Protein energy malnutrition differential diagnosis: Difference between revisions
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Kwashiorkor''' | | style="background: #F5F5F5; padding: 5px; text-align: center;" | '''Kwashiorkor''' | ||
| style="background: #DCDCDC; padding: 5px;" | | | style="background: #DCDCDC; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | * Deficiency of protein-rich foods like meat and poultry in diet | ||
| style="background: #F5F5F5; padding: 5px;" | | * Early weaning | ||
| style="background: #F5F5F5; padding: 5px;" | < 1 | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Apathy | |||
* Lethargy | |||
* Irritability | |||
* Cachexic | |||
* Flag sign of hair | |||
* Hyperkeratosis / dermatitis of skin | |||
* Anemia | |||
* Congestive heart failure | |||
* Hypoalbuminemia | |||
* Chronic fatty liver | |||
* Hepatomegaly | |||
* Edema | |||
| style="background: #DCDCDC; padding: 5px;" | High | | style="background: #DCDCDC; padding: 5px;" | High | ||
| style="background: #F5F5F5; padding: 5px;" | 1-2; it follows defervescence | | style="background: #F5F5F5; padding: 5px;" | 1-2; it follows defervescence |
Revision as of 11:59, 11 August 2017
Protein energy malnutrition Microchapters |
Patient Information |
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Differentiating Protein energy malnutrition from other Diseases |
Diagnosis |
Treatment |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Protein energy malnutrition must be differentiated from other diseases that cause failure to thrive, edema, wasting recurrent infections, skin and hair changes. It is important to also differentiate kwashiorkor from marasmus as the two diseases belong to the protein energy malnutrition.
Differentiating Protein energy malnutrition from other Diseases
Differentiating kwashiorkor from marasmus[1]
Distinguishing Features | Kwashiorkor | Marasmus |
---|---|---|
Cause | Deficiency of protein in the diet of child | Deficiency of protein as well as energy nutrients (that is carbohydrates and fats) in the diet |
Age | Occurs in children in the age group 1-5 years | Typically occurs in children below the age of 1 year |
Association | More common in villages where there is small gap period between successive pregnancies | More common in towns and cities where breast-feeding in discontinued quite early |
Edema | Presence of edema | Absence of edema |
Muscles | Wasting of muscles | Wasting of muscles is quite evident. The child is reduced to skin and bones |
Skin changes | Dermatitis and Hyperpigmentation noticed | Dry and atrophic skin but no changes in color |
Serum cortisol | Decreased/Normal | Increased |
Fasting blood glucose | Decreased | Decreased |
Growth retardation | Mildly retarded in growth | Severely retarded in growth |
Facial appearance | Moon-like face | Elderly man face |
Abdomen | Protuded | Shrunken |
Vitamin deficiency | Present | Present |
Weight | 60-80% of normal weight for age | <60% of normal weight for age |
Differential diagnosis of childhood malnutrition
Kwashiorkor | ||||||
Marasmus | ||||||
Protein losing enteropathy | ||||||
Anasarca | ||||||
HIV wasting syndrome | ||||||
Congenital heart disease | ||||||
Chronic pancreatitis | ||||||
Congenital nephrotic syndrome | ||||||
Portal cirrhosis |
Disease | Cause | Age | Presentation | Prevention | Workup | Prognosis | Treatment |
---|---|---|---|---|---|---|---|
Kwashiorkor |
|
< 1 |
|
High | 1-2; it follows defervescence | Discrete erythematous macules, rarely involves face, begins as fever ends | Lymphadenopathy, irritability |
Marasmus | Paramyxovirus Measles virus |
Winter - Spring | 2-4 days of cough, conjunctivitis, and coryza | High | 5 - 6 | Erythematous, irregular size, maculopapular; starts on temples and behind ears; progresses down from face; fades to brownish | Koplik's spots: C blue-white papules (salt grains) on bright red mucosa opposite premolar teeth |
Protein losing enteropathy | Togavirus | Spring | 0 - 4 days; mild malaise, fever; absent in children | Low grade | 1 - 3 | Discrete, rose-pink, diffuse, maculopapular; progresses downward from face, may change quickly | Arthralgia (usually in adults), tender posterior cervical and suboccipital lymphadenopathy, malaise, petechiae on soft palate |
Anasarca | Human parvovirus type B19 | Spring | None, usually in children, may occur in adults | None to low-grade | 2 - 4 | Starts as “slapped cheek”, maculopapular; progresses to reticular (lacy) pattern; can recur with environmental changes such as sunlight exposure | Arthralgia/arthritis in adults, adenopathy |
HIV wasting syndrome | Epstein-Barr Virus | None | 2 - 5 days of malaise and fatigue | Low to high | 2 - 7 | Trunk and proximal extremities. Rash common if Ampicillin given | Pharyngitis, lymphadenopathy, splenomegaly, malaise |
Congenital heart disease | Unknown | Winter - Spring | 3 days of abrupt fever | High; fever of 5 days is a diagnostic criteria | 5 - 7 | Erythematous, morbilliform, maculopapular or scarlatiniform, central distribution; erythematous, indurated palms and soles | Acute: dry, fissured and injected lips, strawberry tongue; irritability; cervical lymphadenopathy; conjunctival injection; peripheral edema; Subacute: finger-tip desquamation; Complications: arthritis, carditis |
Chronic pancreatitis | ß-hemolytic streptococci | Winter | 0 - 6 day, marked | Low to high | 2 - 7 | Scarlet "sunburn" with punctate papules "sandpaper", circumoral pallor, increased intensity in skin folds, blanches stars face/head, upper trunk and progresses downward | Sore throat, exudative tonsillitis, vomiting, abdominal pain, lmphadenopathy, white then red strawberry tongue |
Congenital nephrotic syndrome | Echovirus Coxsackie virus |
Summer - Fall | 0 - 1 day fever and myalias | Low to high | 1 - 5 | Fine, pink, always affects face; variant is Boston exanthem (large ~ 1 cm, discrete maculopapules) | Sore throat, headache, malaise, no lymphadenopathy, gastroenteritis |
Portal cirrhosis | Flavivirus Dengue virus types 1 - 4 |
None | High | 1 - 5 | Generalized maculopapular rash after defervescence; spares palms and soles | Headache, myalgia, abdominal pain, pharyngitis, vomiting | |
Drug induced rash | Many | Any | Possible due to underlying illness | Possible | Varies | Typically diffuse but may be concentrated in diaper area, typically no progression, erythema multiform rash can progress over a few days | Possibly due to underlying illness or complications |
Pharyngoconjunctival Fever | Adenovirus types 2, 3, 4, 7, 7a | Winter - Spring | Low to high | 3 - 5 | Starts on face and spreads down to trunk and extremities | Sore throat, conjunctivitis, headache, anorexia |
Table adapted from CDC Pinkbook.[2]
References
- ↑ Müller O, Krawinkel M (2005). "Malnutrition and health in developing countries". CMAJ. 173 (3): 279–86. doi:10.1503/cmaj.050342. PMC 1180662. PMID 16076825.
- ↑ "Epidemiology and Prevention of Vaccine-Preventable Diseases".