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.
