KWASHIORKOR

- Definition1

Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet.

- Epidemiology and Causes2

Kwashiorkor is most common in areas where there is:

 Famine
 Limited food supply
 Low levels of education (when people do not understand how to eat a proper diet)

This disease is more common in very poor countries. It often occurs during a drought or other
natural disaster, or during political unrest. These conditions are responsible for a lack of food,
which leads to malnutrition.

Kwashiorkor is very rare in children in the United States. There are only isolated cases.
However, one government estimate suggests that as many as 50% of elderly people in nursing
homes in the United States do not get enough protein in their diet.

When kwashiorkor does occur in the United States, it is usually a sign of child abuse and severe
neglect.

Over one-third of child deaths are due to undernutrition, mostly from increased severity of
disease.
• Children who are undernourished between conception and age two are at high risk for
impaired cognitive development, which adversely affects the country’s productivity and
growth.
• The economic costs of undernutrition include direct costs such as the increased burden on
the health care system, and indirect costs of lost productivity.
• Childhood anemia alone is associated with a 2.5% drop in adult wages.

Where Does Indonesia Stand?

• 37% of children under the age of five are stunted, 18% are underweight, and 14% are wasted.
• 1 in 10 infants are born with a low birth weight.
• Indonesia has achieved high rates of vitamin A supplementation: 86% of children 6–59
months of age receive the recommended two doses of vitamin A approximately six months
apart.

- Symptoms1

 Changes in skin pigment

 Decreased muscle mass
 Diarrhea
 Failure to gain weight and grow
 Fatigue
 Hair changes (change in color or texture)
 Increased and more severe infections due to damaged immune system
 Irritability
 Large belly that sticks out (protrudes)
 Lethargy or apathy
 Loss of muscle mass
 Rash (dermatitis)
 Shock (late stage)
 Swelling (edema)

- Exams and Tests1

The physical examination may show an enlarged liver (hepatomegaly) and general swelling.

Tests may include:

 Arterial blood gas

 BUN
 Complete blood count (CBC)
 Creatinine clearance
 Serum creatinine
 Serum potassium
 Total protein levels
 Urinalysis
 - Treatment1

Getting more calories and protein will correct kwashiorkor, if treatment is started early enough.
However, children who have had this condition will never reach their full potential for height
and growth.

Treatment depends on the severity of the condition. People who are in shock need immediate
treatment to restore blood volume and maintain blood pressure.

Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are
started after other sources of calories have already provided energy. Vitamin and mineral
supplements are essential.

Since the person will have been without much food for a long period of time, eating can cause
problems, especially if the calories are too high at first. Food must be reintroduced slowly.
Carbohydrates are given first to supply energy, followed by protein foods.

Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They
will need to be given supplements with the enzyme lactase so that they can tolerate milk
products.

- Outlook (Prognosis)1

Getting treatment early generally leads to good results. Treating kwashiorkor in its late stages
will improve the child's general health. However, the child may be left with permanent physical
and mental problems. If treatment is not given or comes too late, this condition is life-
threatening.

- Possible Complications1

 Coma
 Permanent mental and physical disability
 Shock

- When to Contact a Medical Professional1

Call your health care provider if your child has symptoms of kwashiorkor.
 - Prevention1

To prevent kwashiorkor, make sure the diet has enough carbohydrates, fat (at least 10% of total
calories), and protein (12% of total calories).

Referensi :

1. https://www.nlm.nih.gov/medlineplus/ency/article/001604.htm
2014 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics,
University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla
Ogilvie, PhD, and the A.D.A.M. Editorial team.
2. WHO Global Database on Child Growth and Malnutrition (figures based on WHO child
growth standards). GNI data were obtained from the World Bank’s World Development
Indicators. Available from http://siteresources.worldbank.org/NUTRITION/Resources/281846-
1271963823772/Indonesia.pdf