Marasmus
All are seen in Marasmus except ‑
| A |
Hepatomegaly |
|
| B |
Muscle wasting |
|
| C |
Voracious appetite |
|
| D |
Weight loss |
All are seen in Marasmus except ‑
| A |
Hepatomegaly |
|
| B |
Muscle wasting |
|
| C |
Voracious appetite |
|
| D |
Weight loss |
Ans. is ‘a’ i.e., Hepatomegaly
Hepatomegaly is seen in kwashiorkor (not in marasmus).
Marasmus
o It is characterized by gross wasting of muscle and subcutaneous tissues resulting in emaciation and marked stunting.
o There is no edema.
o Body weight is less then 60% of expected.
o Fat in adipose tissues is severely depleted. However the buccal pad of fat is preserved till the malnutrition becomes extreme because a higher proportion of saturated fatty acids is stored there and the saturated fat is the last to be depleted.
o Skin is dry, scaly and inelastic with wrinkles.
o The hair is hypopigmented.
o Abdomen is distended due to wasting and hypotonia of abdominal wall muscles.
o The child is alert but irritable.
o Child may show voracious appetite.
Which of the following is seen in Marasmus and not in Kwashiorkor –
| A |
Vocarious appetite |
|
| B |
Fatty change in liver |
|
| C |
Hypoalbuminem ia |
|
| D |
Edema |
Which of the following is seen in Marasmus and not in Kwashiorkor –
| A |
Vocarious appetite |
|
| B |
Fatty change in liver |
|
| C |
Hypoalbuminem ia |
|
| D |
Edema |
Ans. is ‘a’ i.e., Vocarious appetite
|
Features Incidence Stage in PEM Activity Muscle wasting Fat wasting Edema Weight for height Appetitite Skin changes Hair changes Anemia Hepatomegaly Liver biopsy Infection Serum albumin Insulin level Others Recovery Mortality |
Marasmus More common Compensated phase Active Obvious Severe loss of subcutaneous fat None Very low Vocarious (good) appetite None None Uncommon Absent Normal or atrophic Less prone Normal or slightly decreased Normal Monkey facies Baggy pant appearance Early Less than kwashiorkor |
Kwashiorkor Less common Uncompensated phase Apathic Sometimes hidden by edema and fat Fat often retained but not firm Present Low but may be masked by edema Poor Diffuse pigmentations, flaky paint dermatosis Sparse, silky, easily pulled out Common Present Fatty changes More prone Low (<3g/100 ml) Low Sugar baby appearance Flag sign of hair Long time High in early stage |
All of the following conditions are observed in
Marasmus, except –
| A |
Hepatomegaly |
|
| B |
Muscle wasting |
|
| C |
Low insulin levels |
|
| D |
Extreme weakness |
All of the following conditions are observed in
Marasmus, except –
| A |
Hepatomegaly |
|
| B |
Muscle wasting |
|
| C |
Low insulin levels |
|
| D |
Extreme weakness |
Ans. is ‘a’ i.e., Hepatomegaly
Changes in body composition in P.E.M.
o Fluid considerations‑
Total body water in malnourished children is increased to 70-80% of body weight as compared to 60% in age matched well noarished controls.
Activity of the sodium pump* is reduced.
o Metabolic alterations.
B.M.R. is reduced by 30% and energy expenditure due to inactivity is very low
Child may behave like poikilotherm.
o Endocrine changes.
Insulin levels are reduced (child has glucose intolerance)
Cortisol and growth hormone levels are increased.
o Cardiovascular system
Cardiac output and stroke volume are reduced
Blood pressure is low and renal perfusion is compromised.
o Renal function
Glomerular.filtration rate and renal plasma flow are reduced in severe P.E.M.
Urinary phosphate and sodium excretion are reduced.
All are true about marasmus except:
March 2011
| A |
Normal albumin levels |
|
| B |
Severe wasting of muscles |
|
| C |
Edema |
|
| D |
Depleted subcutaneous fat |
All are true about marasmus except:
March 2011
| A |
Normal albumin levels |
|
| B |
Severe wasting of muscles |
|
| C |
Edema |
|
| D |
Depleted subcutaneous fat |
Ans. C: Edema
Edema is a feature of Kwashiorkar; it ranges from mild to gross, and may represent upto 5-20% of the body weight Remember:
Acute malnutrition is judged by: Weight for height
Chronic malnutrition is judged by: Height for age
Flag sign is seen in Kwashiorkar (hair is thin, brittle, lusterless, sparse, easily pluckable and hypopigmented) Hepatomegaly may be associated with Kwashiorkar
In marasmus wasting is due to ‑
| A |
Prolonge dietery deficiency of calori |
|
| B |
Prolonge dietery deficiency of protein |
|
| C |
Excess catabolism of fat & muscle mass to provide energy |
|
| D |
All of above |
In marasmus wasting is due to ‑
| A |
Prolonge dietery deficiency of calori |
|
| B |
Prolonge dietery deficiency of protein |
|
| C |
Excess catabolism of fat & muscle mass to provide energy |
|
| D |
All of above |
Ans. is ‘d’ i.e., All of above
Marasmus
- Prolonge deficiency of calory & protein due to starvation.
- Monkey facies- loss of buccal fat.
- Baggy pants appearance- loose skin of the buttocks hanging down.
- Loss of axillary fat.
- Appetite is preserved.
- No edema.
