GI - Kwashiorkor

Question 1

Definition

Answer 1

Kwashiorkor or oedematous malnutrition is a disease marked by severe protein malnutrition and bilateral extremity swelling.

Question 2

Epidemiology

Answer 2

1 - 3 years old

Question 3

Aetiology

Answer 3

Unknown

Question 4

Risk factors

Answer 4

• Endemic food insecurity or famine
• Rural communities
• < 5 years of age
• Monotonous diet based on corn or cassava

Question 5

Pathophysiology

Answer 5

Inadequate protein
intake, malnutrition, and altered metabolism, leading to various physiological changes in the body.
Primary characterised by a severe deficiency of dietary protein = Inadequate protein intake leads to a lack of essential amino acids.
Certain amino acids, such as arginine, cysteine, and histidine, become particularly deficient in kwashiorkor = plays important role in immune function, wound healing, and antioxidant defences.

Question 6

Body’s undergoes significant metabolic changes

Answer 6

• Energy metabolism shifts
  towards the utilization of alternative energy sources, such as glucose and fat stores. This results in decreased insulin production and increased lipolysis (breakdown of fats) as the body tries to compensate for the lack of energy from protein.
• The liver = protein metabolism, including the synthesis of albumin, clotting factors, and other important proteins. In kwashiorkor, the liver may become enlarged due to
  fatty infiltration and impaired liver function. This leads to a reduction in the synthesis of
  proteins, disruption of metabolic processes, and altered immune function.
• Protein deficiency affects the balance of fluids in the body. Decreased levels of proteins,
  particularly albumin, in the bloodstream contribute to a reduction in oncotic pressure. This leads to the movement of fluid from the blood vessels into the interstitial spaces, causing oedema characteristic of kwashiorkor.
• Kwashiorkor can lead to imbalances in electrolytes, such as sodium, potassium, and
  magnesium, due to fluid shifts and altered kidney function.

Question 7

Symptoms

Answer 7

● Bilateral pitting oedema
● Hair discolouration-Hair becomes thin, sparse, and easily pulled out, and black hair
often turns orange or reddish-brown in colour.
● Dermatosis/ulceration-Classically seen as hyper-pigmentation
● Malnutrition
● Delayed wound healing
● Hepatomegaly
● Skin and hair changes
● Protuberant belly

Question 8

Investigations

Answer 8

FIRST LINE =
- Clinical diagnosis
- FBC
- U and E’s
- LFTs
- Urea and Creatinine

Question 9

Management

Answer 9

Nutritional rehabilitation
- Therapeutic feeding = (RUFTS)
- Breastfeeding promotion
Establish a balanced diet
Fluid management
Consider Abx

Question 10

Complications

Answer 10

Growth stunting
Loss of vision