fat is preserved. Subcutaneous fat is not preserved Oedema is present. Oedema is absent. Enlarged fatty liver.
No fatty liver. Ribs are not very prominent. Ribs become very prominent. Lethargic Alert and irritable.
Mild or no Muscle wasting. Severe muscle wasting Poor appetite. Voracious feeder. The person suffering from kwashiorkor needs adequate amounts of proteins.
The person suffering from marasmus needs adequate amount of proteins, fats and carbohydrates. - - Proteins and lipids . . Treatment of PEM Children with severe PEM are often seriously ill when they first present for treatment.
They should be admitted to a hospital for the treatment of life- threatening problems. Specific deficiencies should be corrected and metabolic abnormalities reversed. When the child’s condition is stable and the appetite has returned,which is usually after - days ,the treatment can be continued outside the hospital . A.
Hospital based management ) Dehydration: Diarrhoea leading to dehydration is a serious and often fatal event in children with severe malnutrition. Skin elasticity is poor in children with marasmus and their eyes are normally sunken. Unlike Kwashiorkor, the altered skin elasticity is masked by oedema. Patients with mild to moderate dehydration can be treated by oral or nasogastric administration of fluids.
) Infection: Infection is often the immediate cause of death in PEM. It is difficult to detect infections clinically as fever and rapid pulse rate may not be present in severely malnourished patients. Since infection is common, antibiotics should be given routinely to all malnourished patients. Children with complications should be treated with broad spectrum antibiotics like amoxicillin and ampicillin.
Intestinal infections like ascariasis must be treated with appropriate de-worming agents. ) Hypoglycemia: A child may become drowsy or develop convulsions due to hypoglycaemia. In mild cases, oral administration of ml of % glucose may be sufficient. If a child develops convulsions or becomes unconscious, % glucose should be given intravenously (5ml/kg) followed by 50ml of % glucose by nasogastric tube.
) Hypothermia: Marasmic children are prone to have low body temperature. If the room is cold, the child should be