Kwarshiorkor

Primary malnutrition is caused by a lack of adequate caloric intake rather than strictly lack of access to food, and most commonly affects children and the elderly. Secondary malnutrition is when a disease process decreases appetite, alters absorption, or disrupts nutrient metabolism. Kwarshiorkor refers to a state of primary malnutrition wherein the overall caloric intake may be adequate, but there is a severe lack of protein intake. The term kwarshiorkor comes from West Africa and is translated as “displaced child,” referring to the malnutrition seen after a child has been weaned from breast milk, a reliable source of protein. Kwarshiorkor is rarely seen in developed countries but is common in poor areas, regions of famine, places with limited food supply, or places with low levels of education. Several physical features are found in children with protein malnutrition. Children often only weight 60 to 80 percent of the weight expected for their age, and the height ranges from normal to decreased. They have a round and protuberant abdomen because of weak abdominal wall muscles, distention of the intestines, and an enlarged liver. Emotionally, children with kwarshiorkor are apathetic when left alone and quickly become irritable and agitated when picked up or held. There is decreased pigmentation of the hair, leading to a reddish-brown, gray, or blond discoloration. The hair on the scalp may thin and fall out easily. The skin may lose pigmentation, and there may be easy desquamation, or shedding of the skin. There is an overall loss of muscle mass and swelling (edema). In late stages, kwarshiorkor can worsen to shock and death.

Treatment depends on the condition of the patient. It is an emergency if the patient has reached the shock stage; treatment involves restoring and maintaining blood pressure. Refeeding can be difficult, and care must be taken to avoid refeeding syndrome complications such as fluid overload, electrolyte imbalances, heart arrhythmias, and diarrhea. Oral feedings are often not successful initially, especially if the caloric density of the food is too high. Resumption of caloric intake begins with slow introduction of carbohydrates to supply energy and then the addition of proteins.

Treatment of kwarshiorkor early in the course of illness usually results in recovery, with few long-term consequences. However, in the late states, there may be stunting of physical growth and decreased intellectual abilities. If left untreated, kwarshiorkor is fatal.