A child has bilateral pitting oedema of the feet, a 'flaky paint' rash over the trunk, miserable affect, and hepatomegaly. Weight-for-height Z-score is −2.5. The MOST likely diagnosis and the pathophysiological basis for oedema is:
- A Marasmus — depletion of subcutaneous fat causing fluid redistribution
- B Marasmus — sodium retention due to aldosterone excess
- C Kwashiorkor — hypoalbuminaemia causing reduced oncotic pressure ✓
- D Pellagra — capillary permeability increase due to niacin deficiency
Explanation
Kwashiorkor (protein-deficient malnutrition) presents with bilateral oedema, skin rash ('flaky paint' or 'crazy paving' dermatosis), hair changes (flag sign, kwashiorkor hair), apathy, hepatomegaly (fatty liver), and adequate weight masking the true degree of wasting. Oedema results from hypoalbuminaemia — severe protein deficiency reduces albumin synthesis, lowering plasma oncotic pressure, causing fluid to shift into the interstitium. In marasmus (energy-deficient), there is severe wasting without oedema. The WHO SAM protocol considers the presence of oedema as the primary criterion for kwashiorkor regardless of anthropometric Z-score.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.