A 15-month-old boy presents with severe wasting, visible rib contours, thin extremities, and an alert expression. Serum albumin is normal and there is no oedema. Which additional finding would be expected?
- A Fatty infiltration of the liver
- B Markedly reduced subcutaneous fat with relative preservation of visceral protein ✓
- C Flag sign of hair depigmentation
- D Serum albumin below 2.0 g/dL
Correct answer: B. Markedly reduced subcutaneous fat with relative preservation of visceral protein
Explanation
This is marasmus: total calorie deprivation with adaptive mobilization of subcutaneous fat and muscle protein while hepatic synthetic function, including albumin production, is relatively preserved, hence no oedema. Fatty liver, flag sign, and hypoalbuminaemia are features of kwashiorkor, where protein deprivation occurs despite adequate calories. In marasmus, insulin is low, cortisol and glucagon are high, and ketogenesis is well preserved.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.