This presentation describes different aspects related to Marasmus

1. MARASMUS
PREPARED BY:
Name
Kh. M. Nuruzzaman
R&D, Specialist

2. OUT LINES
• Introduction
• Definition
• Clinical features
• Etiology
• Complications
• Investigations
• Treatment & prevention of marasmus
• Nursing management

3. Marasmus is one of the 3 forms of serious protein-energy
malnutrition (PEM).
These forms of PEM represent a group of pathologic
conditions mainly in young children from developing
countries .
According to the World Health Organization (WHO), 49%
of the 10.4 million deaths occurring in children younger
than 5 years in developing countries are associated with
PEM.

4. WHAT IS MARASMUS?
 The term Marasmus is derived from the Greek
Marasmos, which means wasting.
It is a clinical syndrome resulting mainly under
nutrition due to sever deficiency of protein ,fat , and
Carbohydrates inadequate calorie supply(starvation).

5. CLINICAL FEATURES

6. ETIOLOGY
• 1- Dietary errors
• 2 - Infection
• 3- Gastroenteritis
• 5-Congenital anomalies : Cardiac , Renal
,G.I.T
• 6-Metabolic diseases.: Galactosemia ,
Fructose intolerance, Idiopathic
hypocalcaemia
• 7- Prematurity
• 8- Some cases of mental retardation
• 9- Low socio economic status
• 10-Endocrine causes

7. ASSESSMENT OF MARASMIC
CHILD/INFANT
• failure to thrive ,loss of weight (weight < 60%of expected)
• loss of subcutaneous fat : measured at many parts of the body
according to the degrees :-
• 1st degree : loss of s.c fat in the abd. wall
• 2nd degree : loss of s.c fat over the buttock and thighs.
• 3rd degree : s.c fat in the abd. wall and limbs and face

8. ASSESSMENT OF MARASMIC
CHILD/INFANT (CONT.)
• Muscle wasting
• G.I.T disturbances as anorexia in advanced cases,
hungry, constipation or diarrhea or starvation diarrhea
• liability to infection
• Hypovolemia
• Weak feeble pulse, subnormal temp, pulse rate
• Senile face and pallor

9. COMPLICATIONS OF
MARASMUS
1. Intercurrent infection : Broncho pneumonia
is the cause of death
2. Gastro enteritis
3. Hypothermia
4. Hypoglycemia
5. joint deformation
6. Sever weakness
7. Organ failure

10. INVESTIGATIONS FOR
MARASMIC INFANT
• 1.Blood analysis : (W.B.C
,Electrolytes Sugars, ketones, Plasma
proteins , normal or lowered )
• 2. Urine analysis: culture, sugar,
ketones, ca, phosphate, amino acids
• 3.Stool analysis for parasites
• 4. X- ray for chest and heart
• 5. Tuberculin test for T.B
• 6. E.N.T examination for otitis media

11. TREATMENT
1- Prevention :-
• proper diet
• encourage breast feeding up to weaning
• proper weaning
• proper vaccination as measles , T.B.
• Education regarding the cheap sources
of balanced diet, family planning.
• Proper follow up of the growth rate
• Early treatment of defects or associated
diseases

12. TREATMENT
2 – Curative treatment:-
A- Proper dietary management:-
• Adequate balanced feeding. Teaching about nutritional needs ,
preparation of diet .
• If there is vomiting or anorexia, give IV fluids or naso gastric tube
feeding.
• Gradual increase the amount and concentration of formula
B – Treatment of the cause
D – Blood transfusion
E – Vitamins and minerals supplementation

13. WHAT’S BEST ?
B-BEGIN FEEDING
E-ENERGY DENSE FEEDING
S-STIMULATION OF EMOTIONAL
,SENSORIMOTOR DEVELOPMENT
T-TRANSFER TO HOME BASED DIET

14. COMMON NURSING
DIAGNOSES OF MARASMUS
1. Altered nutrition :Less than body requirements related
to knowledge deficit, infection, physical deficit
2. Body temperature alteration (hypothermia)
3. Impaired skin integrity
4. Fluid volume deficit related to diarrhea
5. High risk for infection .

15. NURSING CARE
OF MARASMUS
1. Provide nutrition rich in essential nutrients
2. Give small amounts of foods limited in proteins, carbohydrates and
fats
3. Maintain body temperature
4. Provide periods of rest and appropriate activity and stimulation
5. Record intake and output
6. Weight daily
7. Change position frequently
8. Refer family to social worker for financial support
9. Education for parents about proper nutrition

16. MARASMIC KWASHIORKOR
Its a combination of caloric deficiency (marasmus )
and protein deficiency (KWO) .
Clinical picture
The clinical picture of this disease represents
manifestations from both diseases as:
• loss of subcutaneous fat as in marasmus
• Edema, hair and skin changes as in KWO but
there is no moon face.