appearance of adequate nutrition. Signs which help in the diagnosis of kwashiorkor are -

• Easily pluckable hair,
• Edema,
• Delayed wound healing.

Laboratory indices which changes are –

1. Severely depressed levels of serum proteins
   1. Albumin < 2.8g/100ml
      
   2. Transferrin < 150mg/dl
   3. TIBC < 250mg
2. Depression in cellular immune function
   1. Lymphopenia
   2. Lyphocytes < 1200/ cu mm in adults & older children.

Lymphopenia: an abnormally small number of lymphocytes in the circulating blood.

Lymphocyte: a type of white blood cell in the vertebrate immune system.

Full blown kwashiorkor in adults requires aggressive nutritional support. In such patients, surgical wounds do not heal, host defences are compromised and often death may occur from infections despite antibiotic therapy. Kwashiorkor is prevented much more easily than treated