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Nursing
QUESTION #9256
Question 1
A child with Protein Energy Malnutrition (PEM) presents with pitting edema of feet and legs, sparse discolored hair, fatty liver, and normal or above-normal weight for age. This presentation is BEST classified as:
Correct Answer Explanation
Classification of Protein Energy Malnutrition (PEM):
| Feature | Marasmus | Kwashiorkor |
|---|---|---|
| Primary deficiency | Total calories (protein + energy) | Protein deficiency with adequate carbohydrates |
| Weight | Severely underweight (<60% expected) | May appear normal (edema masks wasting) |
| Edema | Absent | Present (pitting, starts from feet) |
| Appearance | 'Old man' face, skin and bones | Moon face, edematous |
| Hair | Sparse, thin | Sparse, discolored (flag sign), brittle |
| Liver | Normal | Fatty liver (due to low apolipoprotein) |
| Appetite | Ravenous | Anorexia |
| Mood | Alert, irritable | Apathetic, miserable |
This child has Kwashiorkor: edema + fatty liver + discolored hair + normal weight (edema masking true weight loss).
WHO management: 10 steps — treat hypoglycemia, hypothermia, dehydration, electrolyte imbalance, infections, micronutrient deficiencies, cautious feeding, catch-up growth, sensory stimulation, and follow-up.
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