Protein energy malnutrition physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]
Overview
Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, and distended abdomen due to an enlarged liver, hyperkeratosis and hyperpigmentation of the skin, generalized edema especially on the dependent areas of the body like the feet. On the other hand, patients with marasmus usually look listless, emaciated with monkey-like faces due to absence of subcutaneous fat pad in the cheeks. The skin looks atrophic and dry.
Physical Examination
Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, and distended abdomen due to an enlarged liver, hyperkeratosis and hyperpigmentation of the skin, generalized edema especially on the dependent areas of the body like the feet. On the other hand, patients with marasmus usually look listless, emaciated and hungry looking with monkey like faces due to absence of subcutaneous fat pad in the cheeks. The skin looks atrophic and dry.[1][2][3]
Appearance of the Patient
Facial appearance in patients with kwashiorkor:
General body appearance:
- Very thin extremities
- Edema of the dependent areas such as the feet and sacral areas of the back
- discoloration of the skin
- Hair with a fluffy texture
Vital signs
- Normal body temperature/Hypothermia
- Hypotension
- Bradycardia
Skin
- Thin, dry, peeling skin with confluent areas of hyperkeratosis and hyperpigmentation
- Enamel paint dermatosis (flaking of skin)
HEENT
- Abnormalities of the head/hair may include presence of sparse and discoloured hair
- Eyes are jaundiced
- Pursed appearance of the mouth
Neck
- Hepatojugular reflux due to hepatomegaly
Lungs
- Decreased chest expansion
- Distant breath sounds maybe present
Heart
- Presence of heart failure in severe cases
Abdomen
Back
Genitourinary
- Reduced glomerular filtration rate
- Reduced capacity of the kidney to excrete sodium
- Excess acid
- Reduced water load
- Urinary tract infections
Extremities
- Pitting edema of the lower extremities
- Muscle atrophy
Neuromuscular
- Patient is usually oriented
- Altered mental status / mental retardation
- Hyporeflexia / areflexia
- Generalised muscle weakness
Courtesy to Dr. Lyle Conrad – Centers for Disease Control and Prevention, Atlanta, Georgia, USA Public Health Image Library (PHIL); ID: 6901 http://phil.cdc.gov/
References
- ↑ Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN; et al. (2003). “Bacteriuria and urinary tract infections in malnourished children”. Pediatr Nephrol. 18 (4): 366–70. doi:10.1007/s00467-003-1118-0. PMID 12700964.
- ↑ Jones KD, Berkley JA (2014). “Severe acute malnutrition and infection”. Paediatr Int Child Health. 34 Suppl 1: S1–S29. doi:10.1179/2046904714Z.000000000218. PMC 4266374. PMID 25475887.
- ↑ Ahmed M, Moremi N, Mirambo MM, Hokororo A, Mushi MF, Seni J; et al. (2015). “Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania”. Ital J Pediatr. 41: 44. doi:10.1186/s13052-015-0151-5. PMC 4472394. PMID 26084628.
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