In kwashiorkor, the pitting edema is specifically described as 'flaky paint dermatosis' on the skin. The primary pathogenesis of edema in kwashiorkor (compared to marasmus) is:
- A Hypernatremia causing water retention in tissues
- B Hypoalbuminemia causing reduced oncotic pressure, combined with dysregulated free radical injury and inflammatory mediator release ✓
- C Lymphatic obstruction due to protein infiltration
- D Excessive fluid intake without caloric intake
Explanation
The pathogenesis of kwashiorkor edema is multifactorial. Hypoalbuminemia reduces plasma oncotic pressure allowing fluid transudation into tissues. Additionally, oxidative stress (aflatoxin, inadequate antioxidants) and inflammatory cytokine dysregulation contribute to vascular permeability and sodium retention. Free radical injury theory (Golden) explains why kwashiorkor does not always correlate purely with protein intake level — oxidant stress is a co-factor. Marasmus (total calorie deficiency) does not cause edema because the body catabolizes protein for energy maintaining some albumin levels.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.