Learning Objectives
- Distinguish between Kwashiorkor and Marasmus based on clinical presentation.
- Explain the pathophysiology of edema and fatty liver in protein malnutrition.
- Identify the “MEALS” mnemonic for rapid board recall.
1. Kwashiorkor (Protein Malnutrition)
Kwashiorkor is primarily a protein deficiency in the setting of adequate (or slightly deficient) caloric intake. It is classically seen in a child after being weaned from breast milk to a high-carbohydrate, protein-poor diet.
- Edema: Caused by a decrease in plasma oncotic pressure due to low serum albumin. This is further exacerbated by increased antidiuretic hormone (ADH).
- Fatty Liver (Hepatomegaly): Malnutrition leads to decreased apolipoprotein synthesis. Without these proteins, lipids cannot be transported out of the liver, resulting in fatty change.
- Clinical Appearance: Small child with a characteristically swollen abdomen.
Mnemonic: Kwashiorkor results from protein-deficient MEALS:
- Malnutrition
- Edema
- Anemia
- Liver (Fatty)
- Skin lesions (e.g., hyperkeratosis, dyspigmentation)
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2. Marasmus (Total Caloric Malnutrition)
Marasmus is a state of overall energy deficiency. The diet is deficient in total calories, but no specific nutrients are absent.
- Muscle Wasting: The body utilizes muscle tissue for energy, leading to significant emaciation.
- Absence of Edema: Unlike Kwashiorkor, oncotic pressure is relatively maintained, so there is no edema.
- Growth: Linear growth is often maintained in acute cases, whereas chronic malnutrition eventually stunts linear growth.
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Summary Comparison
| Feature | Kwashiorkor | Marasmus |
|---|---|---|
| Primary Deficiency | Protein | Total Calories (Energy) |
| Edema | Present | Absent |
| Liver Involvement | Fatty Liver (Apolipoprotein ↓) | Uncommon |
| Body Habitus | Swollen abdomen (“Potbelly”) | Emaciated (“Skin and bones”) |
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