MARASMUS

insufficient energy intake to match the body's requirements

Duration : months to years
SIGNS
Emaciation
loss of subcutaneous fat
muscle wasting
an adaptive response to starvation
skin is xerotic, wrinkled, and loose
Monkey facies
fine, brittle hair; alopecia; impaired growth; and fissuring of the nails
Good appetite
Listless
Temperature subnormal
KWASHIORKAR
adequate carbohydrate consumption
decreased protein intake
Duration : weeks
edema, moon facies
a swollen abdomen (potbelly)
Poor appetite
Irritable, moaning cry
Hypoalbuminemia
-Impaired synthesis of B-lipoprotein
produces a fatty liver
- Atrophy of pancreas,salivary gland and intestine

hair-pull analysis
Flaky paint dermatosis
Pavement dermatosis
Proteins - decreases
hypoalbuminemia (< 2.8 g/dl)
Hypoglobulinemia
Amino acids
essential amino acids ( branched ones) decreases
Non essential - tyrosine, arginine, citrulline, - amino butyric acid - decreases
Ratio branched essential amino acids
glycine, glutamic acid, serine
Incomplete metabolism of histidine, phenylalanine, tryptophan
transferrin (<150 mg/dl)
Iron binding capacity < 200 mcg/dl
hypoglycemia
lymphopenia
growth hormone levels are high
insulin secretion and insulin like growth factor levels are decreased.
percentage of body water and extracellular water is increased
potassium and magnesium depleted
iron deficiency anemia
lactase, amylase, lipase - reduced