How does kwashiorkor cause edema

Volume Kwashiorkor revisited: the pathogenesis of oedema in kwashiorkor and its significance. Waterlow J. Oxford Academic. Google Scholar. Cite Cite J. Select Format Select format. Permissions Icon Permissions. Summary Cicely Williams, in her original description of kwashiorkor, implied that deficiency of protein in the baby's food could be a main cause of the syndrome.

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Marasmic children, whose hypovolaemic shock is caused by an acute loss of salt and water uncomplicated by hypoalbuminaemia, then require an intravenous infusion of sufficient isotonic fluid to promptly restore the circulating blood volume. They have no mechanisms in reserve; the mildest extra stress can rapidly precipitate severe shock.

If that child happens to be one with CNS in a developed country, they will receive a prompt intravenous albumin infusion, and almost at once their signs of shock will wane as interstitial fluid is drawn into their blood vessels.

A dose of frusemide administered soon after this will prevent rebound hypervolaemia and pulmonary oedema. They will mobilise large quantities of oedema as urine, re-establish a stable circulation, and will have a virtually guaranteed survival. Yet this is what is recommended for shocked children whose hypoalbuminaemia happens to be caused by kwashiorkor.

The adoption of relatively conservative resuscitation fluid volumes for malnourished children has been driven in part by the concerns that larger quantities may precipitate congestive cardiac failure.

This followed the fact that some very anaemic children died of heart failure after a few days of apparently successful progress on a therapeutic diet which contained a high salt content. The mistaken belief that the oedema of kwashiorkor is unrelated to profound hypoalbuminaemia, combined with an exaggerated concern about the risks of congestive cardiac failure, has resulted in guidelines for shock management that fail to address their physiological needs, and which has not reduced their high mortality rate.

Rather, children with kwashiorkor and CNS share a similar pathophysiology; both are malnourished and verge on intravascular hypovolaemia due to hypoalbuminaemia, and can be readily precipitated into shock.

It is time for a trial of acute intravenous albumin therapy in children with kwashiorkor-related shock. National Center for Biotechnology Information , U. Paediatrics and International Child Health. Paediatr Int Child Health. Malcolm G. Author information Copyright and License information Disclaimer. Email: moc. This article has been cited by other articles in PMC. Abstract It has been argued that the oedema of kwashiorkor is not caused by hypoalbuminaemia because the oedema disappears with dietary treatment before the plasma albumin concentration rises.

Introduction Malnutrition in young children may lead to severe wasting alone marasmus , or may be associated with oedema kwashiorkor. Open in a separate window. Figure 1. Figure 2. Measuring Plasma Albumin Concentrations Albumin concentrations can be measured accurately by using specific immunological assays that only respond to that particular protein, even at very low levels.

Figure 3. The Physiology of Kwashiorkor Looks a lot like Finnish Congenital Nephrotic Syndrome The evidence I have reviewed thus far points to the pathophysiology of kwashiorkor being a combination of severe malnutrition and a low plasma oncotic pressure due to extreme hypoalbuminaemia. Figure 4. Conclusion The mistaken belief that the oedema of kwashiorkor is unrelated to profound hypoalbuminaemia, combined with an exaggerated concern about the risks of congestive cardiac failure, has resulted in guidelines for shock management that fail to address their physiological needs, and which has not reduced their high mortality rate.

References 1. Schofield C, Ashworth A. Why have mortality rates for severe malnutrition remained so high? Bull WHO. Williams CD. A nutritional disease of childhood associated with a maize diet. Arch Dis Child. Acute severe malnutrition.

Geneva: WHO; Albumin metabolism in children with protein malnutrition. J Clin Invest. Value of serum-albumin measurements in nutritional surveys: a reappraisal. Serum-albumin concentration and the onset of kwashorkor. Serum-albumin as a prognostic indicator in oedematous malnutrition.

Biological risk factors for fatal protein energy malnutrition in hospitalised children in Zaire. J Pediatr Gastroenterol Nutr. Albumin and nutritional oedema. Inflammatory markers in children with protein-energy malnutrition. Am J Clin Nutr. Free radicals in the pathogenesis of kwashiorkor. Proc Nutr Soc. Golden MHN. Oedematous malnutrition. Brit Med Bull. The development of concepts of malnutrition. J Nutr. Starling EH. On the absorption of fluid from the connective tissue spaces.

J Physiol. Albumin as an outcome measure in haemodialysis in patients: the effect of variation in assay method. Nephrol Dial Transpl. An assessment of the suitability of bromcresol green for the determination of serum albumin. If treatment was started early, the person will usually recover well, although children may never reach their full growth potential and be shorter than their peers.

If treatment was started in the later stages of protein malnutrition, the person may be left with physical and intellectual disabilities. Marasmus is another type of malnutrition that can affect young children in regions of the world where there's an unstable food supply. Signs of marasmus include thinness and loss of fat and muscle without any tissue swelling oedema.

Like kwashiorkor, marasmus is caused by a lack of the right types of nutrients. Tests may need to be done to rule out other causes of thinness.

The treatment for marasmus is similar to that for kwashiorkor. Page last reviewed: 28 August Next review due: 28 August Symptoms of kwashiorkor As well as oedema, symptoms of kwashiorkor can include: loss of muscle mass an enlarged tummy "pot belly" regular infections, or more serious or long-lasting infections red, inflamed patches of skin that darken and peel or split open dry, brittle hair that falls out easily and may lose its colour failure to grow in height tiredness or irritability ridged or cracked nails Kwashiorkor can be fatal if it's left untreated for too long because children become very vulnerable to infections.

What causes kwashiorkor? Although kwashiorkor can affect people of all ages, it's more common in children than adults.