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Malnutrition is a condition that results from inadequate or excess nutrients in the body, causing fatigue, growth impairment, and dizziness. There are various forms of malnutrition, including overweight and obesity, diet-related disease, undernutrition, and micronutrient-related malnutrition (World Health Organization, 2021). Children, geriatrics, and chronically ill patients are the most vulnerable to malnutrition. One of the diseases that can arise from malnutrition is kwashiorkor.
Kwashiorkor is defined as protein-energy deficiency due to inadequate protein intake. Generally, kwashiorkor causes generalized body swelling, including the face, hands, and feet. Kwashiorkor usually affects children under the age of 5 years and infants who are not exclusively breastfed. According to Benjamin & Lappin (2021), the physiological effects of kwashiorkor include depletion of body fats, decreased albumin levels, increased interstitial fluid accumulation, hypothermia, hypotension, and bradycardia. The hallmark of kwashiorkor is edema. Edema arises from fluid imbalance between oncotic and hydrostatic pressure, causing retention of fluids within the vessels. Due to protein deficiency, the level of albumin is reduced, resulting in intravascular fluid loss to the interstitium. As a result, the body responds by increasing the production of an antidiuretic hormone that causes more fluid accumulation. In addition, the body increases renin production, increasing sodium retention and hence water, and further causes edema. In addition to the above, the other symptoms of kwashiorkor include muscle atrophy, abdominal distension, round face, hepatomegaly due to infiltrates from fatty liver, growth retardation, and retention of subcutaneous associated with loss of skin folds in the inguinal region. The disease also affects the skin and its appendages. The skin may appear dry, thin, scaly, and hyperpigmentation. The hair appears hypopigmented, dry, thin and easily falls out. Like other diseases, kwashiorkor does not spare the psychology, and the psychic effects of kwashiorkor include apathy, anergia, and anorexia. With all these mentioned effects of kwashiorkor, if not well managed, it can complicate and even lead to death.
As mentioned in the previous discussion, kwashiorkor occurs due to protein-energy deficiency, hence the name protein-energy malnutrition. According to Benjamin & Lappin (2021), the etiology of kwashiorkor is not well known. However, the disease is often associated with protein deficiency, aflatoxins, and low levels of antioxidants. Children who are often present with kwashiorkor have a history of taking cassavas, rice, and maize without accompanying proteins.
There are no specific nutrients that are contraindicated in children with kwashiorkor. However, it is thought that patients with kwashiorkor tend to develop lactose intolerance, and therefore, the intake of nutrients and feeds containing milk should be initiated slowly. With rapid correction of kwashiorkor, refeeding syndrome occurs. The syndrome is fatal, and it comprises disturbances of metabolism after initiation of feeding after a long fasting period (da Silva et al., 2020). The hallmark of the syndrome is hypophosphatemia and hypokalemia. This, therefore, justifies the importance of the gradual introduction of parenteral nutrition.
The specific nutrients required for kwashiorkor are carbohydrates and proteins. The feeds are introduced gradually, beginning with carbohydrates and followed by proteins. The specific foods that can provide proteins include eggs, fish, meat, nuts, and cereals such as soya beans. Protein is essential for the repair of cells in the body and the synthesis of new cells. For the total parenteral nutrition used in the management of kwashiorkor, the proteins increase the oncotic pressure and, hence, reduce the edema. Since proteins are used in the synthesis of antibodies in the body, the nutrient also improves immunity. In addition, proteins are also essential for growth in children.
The treatment of kwashiorkor involves ten steps that are carried out in phases starting from when the patient lands in the ward. The ten steps include treatment or prevention of hypocalcemia, Prevention or treatment of hypothermia, Prevention of dehydration, correction of electrolyte imbalance, prevention and treatment of infections using antibiotics, correction of micronutrient deficiencies such as vitamins, initiation of cautious feeding, Achievement catch feeding to enhance growth, provision of emotional support and sensory s
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