Marasmus is a form of severe protein-energy malnutrition that occurs due to negative energy balance, particularly in infants. It is characterized by severe wasting of over 60% of expected weight, loss of subcutaneous fat and muscle wasting. The causes include poor feeding habits, physical defects preventing eating, diseases interfering with food assimilation, infections causing loss of appetite, and loss of food through vomiting or diarrhea. Treatment involves rehydration and refeeding through intravenous fluids or feeding tubes to prevent complications like organ failure or coma from developing.

1. MARASMUSMARASMUS
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2. Marasmus - Definition
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Marasmus is a form of severe PEM occur as result from a negative energy
balance that may occur at any age, particularly in early infancy and is
characterized by:
Severe wasting (body weight is less than 60% of the expected), the body
utilizes all fat stores before using muscles.
Loss of subcutaneous fat.
Gross muscle wasting.
Absence of edema.

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Children adapt to an energy deficiency with:
1- a decrease in physical activity.
2- lethargy.
3- a decrease in basal energy metabolism.
4- slowing of growth.
5- finally, weight loss.
Cont..

4. Etiology:
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The specific cause
may be:
1. Poor feeding habits due to improper training. lack of breast
feeding and the use of dilute animal milk.
2.A physical defect e.g. cleft lip or cleft palate or cardiac
abnormalities, which prevent the infant from taking an
adequate diet.

5. Etiology:
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3. Diseases, which interfere with the assimilation of food e.g.
cystic fibrosis.
4. Infections, which produce anorexia.
5. Loss of food through vomiting and diarrhea.
6. Emotional problems e.g. disturbed mother- child
relationship.

6. Sign and symptoms
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1. Growth retardation:
Weight is less than 60% of expected for age and sex.
Length, head, chest, and abdominal circumferences are also
affected but to a lesser extent than weight.

7. Assessment (S&S)
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2. Loss of Subcutaneous Fat from:
The abdominal wall leading to loss of skin elasticity
The limbs (thighs and buttocks): the skin becomes wrinkled and
hanging into longitudinal folds.
The buccinators pad of fat is the last to disappear.This leads to
hollowing these cheeks, which leads to triangle face and an
appearance resembling the old man.

8. Assessment (S&S)
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3. MarkedWasting of Muscles:
This together with the loss of subcutaneous fat lead to
Scaphoid abdomen with marked thinning of abdominal wall.
Stick -like appearance of limbs.

9. Assessment (S&S)
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4. Psychic Changes:
Marasmic infants look anxious, irritable, excessively cry and
sleep little. However, they look less miserable than the cases of
kwashiorkor.
Marasmic infants are usually hungry and have good appetite.
Sometimes, there is anorexia and poor feeding.

10. Assessment (S&S)
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5. Chronic diarrhea with or without vomiting.
6. Intercurrent infections:
Like otitis media, bronchopneumonia, urinary tract infections.
7. Associated deficiencies of iron, vitamin A and D.
8. Hypothermia due to loss of subcutaneous fat.

11. Laboratory Findings:
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Blood glucose levels
Hemoglobin levels
Urinalysis
Stool tests
Electrolyte test.

12. Treatment of Marasmus
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The best way to treat Marasmus is to give the affected
individual a healthy and nutritious diet which is rich in
proteins and calories so that the body gets sufficient
energy to function. There are specific methods of refeeding
and rehydrating the affected individual so as to prevent
complications arising out of refeeding. The methods
generally used for refeeding are use of IV fluids,
rehydration solutions administered orally, and feeding
through NG tubes.

13. Complications of Marasmus:
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Lack of proper growth in children
Joint deformities
Severe weakness
Permanent vision loss
Organ failure
Coma.

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