Question

Case Study about Protein-Related Medical Problem (Kwashiorkor’s Disease)

Patient BF, an exclusively breastfed boy infant developed Atopic Dermatitis at the age of
4 months. In the beginning, the eczema was treated with antibiotics, topical steroids and brief
courses of oral steroids. The mother was dissatisfied by the outcome of the pediatrician’s advice
so she consulted a naturopathic doctor who prescribed a restricted diet. At 6 months the child’s
daily diet consisted of rice milk, fruits, rice poultry and vegetable broth.

After about 2 months of this diet, the child began to reject the food, in particular solid foods and
to suffer from dysphonia and dysphagia due to the occurrence of laryngeal edema. Because of
this the child was given only rice milk. After a few days the edema appeared on his feet, legs and
upper extremities followed by a reduced urine output. He had no symptoms of gastroesophageal
reflux, but he had forceful vomiting. When hospitalized, he was in a poor clinical condition with
generalized edemaand low urine output. He weighed 7.600 Kg from the age of six months up to
1 year. Blood and urine findings were normal except for the following results: total protein
3 g/dl; albumin 1.365 g/dl (45.5 %); total serum IgE 30 KUA/L; specific serum IgE: milk 0.64
KUA/L; albumin 1.74 KUA/L. Protein was not found in the urine. He required central access due
to difficulty obtaining peripheral rice milk, fruits, rice poultry and vegetable broth access due to
severe edema. He was also found to be anemic with a hemoglobin 5.7 g/dl.

Based on the given case, answer the following guide questions:

1. What is the relationship between Kwashiorkor and Proteins? How is protein contributing
to the patient’s diagnosis of Kwashiorkor?
2. Among the biomedical importance of Proteins, what is most likely related to
Kwashiorkor and Proteins? Explain.
3. How was the patient diagnosed with Kwashiorkor? Discuss the biochemical tests used in
the patient.

4. Based on the case, should the patient have high protein, or low protein intake as his
treatment? What foods would you recommend? Explain.

Answer 1

ANSWER

1 Kwashiorkor is severe protein malnutrition characterized by oedema. It occurs due to insufficient intake of protein. Proteins are responsible for balancing fluid in our body and keep the fluids in the blood vessels. Due to lack of protein intake, the oncotic pressure will be reduced, results in shifting of fluids into interstitial spaces and tissue , results in oedema: a classic sign of kwashiorkor.

2 The main biomedical function of the protein in relation to kwashiorkor is fluid balance. Proteins regulate body process to maintain fluid balance. Albumin and globulin are proteins in the blood that help in maintaining body fluid balance by holding salt and water inside the blood vessels, so fluids will not seep into the tissues. Insufficient intake of proteins can cause a low level of albumin and globulin. This results in a decrease in plasma oncotic pressure and an increase in hydrostatic pressure, which leads to an increase in capillary permeability and the fluid or plasma leak into the tissue and interstitial space and oedema develop.

3 Physical examination: Marked muscular atrophy, abdominal distension, dermatitis, peripheral pitting oedema, low mid-upper arm circumference, low weight for height, pot belly, red inflamed patches of skin, dry brittle hair and hepatomegaly.

The clinical test includes liver function test especially the level of albumin and globulin. It will be lower in kwashiorkor.

Arterial blood gas, renal function test like blood urea nitrogen (decrease)and serum creatinine ( decrease), serum potassium (decrease), creatinine clearance and complete blood count including Hb(decrease)

4 The child should have high protein diet.It can correctedby eating more protein and calorie food. Start with light food with high protein. Properly boiled gree grams,vegetable soups, fruit juices, porridge of lentil and rice, porridge of pulses and legumes, milk, soft cooked meat etc can be included.

The food should be properly cooked. Boiled and mashed vegetables can be included. Child should e provided with egg white daily. Fish can be included