marasmic

Symptoms

Signs include loss of muscle mass and other soft tissues and a wizened, sunken face, resembling that of an elderly person, from loss of temporal and buccal fat pads. Failure to gain weight is followed by a loss of weight. Brain and skeletal growth continues, resulting in a long body and a head too large in proportion to weight. Subcutaneous fat is minimal, the eyes are sunken, and tissue turgor is lost. The skin appears loose and sags. The infant is not active, muscles are flabby and relaxed, and the cry is weak and shrill. The absence of pitting edema of the hands and feet and of a protuberant abdomen differentiate this condition from kwashiorkor, but in marasmic kwashiorkor, features of both conditions are combined.

Treatment

Initial feedings should be small and low in calories because digestive capacity is poor and a “refeeding” syndrome can occur, marked by hypophosphatemia, congestive heart failure, respiratory distress, convulsions, coma, and death. Diluted formula or breast milk is best. The amount of calories and protein, carbohydrates, and fat should be increased gradually. The goal for protein intake is 5 g/kg of body weight per day. If diarrhea due to disaccharidase deficiency is present, a low-lactose diet is beneficial. Parenteral fluid therapy is indicated if shock or fluid and electrolyte imbalance exists.

Prognosis

Death occurs in 40% of affected children.