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Kwashiorkor...?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 2 replies. You can also reply via email – be sure to leave the subject unchanged.

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steve munyi

Normal user

26 Feb 2015, 16:58

Whats the best way to confirm that edema in a 4 year old child, is specifically caused by malnutrition especially if diet history from the caregiver is not reliable
(NB. Albumin test not available)

Marko Kerac

LSHTM

Normal user

26 Feb 2015, 17:21

Good question but relatively simple to answer:

- Kwash oedema will (the vast majority of the time) resolve with proper nutritional treatment. See WHO for latest international guidance: http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren/en/

If the diagnosis it something else (e.g. nephrotic syndrome; heart failure) the oedema will persist. A pragmatic way forward is to start empirical treatment as if it were kwash (you're unlikely to do any harm; most other things do not need as urgent care). Reconsider in more detail/move other 'differentials' up the list if things don't start improving after a day or two. If things do settle (or start to settle - very severe oedema can take a while to subside) then you've got your most likely diagnosis.

Other signs of kwash CAN include: flaky paint dermatosis; sparse/discoloured hair; enlarged liver; apathy and lethargy. But note that these are not essential to the diagnosis: they may not be present, especially in early kwash.

steve munyi

Normal user

26 Feb 2015, 20:13

Thank marko for the response. My major concern is, if there is any standard criteria for determining whether edema is as a result of kwash

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