Marasmus Workup

Updated: Dec 13, 2021
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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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.



Lumbar puncture is rarely performed.

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