Marasmus And Kwashikor

Question 1

What is Marasmus?

Answer 1

• Insufficient energy intake resulting in negative energy balance

Question 2

What are the multiple nutritional deficiencies of Marasmus?

Answer 2

• Energy
• Protein
• Vitamins And Minerals
• Dehydration

Question 3

What are other characteristics of marasmus ?

Answer 3

• Can occur in anyone with severe malnutrition, but typically found in children
• Chronic slow onset
• Severe weight loss

Question 4

What are the clinical/ physical signs and symptoms of Marasmus?

Answer 4

• Muscle wasting most prominent symptoms
• Protruding ribs
• Diarrhoea and dehydration is common
• No protruding abdomen
• Negative energy balance leads to mobilisation of fat stores
• Muscle proteins broken down to amino acids for gluconeogenesis

Question 5

What is Kwashikor?

Answer 5

Insufficient protein intake leading to a deficit in essential amino acids

Question 6

What are characteristics of Kwashikor?

Answer 6

• Energy intake typically normal
• Rapid acute onset
• Some weight loss
• High mortality
• Poor appetite
• Disease in children between 1.5 to 3 years typically when displaced from breast milk by younger siblings
• Typically in developing countries

Question 7

What are the clinical signs and symptoms of Kwashikor?

Answer 7

• Presence of bilateral pitting oedema
• Hair changes (brownish, scanty, straight)
• Flaky appearance of skin
• A large, protuberant abdomen
• Anaemia
• Enlarged and fatty liver, contributes to protuberant abdomen

Question 8

What is the assessment for bilateral pitting oedema

Answer 8

• Normal thumb pressure applied to both feet for three
seconds.

• Persistent shallow pit on both feet after thumbs are lifted confirms presence of oedema.
• Only way to confirm nutritional oedema. Not possible to tell by just looking.

Question 9

What is Starlings law of capillary ?

Answer 9

• Governs the passive exchange of water between capillaries and interstitial fluid.

Question 10

What is the mechanism of oedema?

Answer 10

• Insufficient protein intake in kwashiorkor results in a deficit in essential amino acids
• Limits ability of liver to produce serum albumin
• Decreased plasma protein leads to greater net flow of fluid into interstitium (oedema)

Question 11

What is the equation for Starling’s law of the capillary

Answer 11

Flow net= (Pc-Pi) – (πc-πi)

Pg 22 Topic review

Question 12

What is the Livers function?

Answer 12

• Metabolise carbohydrates to fat

• Synthesise lipoproteins required to transport this fat
around body in blood.

• Synthesise serum proteins (e.g. albumin)

Question 13

How does fatty liver occur?

Answer 13

• If liver is unable to synthesise sufficient lipoproteins due to dietary deficiency of essential amino acids, lipids will accumulate in liver instead of being transported around body leads to fatty liver leads to hepatic dysfunction

Question 14

How to reintroduce food for marasmus?

Answer 14

• Reintroduction of food slowly – small amounts, carefully monitored

Question 15

How to reintroduce food with Kwashikor?

Answer 15

• Unable to deal with protein rich foods in large amounts due to downregulation of enzymes in urea cycle
• Can leads to build up of ammonia which is toxic
• Therefore feed small amounts of protein at regular intervals is required

Question 16

What is Re-feeding Syndrome?

Answer 16

• Occurs clinically in anorexic patients, cancer patients, post surgery,alcoholics
• Can lead to confusion, coma, convulsion, death

• Precise cause unclear but ammonia toxicity due to downregulation
of enzymes in urea cycle thought to play a role.

• Also, rapid increase in metabolism on re-feeding will utilise more
phosphate, Mg2+ and K+. Body stores are already depleted and
electrolyte abnormalities such as hypophosphataemia can occur if
re-feeding too rapid

• Re-feed at 5 -10 kcal/kg/day raised gradually over 1 week