Makindo Medical Notes

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

• WHO – Malnutrition
• NCBI – Kwashiorkor

📝 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.”