CLINICAL NUTRITION

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

Weeks

Clinical Features

• 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.

Mortality

Low(unless there is underlying disease)

High

Hepatomegaly is swelling of the liver beyond its normal size.