Kwashiorkor

Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet. It is usually an acute form of childhood protein-energy malnutrition. The presence of edema caused by poor nutrition defines kwashiorkor.

Kwashiorkor is most common in areas where there is famine, limited food supply and low levels of education. This disease is more common in very poor countries. It often occurs during a drought, other natural disasters or during political turbulence. These conditions are responsible for scarcity of food, which leads to malnutrition.

Symptoms:

  • Changes in skin pigment
  • Decreased muscle mass
  • Diarrhea
  • Failure to gain weight and grow
  • Fatigue
  • Changes in color and texture of hair
  • Increased and more severe infections due to damaged immune system
  • Irritability
  • Protruding abdomen
  • Lethargy or apathy
  • Loss of muscle mass
  • Rash
  • Swelling or edema

Diagnostic Evaluation:

The physical examination may show an enlarged liver or hepatomegaly and generalized swelling.

Other tests may include:

  • Arterial blood gas
  • BUN
  • Complete blood count (CBC)
  • Creatinine clearance
  • Serum creatinine
  • Serum potassium
  • Total protein levels
  • Urinalysis
  • Coma
  • Permanent mental and physical disability
  • Shock

Possible Complications:

  • Coma
  • Permanent mental and physical disability
  • Shock

Management:

  • Getting more calories and protein will correct this form of malnutrition, if treatment is started early enough. However, children who have condition will never reach their full potential for height and growth.
  • Treatment depends on the severity of the condition. Patients who are in shock need immediate treatment to restore blood volume and maintain blood pressure.
  • Calories are given first in the form of complex carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.
  • Since the patient has not taken in adequate food for a long period of time, eating can cause problems, especially if high caloric foods are given simultaneously. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.
  • Many malnourished children will develop lactose intolerance. They need to be given supplements with the enzyme lactase, so that they can tolerate milk products.

As kwashiorkor is a nutrition problem, make sure that the diet is composed of 40-50% carbohydrates, 25-35% protein and 20-30% fat.

Photo credits: www.nlm.nih.gov

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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