MARASMIC KWASHIORKOR

Marasmic-kwashiorkor is a mixed form of both marasmus and kwashiorkor and is

characterized by the presence of both wasting and bilateral pitting oedema. Both Kwashiorkor
and Marasmic-kwashiorkor are very serious conditions and are classified as forms of severe
acute malnutrition.
Children with features of both nutritional marasmus and kwashiorkor are diagnosed as
having marasmic kwashiorkor. In the Wellcome classification this diagnosis is given for a child
with severe malnutrition who is found to have both oedema and a weight for age below 60
percent of that expected for his or her age. Dependent edema is present. Mental changes, skin
and hair changes and hepatomegaly are evident. Secondary infection is very common in protein
energy malnutrition. This is due to the fact that both humoral and cellular immunity are
defective. The intestinal flora is altered and this may account for the diarrhea. Episodes of
infection further jeopardize the nutritional status.
Children with marasmic kwashiorkor have all the features of nutritional marasmus
including severe wasting, lack of subcutaneous fat and poor growth, and in addition to oedema,
which is always present, they may also have any of the features of kwashiorkor described above.
There may be skin changes including flaky-paint dermatosis, hair changes, mental changes and
hepatomegaly. Many of these children have diarrhoea.
Depends on the severity of the disease at diagnosis and promptness of treatment. Marked
weight loss, severe infections, fluid and electrolyte imbalance, hypoglycemia, hypothermia,
cardiac failure, elevation of serum bilirubin and liver enzymes, drowsiness and xerophthalmia
indicate poor prognosis. Ins sever cases, mortality goes up to 20%.