Iseline was sent to us by Dr. Jen in April. She has kwashiorkor and was sick. It took her several months to recover.
Here she is going home with a weight gain of 6 pounds. Her mother is 6 months pregnant with another child. But was so happy to be able to take her back home. She will follow-up with 2 week check up for a few months.
This is Elmanica. She is five years old and lives about 20 minutes from the RC. Her mother only has one other child. That child lives with someone else. It is hard to understand why but she is not getting enough food. This is the first time she has had Kwashiorkor. She is very weak and tired always sleeping.
Near the end of May this young 13 year old girl was admitted into the RC. She was suffering from Kwashiorkor. She was so sick that she could not walk with out someone helping her the first two weeks she was here. She is improving greatly.
Many times when children come into the RC with kwashiorkor, their hair is an orange color, it breaks, and falls out. She has lost a lot of her hair. But, I want you to first notice in the picture the orange colored part in her hair. This is where it was when she first got her at the end of May. Now notice the black hair coming in. This always totally amazes me that just eating healthy foods 5 times a day can change your body that quickly. She still needs to gain a few more pounds before I send her back home.
SOME MORE INFO ON KWASHIORKOR
Kwashiorkor is a form of protein-energy malnutrition caused by the inadequate intake of protein with reasonable caloric (energy) intake. The other form of protein-energy malnutrition is the condition known as marasmus. Marasmus involves inadequate intake of both protein and calories. Hence, protein-calorie malnutrition encompasses a group of related disorders that include kwashiorkor, marasmus, and intermediate or mixed states of kwashiorkor and marasmus.
What are the signs and symptoms of kwashiorkor?
Early signs of kwashiorkor present as general symptoms of malnutrition and include fatigue, irritability and lethargy. As protein deprivation continues the following abnormalities become apparent.
- Failure to thrive (failure to put on height and weight)
- Loss of muscle mass
- Generalised swelling (oedema)
- Large protuberant belly (pot belly)
- Fatty liver
- Failing immune system so prone to infections and increased severity of normally mild infections
- Skin and hair changes
Cutaneous features of kwashiorkor
Characteristic skin and hair changes occur in kwashiorkor and develop over a few days.
- Skin lesions are at first erythematous before turning purple and reddish-brown in colour with marked exfoliation (skin peeling and sloughing)
- Where the skin becomes dark and dry, it splits open when stretched to reveal pale areas between the cracks (“lacquered flaky paint”, “crazy pavement dermatosis”)
- Irregular or patchy discolouration of the skin caused by pigmentary changes
- Hair becomes dry and lustreless and may turn reddish yellow to white in colour. It becomes sparse and brittle and can be pulled out easily.
- Nail plates are thin and soft and may be fissured or ridged.
What causes kwashiorkor?
Kwashiorkor is the commonest and most widespread nutritional disorders in developing countries. It occurs in areas of famine or areas of limited food supply, and particularly in those countries where the diet consists mainly of corn, rice and beans.
It is more common in children than in adults. The onset in infancy is during the weaning or post-weaning period where protein intake has not been sufficiently replaced.
What is the treatment for kwashiorkor?
Treatment should start with correcting fluid and electrolyte imbalances. Any infections should also be treated appropriately. Once the patient is stabilised, usually within 48 hours, small amounts of food should be introduced. Food must be reintroduced slowly, carbohydrates first to provide energy, followed by protein foods. Vitamin and mineral supplements may also be given. The reintroduction of food may take over a week by which time the intake rates should approach 175kcal/kg and 4g/kg of protein for children and 60kcal/kg and 2g/kg of protein for adults.
The outlook for patients with kwashiorkor is dependent on the stage of the disease at the time it is first treated.
- Treatment given early in the course of the disease generally produces a good recovery, although growth potential will never be achieved in children who have had kwashiorkor.
- Treatment in the later stages of the disease generally improves the patient’s health but physical and intellectual disabilities are usually irreversible.
- The disease can be fatal if it is not treated or when treatment is given too late in the course of the condition