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Causes

Kwashiorkor is most common in areas where there is:

  • Famine
  • Limited food supply
  • Low levels of education (when people do not understand how to eat a proper diet)

This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition.

Kwashiorkor is very rare in children in the United States. There are only isolated cases. However, one government estimate suggests that as many as 50% of elderly people in nursing homes in the United States do not get enough protein in their diet.

When kwashiorkor does occur in the United States, it is most often a sign of child abuse and severe neglect.

 

 

Kwashiorkor is a form of malnutrition that occurs when there is not enough protein in the diet.

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  • Treatment

    Getting more calories and protein will correct kwashiorkor, if treatment is started early enough.

    Treatment depends on the severity of the condition. People who are in shock need treatment right away to restore blood volume and maintain blood pressure.

    Calories are given first in the form of carbohydratessimple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.

    Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly.

    Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzyme lactase so that they can tolerate milk products.

    Outlook (Prognosis)

    Getting treatment early generally leads to good results. Treating kwashiorkor in its late stages will improve the child's general health. However, the child may be left with permanent physical and mental problems. If treatment is not given or comes too late, this condition is life threatening.

    Possible Complications

    Complications may include:

    • Coma
    • Permanent mental and physical disability
    • Shock

    When to Contact a Medical Professional

    Call your health care provider if your child has symptoms of kwashiorkor.

    Prevention

    To prevent kwashiorkor, make sure the diet has enough carbohydrates, fat (at least 10% of total calories), and protein (12% of total calories).

    Alternative Names

    Protein malnutrition; Protein-calorie malnutrition; Malignant malnutrition

    References

    Ashworth A. Nutrition, food security, and health. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 456.

    Manary MJ, Trehan I. Protein-energy malnutrition. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 215.


 

Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.

 

However, children who have had this condition will never reach their full potential for height and growth.

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Question 1 of 1

A 42-year-old African-American man has been diagnosed with hypertension for the past 10 years and treated with medication. One morning, he is found unresponsive by his wife. He is taken to the emergency department and pronounced dead by the physician. An autopsy revealed cardiac hypertrophy and a narrowing of the aorta just distal to the ligamentum arteriosum, with dilation of the intercostal artery's ostia. How could the death have possibly been prevented?

Answer

 

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