Kwashiorkor ماده التغذيه مهند الحبابي.pdf

Kwashiorkor

1. Kwashiorkor
Done by/ MohnedAL-Hababi.

2. Introduction:-
Definition: Type of malnutrition in which there's:
Acute protein deficiency. Normal or even high caloric intake.
Kwashiorkor means: -Deposed child, who no longer suckled.
A disease the older child catches when a younger baby is
born
Causes:
1-Primary (dietetic) KWO: Occur more frequently with poor,
ignorant mothers due to: Faulty weaning on starchy,
carbohydrate diet. Depressed child -* KWO occur in the I" baby
when a 2nd is born due to: Sudden weaning on starchy (sugary )
food. Maternal deprivation.

3. Introduction:-
2-Secondary KWO The following are predisposing
factors rather than actual causes:
-Pertussis -> due to recurrent vomiting.
-Chronic diarrhea -> due to protein loss in stool.
-Measles -> due to complicating enterocolitis.
-Parasitic infestation e.g. Giardia lamblia.
-Along with associated anorexia & faulty food
restriction

4. Causes of Kwashiorkor :
1) Primary (dietetic) KWO :Occur more
frequently with poor, ignorant mothers due to:
-Faulty weaning on starchy, carbohydrate diet.
-Depressed child→ KWO occur in the I“ baby
when a 2nd is born
-Sudden weaning on starchy (sugary) food.
-Maternal deprivation.

5. Causes of Kwashiorkor :
2) Secondary KWO: The following are
predisposing factors rather than actual causes:
-Pertussis due to recurrent vomiting.
-Chronic diarrhea→ due to protein loss in stool.
-Measles → due to complicating enterocolitis.
-Parasitic infestation e.g. Giardia lamblia.

6. Risk factors of Kwashiorkor :
✓Conditions that interfere with protein absorption.
✓Diets that are low in protein such as a vegan diet.
✓Drought or famine.
✓Infections that interfere with protein absorption.
✓Limited food supply, as may occur during political
unrest.
✓Parasites such as intestinal worms.

7. Risk factors of Kwashiorkor :
✓Poor education about proper nutrition.
✓Insufficient intake of protein of good biological value.
✓Impaired absorption of protein e.g. chronic diarrhoea.
✓Abnormal losses of protein e.g. severe nephrosis. Severe
or prolonged infection.
✓Failure of protein synthesis e.g. chronic liver diseases.

8. Risk factors of Kwashiorkor :
Kwashiorkor is a severe form of malnutrition that occurs due to
a lack of protein in the diet. It is more common in developing
countries and can affect children and adults.
Some of the risk factors that can contribute to the development
of Kwashiorkor include:
1)Poverty.
2)Limited food supply.
3)Poor breastfeeding practices.
4)Infections and diseases.
5)Early weaning.
6)Lack of education on proper nutrition

9. Pathology of Kwashiorkor :
Acute protein deficiency leads to:
Decreased plasma proteins.
Brain -> slow atrophy (but reversible with treatment).
Delayed bone growth, with a reduction of total bone
mass and osteoporosis
Skeletal muscles -> degenerative changes to
compensate for V plasma proteins.

10. Pathology of Kwashiorkor :
Liver -> fatty infiltration (steatosis) but usually no
necrosis nor cirrhosis.
Gastrointestinal tract -> atrophy of villi -> v digestive
& absorptive enzymes.
Pancreas -> atrophy of acini-> V digestive enzymes ->
steatorrhea.
Heart -> degenerative changes in cardiac muscles ->
weakness (heart is small in early stages -> dilated late)

11. Clinical picture of Kwashiorkor :
1)Edema:
•Starts in dorsa of hands & feet -gradually increases to involve face, arms &thigh .
•Facial edema produce prominent cheeks -→ moon face appearance.
•Edema is bilateral, pitting & painless.
Due to:
-Hypoalbuminemia→ reduced plasma osmotic pressure
-Salt & water retention due to decreased inactivation of aldosterone
by the fatty liver
-Increased activity of ADH→ water retention

12. Clinical picture of Kwashiorkor :
2)Mentality changes :
The baby looks apathetic, miserable, disinterested in his surroundings
with marked anorexiaDue to :Reduced aromatic amino acids
reduced serotonine, nicotinic acid & adrenergic neurotransmitters
3)Growth retardation :
Failure to gain weight followed by weight loss → loss of 20-40%
of body weight
4)Muscle wasting :
Due to: Protein deficiency

13. Kwashiorkor Marasmus
Causes caused by a deficiency of protein in the
diet
while Marasmus is caused by a
deficiency of both protein and
calories in the diet.
Onset usually occurs in older infants and young
children, often after the introduction of a
low-protein diet.
often occurs in very young
infants who have been
malnourished since birth.
Symptoms The main symptom of Kwashiorkor is the
swelling of the limbs, face, and belly due
to fluid accumulation.
Marasmus is characterized by
severe wasting of muscle and
body fat, resulting in a very thin
appearance.
Skin and
hair
changes
Kwashiorkor often causes changes in the
skin and hair, such as patches of dry, scaly
skin and dull, discolored hair.
Marasmus, on the other hand,
typically does not cause these
changes.
PrognosisBoth conditions can be life-threatening if left untreated, but Kwashiorkor
has a higher mortality rate. With proper treatment, however, both
conditions can be reversed.
Summary Kwashiorkor is caused by a protein
deficiency, and its main symptom is
swelling.
Marasmus is caused by a
deficiency of both protein and
calories and is characterized by
severe wasting.

