Pitting Edema and Desquamation

  • Sowmya ShashidharaEmail author
  • H. Koushik
  • Sangita Trivedi


  • Generalized edema with dermatosis in a malnourished child should raise clinical suspicion of kwashiorkor

  • The clinical presentation of kwashiorkor may mimic features of sepsis, heart and kidney disease

  • A child satisfying WHO criteria for severe acute malnutrition (SAM) with good appetite in the absence of medical complications can be treated on an outpatient basis

  • In the management of shock or severe dehydration in children with SAM, cautious use of fluids must be done as SAM is a state of relative sodium excess in the body

  • Reductive adaptation is a compensatory response to chronic malnutrition, which simply means limitation of functioning of multiple organs

  • Chronic malnutrition is an immunosuppressed state, affecting both cell-mediated and humoral immunity

  • Micronutrient deficiency contributes to immunosuppression in chronic malnutrition


Severe acute malnutrition Kwashiorkor Mid upper arm circumference 


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    Rytter MJ, Kolte L, Briend A, Friis H, Christensen VB. The immune system in children with malnutrition—a systematic review. PLoS One. 2014;9(8):e105017.CrossRefGoogle Scholar
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    Bhaskaram P. Micronutrient malnutrition, infection, and immunity: an overview. Nutr Rev. 2002;60(5 Pt 2):S40–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sowmya Shashidhara
    • 1
    • 2
    Email author
  • H. Koushik
    • 1
  • Sangita Trivedi
    • 3
  1. 1.Department of PediatricsKasturba Medical College, Manipal UniversityManipalIndia
  2. 2.Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)Universal Scientific Education and Research Network (USERN)ManipalIndia
  3. 3.Department of PediatricsGovernment Medical College, Surat, Veer Narmad South Gujarat UniversitySuratIndia

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