Kwashiorkor 🍚: Classically occurs when a child is weaned from breast milk (protein-rich 🍼) to a carbohydrate-heavy diet (e.g., maize porridge) that is grossly deficient in protein. Despite adequate calories, the lack of protein leads to serious metabolic derangements.

📖 About

Kwashiorkor = protein-energy malnutrition caused by protein deficiency with relatively adequate energy intake.
Seen most often in developing regions where diets are high in carbohydrate staples but lack essential amino acids.

⚠️ Aetiology

Low dietary protein intake after weaning from breast milk.
Diet dominated by carbohydrates (e.g., cassava, maize, yams, rice).
Poverty, famine, or displacement can precipitate the condition.
Contributory factors: chronic infections, poor weaning practices, or limited access to animal protein.

🩺 Clinical Features

Oedema 💧 – pitting oedema of legs, feet, and sometimes face due to hypoalbuminaemia.
Swollen abdomen 🌐 – ascites + hepatomegaly from fatty liver.
Skin/hair changes 🎨 – “flaky paint” dermatitis, hyperpigmentation, depigmentation, hair that is sparse and depigmented (“flag sign”).
Growth retardation 📉 – stunted growth, failure to thrive.
Behavioural changes 🧒 – apathy, irritability, and intellectual impairment in severe cases.
Recurrent infections 🦠 – due to profound immune suppression.

🔍 Differentials

Marasmus – due to total calorie deficiency → extreme wasting without oedema.
Mixed malnutrition (marasmic-kwashiorkor).

🧪 Investigations

Serum proteins – low albumin, low total protein.
FBC – anaemia (multifactorial: iron, folate, chronic disease).
Electrolytes and glucose monitoring – for risk of refeeding syndrome.
LFTs – fatty liver changes.

💊 Management

Stabilisation first ⚕️ – treat hypoglycaemia, dehydration, electrolyte imbalance, and infections.
Careful nutritional rehabilitation 🥣 – gradual reintroduction of protein and calories to avoid refeeding syndrome.
Therapeutic feeds – e.g., WHO “F-75” (stabilisation phase) followed by “F-100” (rehabilitation phase).
Micronutrient supplementation 💊 – vitamins (esp. A, D, folate), zinc, and iron (after stabilisation).
Close monitoring 👀 – watch for heart failure, electrolyte disturbances, and sepsis.

📚 References

📝 Exam Tip

Key difference: Kwashiorkor = oedema, fatty liver, flaky skin, hair changes. Marasmus = severe wasting, no oedema. A common exam vignette: “Child with swollen belly, oedema, weaned onto maize porridge.”

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Kwashiorkor