14. Diagnosis of kwashiorkor:
First examine you to check for an enlarged liver (hepatomegaly)
and swelling and you will notes that some symptoms:
1-moon face. 2-thin hair. 3-lose teeth. 4-lose of appetite.
5-weight lose. 6-anaemia 7-skin(dry)'(wrinkled)
Next, blood and urine tests may be ordered to measure the level of
protein and sugar in your bloodLaboratorydata of kwashiorkor:
Confirm diagnosis:
Plasma proteins :
-Decreased total plasma proteins (normal 6-8 gm/di).
-Decreased albumin < 2.5 gm/ dl (normal 3.5 -5 gm/dl).

15. Diagnosis of kwashiorkor:

16. Prognosis of kwashiorkor :
In kwashiorkor, mortality decreases as the
age of onset of the disease increases.
Children may not grow or develop
abnormally and may remain stunted.
There can be serious complications when
treatment is not started earlier in the
disease course, including shock, coma,
and permanent physical and mental
disabilities.
Kwashiorkor can be life-threatening if left
untreated

17. Complications of kwashiorkor :
Hepatomegaly (from the fatty liver)
Cardiovascular system collapse/hypovolemic shock
Urinary tract infections
Abnormalities of the gastrointestinal tract including
atrophy of the pancreas with subsequent glucose
intolerance, atrophy of the mucosa of the small
intestine, lactase deficiency, ileus, bacterial
overgrowth, which can lead to bacterial septicemia
and death.
Loss of immune function, antioxidant function,
subsequent infections, septic shock, and death
Metabolic disturbances and hypothermia
Impaired cellular functions, including endothelial
dysfunction
Electrolyte abnormalities are commonplace

18. Treatment of kwashiorkor :
Hospitalization: Phases of treatment include:
•The 1st week: Stabilization phase; include emergency treatment &
slow feeding.
•From 2nd week to the 6th week :Rehabilitation phase ;include
advancement of feeding and supportive treatment.
•From 7th week to 26th weeks:Emergencytreatment (In
the 1st 24-48 hours) for:
1-Hypoglycemia:-Glucose 10% 2-5 ml!kgI.V. then 50 ml by
nasogastric tube , Antibiotics for serious infections,
Frequent feeding every 2-3 hours day & night.

19. Treatment of kwashiorkor :
2-Dehydration: . Start with lactated ringer or half strength saline for
severe dehydration. Oral rehydration solution.(preferably ReSoMal) .
Continue breast feeding or starter formula F-75
3-Anemia: blood transfusion indications: if Heamoglobin< 4 gm/dl
or Heamoglobinbetween 4-6 gm/dl with respiratory distress.
4-Hypothermia : Keep dry and wrap with warmed blankets , Radiant
warmer. Treat hypoglycemia & serious systemic infections.
5-Electrolytes correction: Hypocalcemia--+ Cagluconate10% slow I.V.
Hypomagnesemia--+ Mg sulphateI.M. Hypokalemia --+ add extra
potassium 3-4 m mollkglday
Infections: -Cotrimoxazoleor Ampicillin /Garamycin

20. prevent of kwashiorkor :
To prevent this from happening, parents
can be educated on proper nutrition and
the importance of breastfeeding infants to
ensure they receive all the nutrients they
need. A diet rich in carbohydrates, fats
that make up 10% of the total caloric
needs, and proteins that make up 15% of
the caloric needs can prevent
kwashiorkor.
Proteins can be found in the following foods :
Seafood , Peas ,Nuts ,Seeds ,Eggs , Lean
meat ,Beans

21. Diet for treating kwashiorkor :
The dietary treatment of kwashiorkor involves
providing adequate protein and calories to the
affected individual. The following are some dietary
recommendations for the treatment of kwashiorkor:
1-High-quality protein:
The diet should include high-quality protein sources such as milk, eggs, fish,
chicken, and beans. These foods provide essential amino acids that are
necessary for the growth and repair of body tissues.
2-Energy-dense foods:
The diet should include energy-dense foods such as peanut
butter, vegetable oil, and whole grains. These foods provide
calories that are necessary for the body to function properly.

22. Diet for treating kwashiorkor :
3-Vitamins and minerals:
The diet should include foods that are rich in vitamins and minerals
such as fruits, vegetables, and whole grains. These foods provide
essential nutrients that are necessary for the body to function properly.
4-Gradual refeeding:
The individual should be gradually reintroduced to solid foods to avoid
overwhelming the digestive system. Small, frequent meals should be
provided to help the body adjust to the increased intake of food.
5-Hydration:
The individual should be encouraged to drink plenty of fluids to prevent
dehydration.
It is important to note that the dietary treatment of kwashiorkor
should be done under the supervision of a healthcare professional.
In severe cases, hospitalization may be necessary to provide the
individual with the necessary medical care and nutritional support.

23. Thank You