Case: Kwashiorkor

Discussion: Kwashiorkor is a protein energy malnutrition occuring when there is an insufficient intake of protein. The term "kwashiorkor" comes from an African dialect on the Gold Coast meaning "the disease of the deposed baby when the next one is born." The onset typically appears in older infants and young children. The main diet is often a carbohydrate source that is low in protein content (i.e. white rice, cassave, yams). Features of kwashiorkor include soft, pitting, painless edema usually in the feet and legs. The edema can also be seen in the face and upper extremities in severe cases. The skin is hyperkeratotic and there is dyspigmentation secondary to desquamation of the epidermis. The hair is dry, brittle and straight and its color changes to red or yellowish-gray. The children are pale and often have cold extremities. There is also fatty infiltration of the liver causing hepatomegaly and the abdomen is frequently protruding. T-cell lymphocytes and cell mediated immunity responses are blunted, making the child with kwashiorkor more susceptible to infections.