Kwashiorkor is a severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates.


It is caused by sufficient calorie intake, but insufficient protein consumption, which distinguishes it from marasmus. 

Kwashiokor is a consequence of severe protein malnutrition and is associated with muscle loss, hepatomegaly, and hypoalduminemia.

A hyperpigmented, ichthyotic and peeling rash is a characteristic finding.

Protein deficiency results in reduced plasma triglyceride and phospholipid levels, an increase in free fatty acid levels, and subsequent liver enlargement attributed to accumulation of triglycerides.

Kwashiorkor cases occur primarily in areas of famine or poor food supply.


It is rare in the developed world.


It occurs in children more than 1 year of age. 


Usually children of age around 5 years are affected by it.


Breast milk contains amino acids vital to a child’s growth, and at-risk populations,  may develop after a mother weans her child from breast milk, replacing it with a diet high in carbohydrates, such as a maize diet.


Its defining clinical sign of kwashiorkor in a malnourished child is pitting edema.


Other findings include:  a distended abdomen, an enlarged liver with fatty infiltrates, thinning of hair, loss of teeth, skin or hair depigmentation, and dermatitis. 


Children with kwashiorkor often develop irritability and anorexia. 


Generally, the disease can be treated by adding protein to the diet.


Kwashiorkor, can have a long-term impact on a child’s physical and mental development.


In severe cases kwashiorkor may lead to death.


In dry climates, marasmus is the more frequent disease associated with malnutrition. 


The precise etiology of kwashiorkor remains unclear.


Several hypotheses: protein deficiency causing hypoalbuminemia, amino acid deficiency, oxidative stress, and gut microbiome changes.


There is an  extreme lack of protein causing  an osmotic imbalance in the gastro-intestinal system causing swelling of the gut diagnosed as an edema or retention of water. 


There is  extreme fluid retention observed in individuals suffering from kwashiorkor as a direct result of irregularities in the lymphatic system and an indication of capillary exchange. 


The lymphatic system serves three major purposes: fluid recovery, immunity, and lipid absorption. 


Kwashiorkor patients commonly exhibit reduced ability to recover fluids, immune system failure, and low lipid absorption, due to  a state of severe undernourishment. 


Fluid recovery in the lymphatic system occurs by re-absorption of water and proteins which are then returned to the blood. 


Impaired lymphatic fluid recovery results in the characteristic belly distension observed in highly malnourished children.


The capillary exchange between the lymph system and the bloodstream is slowed  due to the inability of the body to effectively overcome the hydrostatic pressure gradient. 


Proteins, mainly albumin, are responsible for creating the colloid osmotic pressure (COP) in the blood and tissue fluids:


The difference in the colloid osmotic pressure of the blood and tissue is called the oncotic pressure. 


The oncotic pressure is in direct opposition with the hydrostatic pressure and tends to draw water back into the capillary by osmosis. 


With kwashiorkor, the lack of proteins, means that no substantial pressure gradient can be established to draw fluids from the tissue back into the blood stream, resulting in the pooling of fluids, causing swelling and distention of the abdomen.


Low protein intake specific signs: edema of the hands and feet, irritability, anorexia, a desquamative rash, hair discoloration, and a large fatty liver. 


The swollen abdomen is due to two causes: ascites because of hypoalbuminemia and low oncotic pressure, and enlarged fatty liver.


Kwashiorkor, is  known as “edematous malnutrition” because of its association with edema.


 It is a subtype of severe acute malnutrition characterized by bilateral peripheral pitting edema, low mid-upper arm circumference,and a low weight-for-height score, muscle atrophy, abdominal distension, dermatitis, and hepatomegaly.


Kwashiorkor is distinguished from marasmus by the presence of edema.


Treatment principles for the inpatient management of severely malnourished children.


Treat and prevent hypoglycemia


Treat and prevent hypothermia


Treat and prevent dehydration


Correct electrolyte imbalances


Treat and prevent infection




Protein should be supplied only for anabolic purposes. 


The catabolic needs should be satisfied with carbohydrate and fat. 


Protein catabolism involves the urea cycle in the the liver and it can easily be overwhelmed, resulting in liver failure which can be fatal. 


Patients suffering from kwashiorkor, must have protein introduced back into the diet on a gradual basis.


Disorders usually resolve with early treatment. 


Delayed treatment may be associated with improcpved overall health of the child, but physical and intellectual sequelae may occur 


Without treatment or if treatment is delayed, kwashiorkor May result in death.


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