Marasmus

Marasmus

Definition:
It is a form of undernutrition characterized by failure to gain weight due to inadequate caloric intake.

Incidence:
Commonly in infants between the age of 6 months to 2 years.Z

Etiology

Malnutrition / Chronic diseases

1. Dietary errors
2. Infection: T.B, pyelonephritis
3. Gastroenteritis
4. Parasitic infestations: Ascaris, ankylostoma, giardia
5. Congenital anomalies: Large V.S.D , renal agenesis, pyloric stenosis (interrupted feedings, tachycardia consuming more calories)
6. Metabolic diseases: Galactosemia, Fructose intolerance
7. Prematurity
8. Some cases of mental retardation
9. Low socio-economic status
10. Endocrine causes: DM, hyperthyroidism

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Assessment of Infant with Marasmus

Failure to thrive loss of weight (weight < 60% of expected)Z

Loss of subcutaneous fat:Z measured at many parts of the body according to the degrees:

• 1st degree: s.c fat in the abdominal wall
• 2nd degree: s.c fat in the abdominal wall and limbs - buttocks, Thighs
• 3rd degree: s.c fat in the abdominal wall, limbs, and senile monkey face

FeaturesZ

• Muscle wasting: thin muscles and prominence of bony surfaces
• G.I.T disturbances: anorexia in advanced cases, hunger, constipation, or diarrhea
• Liability to infection
• Hypovolemia
• Weak feeble pulse, subnormal temperature, pulse rate
• Senile face
• Pallor

Complications of Marasmus

• Intercurrent infection: Bronchopneumonia is the cause of death
• Gastroenteritis
• Hemorrhagic tendency, purpura
• Hypothermia; low subcutanous fat
• Hypoglycemia; low glycogen stores
• Edema; Uncommon pure marasmus (marasmic kwashiorkor)

Investigations for Marasmic Infant

1. Blood analysis: W.B.C, Electrolytes, Sugars, ketones, Plasma proteins
2. Urine analysis: culture, sugar, ketones, calcium, phosphate, amino acids
3. Stool analysis for parasites
4. X-ray for chest and heart
5. Tuberculin test for T.B.

Prevention

• Proper diet: balanced nutritional diet
• Encourage breastfeeding up to weaning
• Proper weaning
• Proper vaccination: measles, T.B., whooping cough
• Education regarding the cheap sources of balanced diet, family planning
• Proper follow-up of the growth rate
• Early treatment of defects or associated diseases

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Treatment

• A. Proper Dietary Management

  • Adequate balanced feeding
  • Teaching about nutritional needs, preparation of diet, technique of administration of food
  • If there is vomiting or anorexia, give IV fluids or nasogastric tube feeding
  • Gradual increase in the amount and concentration of formula (total calories is 120-200 cal/kg/d)

• B. Treatment of the Cause

• C. Emergency Treatment for Complications

• D. Blood Transfusion

• E. Vitamins and Minerals Supplementation