Kwashiorkor, or edematous malnutrition, affects children, and is characterized by bilateral pitting edema, in the absence of another medical cause of edema.
Other clinical signs include a poor appetite, ulcerating dermatosis, and apathy.
Etiology remains ill defined, but is not entirely caused by dietary protein deficiency, as commonly suggested. It is typically associated with a maize-based diet, recent weaning, measles, or diarrheal illness.
Most often seen in sub-Saharan Africa and is rare in the developed world unless associated with underlying disease such as tuberculosis or HIV, or severely restricted diet (e.g., in children with severe autism or other behavioral disorders).
Uncomplicated cases are managed with ready-to-use therapeutic food (RUTF) at home. Complicated cases are treated at an inpatient facility.
Complications include infections, hypoglycemia, hypothermia, xerophthalmia, electrolyte disturbance, and cardiac failure.
Initial stabilization is with fluid and oral calorie intake restricted to maintenance requirements. Antibiotic therapy should be routinely given to all cases.
Kwashiorkor, or edematous malnutrition, is defined as the presence of bilateral pitting edema, in the absence of another medical cause of edema, generally occurring while receiving a monotonous cereal-based diet. Marasmic kwashiorkor is the presence of severe wasting in addition to edema. Kwashiorkor typically occurs in children around the time of weaning and up to 5 years of age, although it may present later, particularly when associated with tuberculosis (TB) or HIV. Edema of kwashiorkor is evident in the soft tissues of the extremities, rather than as ascites.
History and exam
Key diagnostic factors
- history of famine or monotonous diet
- child <5 years of age and living in rural community
- low weight for height, low height for age, or a low mid-upper arm circumference (MUAC)
- bilateral pitting edema
Other diagnostic factors
- hair discoloration
- apathy and reluctance to feed
- oral candida
- poor hydration
- endemic food insecurity or famine
- rural communities
- <5 years of age
- monotonous diet based on maize or cassava
- dietary protein deficiency
- tuberculosis (TB)
- weaning off the breast
- exposure to free radicals
- antioxidant deficiency
- aflatoxin poisoning
- incomplete immunization
- poor social or economic conditions
- cerebral palsy
1st investigations to order
- clinical diagnosis
Investigations to consider
- urine dipstick
- complete blood count (CBC)
- serum electrolytes
- serum protein
- serum albumin
- blood glucose
- chest x-ray (CXR)
- urine culture
- blood culture
- stool culture
- tuberculosis (TB) skin testing
- HIV serology/polymerase chain reaction (PCR)
- malaria screen
Mark J. Manary, MD
Helene B. Roberson Professor of Pediatrics
Washington University School of Medicine
MJM is an author of a number of references cited in this topic.
Indi Trehan, MD, MPH, DTM&H
Associate Professor of Pediatrics
Adjunct Associate Professor of Global Health and Epidemiology
University of Washington
IT is the co-author of a reference cited in this topic.
Dr Mark J. Manary and Dr Indi Trehan would like to gratefully acknowledge Dr James E.G. Bunn, the previous contributor to this topic.
JEGB declared that he had no competing interests.
Beatrice Amadi, MD, MMed.Paed
University Teaching Hospital
Department of Paediatrics and Child Health
BA declares that she has no competing interests.
Tahmeed Ahmed, MD
Public Health Nutrition
James P. Grant School of Public Health
TA declares that he has no competing interests.
George J. Fuchs III, MD
Professor of Pediatrics and Health Policy and Management
University of Arkansas for Medical Sciences
GJF declares that he has no competing interests.
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