A 2-year-old child has pitting oedema of feet, skin lesions, and hair changes (flag sign). Weight is 75% of expected. Serum albumin is 1.8 g/dL. This is most consistent with:

• A Marasmus — severe stunting with adequate adaptive response
• B Marasmic-kwashiorkor — combined severe wasting and oedematous malnutrition
• C Kwashiorkor — protein-deficient malnutrition with oedema and low serum albumin ✓
• D Nutritional oedema from thiamine deficiency (wet beriberi)

Explanation

The clinical picture — oedema (feet), skin changes (flaky paint dermatosis), flag sign in hair (alternating bands due to episodic malnutrition), and low albumin (1.8 g/dL) — is classic Kwashiorkor. Weight at 75% of expected indicates moderate wasting but not the severe wasting of marasmus. Marasmic-kwashiorkor shows severe wasting (<60% expected weight) WITH oedema. Wet beriberi does not cause the dermatological changes or hypoalbuminaemia described and does not show flag sign.

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.