Malnutrition in a child: Kwashiorkor Flashcards
Define Kwashiorkor.
Oedematous malnutrition affecting children, characterised by bilateral pitting oedema, in the absence of another medical cause of oedema.
Explain the aetiology/risk factors for Kwashiorkor.
Severe deficiency of protein/essential amino acids
Corn or cassava diet
Recent cessation of breastfeeding, high birth order, and incomplete immunisation. Uncertain family status such as parental death, not living with a parent, unmarried carer, young age of mother, living in a temporary home, or parents not owning land have also been suggested as contributing factors but remain unconfirmed.
Summarise the epidemiology of Kwashiorkor.
Kwashiorkor is almost never seen in developed countries.
Widespread in sub-Saharan Africa and common in SouthEast Asia and Central America, kwashiorkor occurs in young children living in areas with endemic food insecurity or famine. The prevalence varies by geographic area, with reported levels of severe acute malnutrition ranging from 6% in chronic food-insecure communities to 25% of young children in areas facing famine.
What are the signs and symptoms of Kwashiorkor?
Growth retardation, diarrhoea, apathy, anorexia
Oedema: Skin/hair depigmentation, abdominal distention with fatty liver
What are appropriate investigations for Kwashiorkor?
Urine dipstick, FBC, serum electrolytes, serum protein, albumin, blood glucose, chest x-ray, urine culture, blood culture.
Stool culture, TB skin testing, HIV (PCR), malaria screen, echo.
What is the management plan for Kwashiorkor?
- Correct dehydration and electrolyte imbalance (IV If required)
- Treat underlying infection and/or parasitic infections
- Treat concurrent/causative disease
- Treat specific nutritional deficiencies
- Orally reefed slowly- watch out for refeeding syndrome
What are complications associated with Kwashiorkor?
Growth stunting
Loss of vision
Treatment related congestive heart failure
What is the prognosis of Kwashiorkor?
Uncomplicated kwashiorkor treated with community-based therapeutic care has a mortality of 5% to 15%. However, for complicated cases with HIV infection, mortality can be as high as 30% during admission and 50% at 1 year.
Longlasting neurodevelopmental defects from uncomplicated kwashiorkor are under-studied but are likely. Faltering growth does not have to be permanent if an appropriate diet can be established and maintained, but growth stunting is common as many children return to a food-insecure environment.
Up to 10% of children returning to the same environment will have a further episode of oedema, which can be successfully managed with prompt initiation of treatment. Blindness resulting from corneal ulceration is now a rare occurrence owing to the routine administration of vitamin A (retinol) and the recognition and treatment of xerophthalmia at an early stage.
