eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Marasmus: Differential Diagnoses & Workup

Author: Simon S Rabinowitz, MD, PhD, Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center
Coauthor(s): Mario Gehri, MD, Consulting Staff, Department of Pediatrics, Hôpital De L'Enfance, Centre Hospitalier Universitaire Vaudois, Switzerland; Ermindo R Di Paolo, PhD, Pharmacist, Department of Pharmacy, Centre Hospitalier Universitaire Vaudois, Vaud, Switzerland; Natalia M Wetterer, MD, Resident Physician, Department of Pediatrics, New York Medical College
Contributor Information and Disclosures

Updated: May 20, 2009

Differential Diagnoses

Other Problems to Be Considered

No differential diagnosis for marasmus are noted. However, when edema is present, it can reflect a kwashiorkor (KW) component of the malnutrition or an underlying cardiac or renal insufficiency. In these circumstances, additional laboratory tests or radiographic tests may be needed.

Workup

Laboratory Studies

  • Generally, for diagnosis and treatment of marasmus, no further evaluation is necessary other than the clinical evaluation. Most laboratory results are within the reference range despite significant changes in body composition and physiology. Furthermore, in regions where malnutrition is frequent, health structures are poorly equipped, and laboratory evaluations are either impossible to obtain or unreliable.
  • If they are available, some laboratory results can be useful to monitor treatment or to diagnose specific complications.
  • Laboratory tests adapted from the WHO include the following:
    • Blood glucose: Hypoglycemia is present if the level is lower than 3 mmol/L.
    • Examination of blood smears by microscopy or direct detection test: Presence of parasites is indicative of infection. Direct test is suitable but expensive.
    • Hemoglobin: A level lower than 40 g/L is indicative of severe anemia.
    • Urine examination and culture, Multistix: More than 10 leukocytes per high-power field is indicative of infection. Nitrites and leukocytes are tested on Multistix also.
    • Stool examination by microscopy: Parasites and blood are indicative of dysentery.
    • Albumin: Although not useful for diagnosis, it is a guide to prognosis; if albumin is lower than 35 g/L, protein synthesis is massively impaired.
    • HIV test: HIV test should not be routinely performed; if completed, it should be accompanied by counseling of the child's parents and the result should be confidential.
    • Electrolytes: Measuring electrolytes is rarely helpful and it may lead to inappropriate therapy. Hyponatremia is a significant finding.

Imaging Studies

  • Radiological examinations are rarely used for the same reasons as the laboratory examinations.
  • Thoracic radiography can show a pulmonary infection despite lack of clinical signs, a primary tuberculosis lesion, cardiomegaly, or signs of rachitism.

Other Tests

  • Skin test results for tuberculosis are often negative in children who are undernourished with tuberculosis or those previously vaccinated with Bacille Calmette-Guérin (BCG) vaccine.

Procedures

  • Lumbar puncture is rarely performed.
  • Urine catheterization or vesical puncture serves to exclude urinary tract infection because direct examination is often not indicative.

More on Marasmus

Overview: Marasmus
Differential Diagnoses & Workup: Marasmus
Treatment & Medication: Marasmus
Follow-up: Marasmus
Multimedia: Marasmus
References
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Further Reading

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Keywords

marasmus, severe malnutrition, protein energy malnutrition, PEM, kwashiorkor, KW, marasmic KW, protein deficiency, mental retardation, cystic fibrosis, malignancy, cardiovascular disease, end stage renal disease, gastroenteritis, measles, tuberculosis, HIV, hypothermia, hypoglycemia, hypokalemia, hypothyroidism, bacteriemia, candidiasis, Pneumocystis carinii, anorexia nervosa, iron deficiency, iodine deficiency, treatment, diagnosis

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Contributor Information and Disclosures

Author

Simon S Rabinowitz, MD, PhD, Professor of Clinical Pediatrics, New York Medical College; Chairman, Chief and Medical Administrator, Department of Pediatrics, Chief, Pediatric Gastroenterology and Nutrition, Richmond University Medical Center
Simon S Rabinowitz, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Gastroenterology, American Gastroenterological Association, American Medical Association, New York Academy of Sciences, North American Society for Pediatric Gastroenterology and Nutrition, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Mario Gehri, MD, Consulting Staff, Department of Pediatrics, Hôpital De L'Enfance, Centre Hospitalier Universitaire Vaudois, Switzerland
Disclosure: Nothing to disclose.

Ermindo R Di Paolo, PhD, Pharmacist, Department of Pharmacy, Centre Hospitalier Universitaire Vaudois, Vaud, Switzerland
Disclosure: Nothing to disclose.

Natalia M Wetterer, MD, Resident Physician, Department of Pediatrics, New York Medical College
Disclosure: Nothing to disclose.

Medical Editor

Maria Rebello Mascarenhas, MBBS, Associate Professor of Pediatrics, University of Pennsylvania School of Medicine; Section Chief, Division of Gastroenterology and Nutrition, Director, Nutrition Support Service, Children's Hospital of Philadelphia
Maria Rebello Mascarenhas, MBBS is a member of the following medical societies: American Gastroenterological Association, American Society for Parenteral and Enteral Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Ovation Honoraria Speaking and teaching

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Ovation Honoraria Speaking and teaching

 
 
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