. KWASHIORKOR Defination - Kwashiorkor (severe or malignant protein malnutrition) -means Literalty "th

after recovery Is established 12. KWASHIORKOR Defination - Kwashiorkor (severe or malignant protein malnutrition) -means Literalty "the neglected one" and describes the young child (usually between 6 months lo 2 years) displaced from the mother's breast by the succeeding intant Theclinical syndrome is recognised in many tropical and subtropical areas where the staple diet deficient In first-class protein it is a severe form of PEM wfth oedema. Oedema occurs due to - (a) Critically low serum albumin .Synthess depressed suddenly by intercurrent infection, (b) Damage to cell membranes by Increased ''free radical" stress Infection in body allow toxic free radicals to accumulate which are not deposed of! adequataly by protective mechanisms, such aa gluttlhlone pathway, beta-carotane. vrtamln E. zinc, etc which are all depressed in severe PEW Toxic free radicals damage cell membranes and its pump mechanisms leading lo loss of K+ and retention of Na+ (c) Aggravated by infection-Induced endothelial leakiness of capillaries. Cinical fealures History - Usual history is that after a few weeks of some dietary change (weaning, separation from mother or a period of economc stress) the child was noticed to be less lively and not eating well. Then some respiratory infection or attack at measles. Jarrhoea or fever leads to a great reduction in food intaKe and the child becomes manifestly ill. Other cases have no preceding infaetio n or fever. Growth retardation - Underweight in spite of much oedema. Shorter than normal children of same age Muscle wasting underlies oedema .Ganeral appearance - Oedema often generalised Extremities often cold hands and feet may be dusky purple. Child appears apathetic but resents attention (•leave mo alone attitude") such as when food to offerad. Eyes red, nose rnoist. mouth dribbling. Cheeks appear boggy because of oedema of buccal pad of fat Moon face is an early sign Oedema • Firsl appears on feet arid face and often spreads to involve all parts of body . Ascites rare Skin - Charaderistic dermatoses - erythema which soon changes into pigmented patches mainly in areas where the skin is subjected to continuous pressure .These patches soon dasquamate to reveal pate underlying areas. The peeling plaques of dermatosis have been compared to cracked peeling areas of paint (flaking paint dermatosis) which is pathognomonic .Occasionally