A child with kwashiorkor is distinguished from marasmus most reliably by which single pathophysiological feature?

• A Total body energy deficit is greater in kwashiorkor
• B Fatty liver in kwashiorkor results from excess carbohydrate intake causing de novo lipogenesis
• C Skin changes in kwashiorkor are caused primarily by zinc deficiency
• D Oedema in kwashiorkor results from hypoalbuminaemia reducing colloid osmotic pressure, exacerbated by sodium retention ✓

Explanation

Kwashiorkor is characterized by oedema caused by a combination of hypoalbuminaemia (reduced colloid osmotic pressure) and impaired sodium excretion with relative preservation of caloric intake (predominantly carbohydrate). Fatty liver results from impaired synthesis of apolipoproteins needed for VLDL export, not from de novo lipogenesis. Marasmus has a greater total energy deficit. Skin changes (flaky paint dermatosis) in kwashiorkor are multifactorial; while zinc deficiency contributes, the characteristic skin lesions are not primarily due to zinc alone.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.