Kwashiorkor

Kwashiorkor

Definition

Kwashiorkor is a severe form of malnutrition characterized by edema (swelling of body tissues), particularly in infants and young children. It occurs due to inadequate protein intake or excessive loss of protein from the body.

Causes / Etiology

Kwashiorkor is caused by a combination of factors including:

1. Inadequate dietary intake of protein or calories.
2. Infection, such as diarrhea or malaria, which can lead to excessive loss of protein from the body.
3. Poor absorption of nutrients due to gastrointestinal disorders.
4. Severe emotional stress, which can lead to changes in appetite and eating habits.

Types or Classification

Kwashiorkor can be classified into two main types:

1. Primary Kwashiorkor: This is the most common type and is caused by inadequate dietary intake of protein or calories.
2. Secondary Kwashiorkor: This type is caused by excessive loss of protein from the body due to infection or other diseases.

Pathology

The pathogenesis of kwashiorkor is a complex process involving multiple steps:

Step 1 → Step 2 → Step 3

Step 1: Inadequate dietary intake of protein or calories leads to a decrease in the concentration of albumin in the blood.

Step 2: The decrease in albumin concentration leads to a shift of fluid from the blood vessels to the tissues, resulting in edema.

Step 3: The edema, in turn, leads to a decrease in the concentration of nutrients and oxygen in the tissues, resulting in impaired growth and development.

Clinical Features

General Features:

• Edema (swelling of body tissues)
• Muscle wasting
• Poor appetite
• Fatigue
• Poor growth and development

Specific Features:

• Moon face (round face with prominent cheeks and temples)
• Red or pink coloration of the skin
• Thin, fragile hair
• Poor wound healing
• Increased susceptibility to infection

Complications

Acute Complications:

• Severe dehydration
• Electrolyte imbalance
• Septicemia (blood infection)
• Respiratory failure

Chronic Complications:

• Impaired growth and development
• Cognitive impairment
• Increased susceptibility to infections
• Increased risk of cardiovascular disease

Diagnosis / Investigations

Routine Tests:

• Complete Blood Count (CBC)
• Blood chemistry tests (including albumin and electrolyte levels)
• Urine tests (including ketone and glucose levels)
• Stool tests (including for bacterial and parasitic infections)

Special Tests:

• Liver function tests
• Kidney function tests
• Endoscopy (for gastrointestinal disorders)
• Imaging studies (such as X-rays or ultrasound)

Management

General Management:

• Hospitalization for severe cases
• Rest and relaxation
• Adequate nutrition and hydration
• Treatment of underlying infections

Modern Treatment:

• Intravenous fluids and electrolytes
• Parenteral nutrition
• Antibiotics for bacterial infections
• Antimalarial medications for malaria

Dietary Advice:

• High-calorie diet with adequate protein
• Frequent, small meals
• Breastfeeding for infants
• Exclusive formula feeding for infants with a history of allergy or intolerance

Homeopathic Therapeutics

1. Arsenicum album:

   • Symptoms: Fatigue, weakness, and anxiety
   • Treatment: Given for symptoms of edema, weight loss, and poor appetite
   • Dosage: 6c, 3 times a day

2. Calcarea carbonica:

   • Symptoms: Fatigue, weakness, and poor appetite
   • Treatment: Given for symptoms of muscle weakness and poor growth and development
   • Dosage: 6c, 3 times a day

3. Natrum muriaticum:

   • Symptoms: Edema, weight loss, and poor appetite
   • Treatment: Given for symptoms of fluid retention and poor nutrition
   • Dosage: 6c, 3 times a day

4. Phosphorus:

   • Symptoms: Fatigue, weakness, and poor appetite
   • Treatment: Given for symptoms of muscle weakness and poor growth and development
   • Dosage: 6c, 3 times a day

5. Silica:

   • Symptoms: Edema, weight loss, and poor appetite
   • Treatment: Given for symptoms of fluid retention and poor nutrition
   • Dosage: 6c, 3 times a day