@Cutie_Angel_Mukta 11 October 2020

𝗞washiorkor 𝗣athology & 𝗖auses : ▪ Sufficient calorie intake, severely inadequate protein intake ▪ AKA “the sickness the baby gets when the new baby comes” ▫ Older children in food-scarce environments weaned off breast milk → carbohydrate rich diet ▪ Characterization ▫ Inadequate adaptation; insufficient dietary nutrient intake ▫ Extreme protein deficiency → ↓ liver protein synthesis → osmotic imbalance → edema, abdominal distension ▫ ↓ lymphatic function → ↓ fluid recovery, low lipid absorption → further abdominal distension 𝗦igns & 𝗦ymptoms : ▪ Bilateral pitting edema, distended abdomen (rarely ascites; typically weak abdominal musculature, hepatomegaly) ▪ Hepatomegaly (with fatty infiltration) ▪ Muscle wasting ▪ Integumentary change (thinning hair, skin/ hair depigmentation, dermatitis) ▪ Irritability, listless affect

𝗗iagnosis : DIAGNOSTIC IMAGING Chest X-ray ▪ Infection workup: respiratory distress LAB RESULTS ▪ Hypoglycemia ▪ ↓ blood lipids ▪ Hypoalbuminemia, hypoproteinemia (transferrin, essential amino acids, lipoprotein) ▪ Anaemia (normochromic-normocytic/ hypochromic microcytic/macrocytic) ▪ Electrolyte depletion → hypocalcemia, hypophosphatemia, hypomagnesemia, hypokalemia Infection workup ▪ Blood culture ▪ Common endemic infection tests (e.g. HIV, malaria, parasites) OTHER DIAGNOSTICS Anthropometry ▪ Body weight < 62.36% expected body weight for age ▪ Weight-for-height Z-score < -3 standard deviations → severe wasting ▪ Mean upper arm circumference < 11.5cm/4.53in → severe wasting 𝗧reatment : MEDICATIONS ▪ Prophylactic antibiotics ▫ Malnutrition-induced immunodeficiency compensation OTHER INTERVENTIONS ▪ Correct glycemic, electrolyte, hydration abnormalities ▪ Protein refeeding, gradually ↑ protein amount ▫ Excessively-rapid protein refeeding → protein catabolism → urea accumulation → may overwhelm already-impaired liver → liver failure.