Kwashiorkor

Subject: Community Health Nursing II

Overview

Dr. Cicely Williams coined the phrase "kwashiorkor" in 1935, which translates to "sickness of the misplaced kid." When the disease was first discovered, it was also known as infantile pellagra and nutritional edema because the cause of the condition was not entirely understood. Occasionally, when there is severe edema, the infant's weight may be within the normal range. The signs and symptoms include the youngster appearing weak and hypotonic and being unable to stand or walk. Edema starts off mildly on the lower limbs before spreading throughout the body.

Dr. Cicely Williams coined the phrase "kwashiorkor" in 1935, which translates to "sickness of the displaced kid." When the disease was first discovered, it was also known as infantile pellagra and nutritional edema because the cause of the condition was not entirely understood. When it was discovered that kwashiorkor was caused by a protein deficiency in the diet, the phrase protein-energy malnutrition was later used; however, when it was discovered how crucial a calorie deficit was in the etiology of this disorder, the name was altered to "protein calorie malnutrition."

Sign and Symptoms:

  • Has a moon face and a chubby, clubby appearance, yet closer inspection reveals muscular atrophy over the buttocks and thighs.
  • The youngster weighs less than 80% of what is typical for his or her age, while this can occasionally happen when there is significant edema.
  • Edema starts out moderate on the lower limbs before spreading later.
  • The infant is unable to stand or walk and appears feeble and hypotonic.
  • In addition to cracking lips, discomfort in the mouth corner, and smoothness of the tongue, hair becomes thin, dull, and breaks easily.
  • Children typically cry intermittently, are uninterested in anything depressing, and refuse to eat.
  • May present with mild to severe anemia and cold and pale extremities due to poor circulation.
  • The abdomen is usually distended and the liver may be enlarged.

Management of mild to moderate PEM

  • Instructing parents in nutrition.
  • The provision of nourishing nourishment as required.
  • Treat them if they are ill, if necessary.
  • Identify the contributing elements and address them.
  • Routine examination and anthropometry measurements.

Management of severe PEM

  • Place the kid in a medical facility.
  • Warm the child's surroundings, his or her clothing, and the blanket to keep them warm.
  • Give 1-2 ml/kg of body weight of 50 dextrose solution IV or 5-10 ml/kg of dextrose solution IV if hypoglycemia is present at the time of admission.
  • Correct dehydration if it manifests.
  • Supplement with additional minerals and vitamins.
  • Take Weight daily.
  • Parents should receive nutritional instruction.

Preventive measures

  • Women who are pregnant or nursing should take this measure ( education, distribution of supplement ).
  • Encouraging breastfeeding.
  • Measures to enhance family nutrition.
  • Birth spacing and family planning.
  • Diarrhea and infection should be treated quickly.
  • Youngsters who are infected yet healthy are dewormed.

REFERENCE

  • Ambika Rai, Kabita Dahal. Community Health Nursing II. Kathmandu: Makalu Publication House, 2012 (reprint).
  • Adhikari R.K and Krantz M.E, 2001, Child Nutrition and Health, 3rd edition, HLMC
  • Dr.Suwal S.N. & Tuitui R. (2063) A Textbook of Community Health Nursing, 1st edition, Vidyarthi Prakashan (P). Ltd. Kamalpokhari, Kathmandu
  • HealthLine. 2005. 2017 http://www.healthline.com/health/kwashiorkor
  • Management of the Child with a Serious Infection or Severe Malnutrition, 2000, Department of Child and Adolescent Health & Development, WHO
  • Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.
  • Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/001604.htm
Things to remember
  • The term kwashiorkor was first introduced by Dr.Cicely Williams in 1935 means disease of the displaced child.
  • It has also been known as infantile pellagra and nutritional edema during those early days when the etiology of the disease was not fully understood. 
  • edema, enlarged liver, distended abdomen and children with weak and hypotonic are the symptoms.
  • it can be managed with the severity of the condition.
  • also can be prevented by breastfeeding, diet, deworming,
Questions and Answers

Dr.Cicely Williams coined the term kwashiorkor in 1935, which means "disease of the displaced child." During the early days, when the etiology of the disease was unknown, it was also known as infantile pellagra and nutritional edema. Later, when it was recognized that kwashiorkor was caused by a lack of protein in the diet, the term protein-energy malnutrition was used; however, with the recognition of the importance of calorie deficiency in the etiology of this condition, the term was changed to "protein calorie malnutrition."

Sign and symptoms

  • Has a fat, clubby appearance with a moon face, but closer inspection reveals muscle wasting over the buttocks and thighs.
  • The child's weight is less than 80% of what is expected for his or her age; however, in the presence of severe edema, the weight may be within normal limits.
  • Edema is mild at first on the lower limbs but becomes generalized later.
  • The child appears to be weak and hypotonic, unable to stand or walk.
  • It becomes thin, dull, and easily broken, with cracking lips, soreness in the corners of the mouth, and smoothness of the tongue.
  • Children are usually unhappy, uninterested in anything, and cry incessantly, refusing to eat.
  • Due to poor circulation, patients may present with mild to severe anemia as well as cold and pale extremities.

 

Mild to moderate PEM management

  • Parents should be educated on nutrition.
  • As needed, provide nutritious food.
  • If they are sick, treat them.
  • Identify and treat the causative factors
  • Regular examinations and anthropometry measurements

Treatment of severe PEM

  • The child is admitted to a hospital.
  • Warm the room, clothing, and cover the child with a warm blanket to keep the child warm.
  • If hypoglycemia is present, immediately administer 1-2 ml per kg body weight of 50 dextrose solution IV or 5-10 ml/kg dextrose solution IV.
  • Correct any signs of dehydration.
  • Other vitamins and minerals are supplemented.
  • Weigh yourself every day.
  • Parents should be educated on nutrition.

Preventive action

  • Pregnant and lactating women are targeted by this measure ( education, distribution of supplement ).
  • Breast-feeding promotion
  • Measures to improve the diet of the family
  • Family planning and birth spacing
  • Diagnosis and treatment of infection and diarrhea as soon as possible.
  • Deworming of infected children who are otherwise healthy.

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