Marasmus

Not to be confused with Marasmius.
Marasmus
Child suffering with Marasmus in India, 1972
Classification and external resources
Specialty Critical care medicine
ICD-10 E41-E42
ICD-9-CM 261
DiseasesDB 7826
eMedicine ped/164
MeSH D011502

Marasmus is a form of severe malnutrition characterized by energy deficiency. A child with marasmus looks emaciated. Body weight is reduced to less than 60% of the normal (expected) body weight for the age.[1] Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein. Protein wasting in kwashiorkor may lead to edema.

The prognosis is better than it is for kwashiorkor[2] but half of severely malnourished children die due to unavailability of adequate treatment.

The word “marasmus” comes from the Greek μαρασμός marasmos ("decay").

Signs and symptoms

Marasmus is commonly represented by a shrunken, wasted appearance, loss of muscle mass and subcutaneous fat mass.[3] Buttocks and upper limb muscle groups are usually more affected than others. Marasmus is not generally associated with severe edema. Other symptoms of marasmus include unusual body temperature (hypothermia, pyrexia), anemia, dehydration (as characterized with consistent thirst and shrunken eyes), hypovolemic shock (weak radial pulse, cold extremities, decreased consciousness), tachypnea (pneumonia, heart failure), abdominal manifestations (distension, decreased or metallic bowel sounds, large or small liver, blood or mucus in the stools), ocular manifestations (corneal lesions associated with vitamin A deficiency), dermal manifestations (evidence of infection, purpura, and ear, nose, and throat symptoms (otitis, rhinitis).

Causes

Marasmus is caused by a severe deficiency of nearly all nutrients, especially protein, carbohydrates, and lipids.

Treatment

It is necessary to treat not only the causes but also the complications of the disorder, including infections, dehydration, and circulation disorders, which are frequently lethal and lead to high mortality if ignored.

Ultimately, marasmus can progress to the point of no return when the body's ability for protein synthesis is lost. At this point, attempts to correct the disorder by giving food or protein are futile.

Epidemiology

Disability-adjusted life year for protein-energy malnutrition per 100,000 inhabitants in 2002.[4]
  no data
  less than 10
  10–100
  100–200
  200–300
  300–400
  400–500
  500–600
  600–700
  700–800
  800–1000
  1000–1350
  more than 1350

See also

References

  1. ↑ Appleton & Vanbergen, Metabolism and Nutrition, Medicine Crash Course 4th ed. Moseby (London: 2013) p.130
  2. ↑ Badaloo AV, Forrester T, Reid M, Jahoor F (June 2006). "Lipid kinetic differences between children with kwashiorkor and those with marasmus". Am. J. Clin. Nutr. 83 (6): 1283–8. PMID 16762938.
  3. ↑ Rabinowitz, Simon. "MD, PhD, FAAP". Emedicine Medscape. Medscape. p. 28. Retrieved 29 January 2015.
  4. ↑ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002.
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