Marasmus ⚠️: A severe form of malnutrition caused by a total calorie deficiency (protein, fat, and carbohydrate). Unlike kwashiorkor, oedema is absent – instead there is extreme wasting and a “skin-and-bone” appearance.

📖 About

Marasmus = profound energy deficiency. Body breaks down both fat and muscle for fuel.
Common in famine, extreme poverty, or chronic illness in infants/young children.
Often co-exists with micronutrient deficiencies and recurrent infections.

⚠️ Aetiology

General malnutrition – prolonged insufficient intake of calories and essential nutrients.
Seen in regions with food scarcity, refugee crises, or severe neglect.
May also occur in chronic disease (e.g., HIV, TB, cancer cachexia).

🩺 Clinical Features

Muscle wasting 💪 – profound loss of muscle bulk and fat.
Cachexia 😔 – sunken cheeks, prominent ribs, “old man” face in a child.
Growth retardation 📉 – stunted growth and delayed milestones.
Immunodeficiency 🦠 – frequent infections due to impaired immunity.
Hypothermia + bradycardia ❄️❤️ – due to low metabolic reserves.
If untreated → multi-organ failure and death.

🔍 Differentials

Kwashiorkor 🍚 – protein deficiency → oedema, fatty liver, skin/hair changes.
Mixed Marasmic-Kwashiorkor – overlapping features (wasting + oedema).

🧪 Investigations

FBC – anaemia is common.
Serum proteins – low, but usually not as profoundly hypoalbuminaemic as kwashiorkor.
Electrolytes – monitor K⁺, phosphate, Mg²⁺ for risk of refeeding syndrome.
Anthropometry – weight-for-height < –3 SD (WHO definition of severe acute malnutrition).

💊 Management

Stabilisation first ⚕️ – treat hypoglycaemia, dehydration, and infection.
Gradual nutritional rehabilitation 🥣 – small, frequent feeds using WHO “F-75” starter formula → later “F-100” for catch-up growth.
Micronutrient replacement 💊 – vitamins (esp. A, D, folate), iron (added later once stable), zinc, and trace elements.
Electrolyte correction ⚡ – monitor potassium, phosphate, magnesium.
Infection control 🦠 – empiric antibiotics often started due to high risk of occult infection.

📚 References

WHO – Malnutrition

📝 Exam Tip

Marasmus = total calorie deficiency → severe wasting, no oedema.
Kwashiorkor = protein deficiency → oedema, fatty liver, skin/hair changes.
👉 Classic OSCE scenario: “Child with severe wasting, sunken eyes, absent oedema, recurrent infections.”

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Marasmus