The following symptomatology is evident in acute or chronic phase of Kwashiorkor:
General appearance: Kwashiorkor patients show apathy and lethargy as acute signs. They may appear with signs of easy irritability which are all attributed to low energy levels due to lack of protein. They are generally thin with cachexia due to the absence of muscle mass with defective protein synthesis.
Integumentary system: Hair may appear with different shades of light and dark bands referred to as the “flag sign”. The different hues in the hair represents the different periods of impaired nutrition. The skin will appear flaky due incompetent connective tissues formed from a defective protein synthesis process.
Cardiovascular and respiratory system: The heart may present with mild murmur due to micronutrient deficiency anemia or impending heart failure in the late stages. Pericardial effusion may present with severe PEM in children . Breathing may be shallow due to metabolic acidosis.
Abdomen: The abdomen may be protuberant or enlarged due to ascites. The liquid damming in the abdominal cavity is due to the hypoalbuminemia effect on osmosis. Hepatomegaly may ensue with chronic fatty liver disease. Intestinal parasitism may not be infrequent with severe malnutrition.
Patients with Kwashiorkor are often subjected to these following tests:
The early intervention of fulfilling protein caloric deficiency in Kwashiorkor will greatly improve patient’s outlook. Dietary replacement therapy are arbitrarily dependent on the severity of the disease. Caloric replacement will usually start with carbohydrates and simple sugars until the patient is able to achieve adequate energy.
By then protein infusion may be necessary along with supplemental vitamins and minerals. Patients who underwent prolonged starvation may not be immediately infused with protein because it may trigger a Refeeding Syndrome (RS) which leads to the uncontrolled catabolic action of insulin . Kwashiorkor patients with superimposed infections treated with antibiotics should be reevaluated for the kidney’s clearance of the drugs used because it is usually impaired in PEM .
Kwashiorkor and other protein energy malnutrition is considered a metabolic emergency. Patients who get medical care early have a good outlook in the clinical course of the disease.
However, those treated at the later stage of the disease may still be alleviated but permanent conditions like mental and growth retardation may occur. Patients who demonstrated lipids and ketones in the urine may have a poorer prognosis with PEM .
Kwashiorkor and PEM carries a grim prognosis when it occurs in patients below 5 years of age and in elderly people beyond 55 years old .
The primary protein energy state in Kwashiorkor may give rise to these complications:
The basic etiology in Kwashiorkor is the limited or meager supply of food available in the community. This condition is greatly influenced by drought, famine, war, and political unrest which are common in some countries in Africa and Central America.
Kwashiorkor may also prevail in communities with no access to protein-rich foods like meat and poultry and are solely dependent on carbohydrates from grains and vegetables.
The incidence of Kwashiorkor in the US is relatively low but PEM is somewhat prevalent among hospitalized patients. The World Health Organization in 2000 announced that there at least 181.9 million children suffering from severe malnutrition especially in developing countries. Statistics in Central Asia and Eastern Africa reveal that approximately half of the children have some form of growth retardation due to protein energy malnutrition.
About 5 million children deaths in the developing countries are related to PEM and Kwashiorkor. Mortality rates in Kwashiorkor decrease with increasing age of its onset. The dark skinned races have more incidence of Kwashiorkor due to the relatively poor socio-economic situation in their country that affects dietary input.
Mediated by some complex mechanism, children suffering from sickle cell anemia are predisposed to PEM and Kwashiorkor .
Kwashiorkor as a protein energy malnutrition state in children happens with adequate carbohydrate nutrition but devoid of protein sources.
This condition will lower the body’s drive to produce its own visceral protein leading to poor energy supply. In Kwashiorkor, low protein substrates (raw materials) can lead to hypoalbuminemia that causes the extravasation of fluid to the extracellular space manifesting as edema.
Consequently, this low protein state may impair the production of B-lipoproteins that results in a fatty liver . The inadequate production of transfer proteins may lead to micronutrient deficiency like zinc.
The concurrent zinc deficiency is implicated as the main cause of skin diseases like ulcerations in Kwashiorkor patients. Kwashiorkor is seen to affect glucose clearance in the blood causing a dysfunction in the beta-cells of the pancreas . Pregnant mothers with PEM may affect inherent metabolic physiology of the fetus that my result to marasmus or Kwashiorkor when the baby is born .