Clinical manifestations Nonedematous PEM (marasmus) Failure to gain weight Irrita bility Weight loss and listlessness skin become wrinkled and loose Subcutaneous fat disappear Muscle: atrophy, hypotonia Pulse slow Constipation, a starvation diarrhea
Clinical manifestations Nonedematous PEM (marasmus) ➢ Failure to gain weight ➢ Irritability ➢ Weight loss and listlessness ➢ skin become wrinkled and loose ➢ Subcutaneous fat disappear ➢ Muscle: atrophy, hypotonia ➢ Pulse slow ➢ Constipation, a starvation diarrhea
Edematous PEM (Kwashiorkor) Vague manifestations Lethargy, apathy, or irritability Inadequate growth Increased susceptibility to infectious Vomiting, diarrhea, anorexia Flabby subcutaneous tissue y Edema Liver enlargement Dermatitis Hair sparse and thin
Vague manifestations ➢ Lethargy, apathy, or irritability ➢ Inadequate growth ➢ Increased susceptibility to infectious ➢ Vomiting, diarrhea, anorexia ➢ Flabby subcutaneous tissue ➢ Edema ➢ Liver enlargement ➢ Dermatitis ➢ Hair sparse and thin Edematous PEM (Kwashiorkor)
Laboratory examination Serum albumin concentration Retinal combined protein Pre-albumin transferrin > IGF-I
Laboratory examination ➢ Serum albumin concentration ➢ Retinal combined protein ➢ Pre-albumin ➢ transferrin ➢ IGF-I