Dawaa Reference

chronic

Kwashiorkor (oedematous protein malnutrition)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class TD74.00 - condition scope only, no dose · Kwashiorkor(Archived) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK507876/ · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Kwashiorkor (oedematous protein malnutrition) - disease-level clinical article (kwashiorkor-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Kwashiorkor typically follows a protein-poor but calorie-adequate diet, often after carbohydrate-heavy foods are introduced abruptly at weaning
  • A recent trigger like an infection or injury often precedes onset, striking a child who had been nursing up to that point
  • Caregivers may report leg or facial swelling, poor appetite, lethargy, or skin breakdown [facial swelling · leg swelling · lethargy · poor appetite]
  • Unlike marasmus, kwashiorkor usually comes with little or no history of hunger or food-seeking behavior

Signs — what you find (7)

  • Exam shows bilateral pitting edema, starting in the legs and potentially progressing to whole-body swelling [leg swelling]
  • Despite looking swollen, these children are usually severely malnourished underneath
  • Skin can show flaky-paint dermatosis - patches of darkened, peeling skin, especially over pressure points or trauma sites [scaling]
  • Cracked sores at the mouth corners and pale, thin, easily plucked hair are common [pallor]
  • An enlarged liver from fatty infiltration is frequently seen [hepatomegaly]
  • These children tend to be apathetic and listless, with little interest in food or their surroundings [lethargy]
  • Bilateral pitting edema of nutritional origin alone is enough to meet criteria for severe acute malnutrition [leg swelling]

Tests (9)

  • Severe acute malnutrition is diagnosed if weight-for-height z-score is very low, mid-upper arm circumference is under 115 mm, or nutritional bilateral pitting edema is present
  • MUAC-for-age z-score and weight-for-height z-score are used together in resource-limited or high-edema settings to improve sensitivity for detecting kwashiorkor
  • Weight-for-age below the third percentile is not a reliable marker for severe acute malnutrition, since it ignores the effect of stunting on linear growth
  • Ascites in a malnourished child should prompt evaluation for tuberculosis, HIV, sepsis, or malaria
  • WHO's core lab panel includes hemoglobin and blood smear, blood glucose, serum albumin and electrolytes, stool microscopy and culture, HIV testing, and urine microscopy and culture
  • Further micronutrient workup includes vitamin D, CBC, iron studies, folate, and vitamin B12 to characterize any anemia
  • Plasma transferrin, albumin, and thyroxine-binding prealbumin serve as markers of nutritional status and response to treatment
  • Suspected TB is worked up with an exposure history, exam, and where available chest imaging plus microbiologic testing such as gastric aspirate, sputum, or urine testing
  • Ascites raising suspicion for abdominal TB should prompt a diagnostic paracentesis

If not this — what else fits (4)

  • Severe edema mimicking kwashiorkor also needs work-up for nephrotic syndrome, liver disease with low albumin, congestive heart failure, and severe anemia
  • Both ascites and kwashiorkor together raise suspicion for coexisting tuberculosis, warranting ascitic fluid analysis and imaging
  • A careful history, exam, and anthropometric measurements are what separate malnutrition from other medical conditions in most cases
  • Children with severe malnutrition often also have coexisting tuberculosis, HIV/AIDS, measles, malaria, or micronutrient deficiencies that need identifying and treating

SourceStatPearls "Severe Acute Malnutrition: Recognition and Management of Marasmus and Kwashiorkor" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Severe protein-energy malnutrition is now rare in Egypt outside extreme poverty or chronic illness, but the GP must recognise it and refer for supervised nutritional rehabilitation. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Severe protein-energy malnutrition is now rare in Egypt outside extreme poverty or chronic illness, but the GP must recognise it and refer for supervised nutritional rehabilitation.

Cautions
  • RED FLAG - Severe underlying systemic infection or septicaemia presenting without typical fever due to impaired immune response: assess urgently and refer.
  • RED FLAG - Severe hypothermia (rectal temperature <35.5 C) or profound hypoglycaemia: assess urgently and refer.
  • Oedema, growth failure, and skin/hair changes in a malnourished child require urgent paediatric or nutrition referral; refeeding must be supervised to avoid refeeding syndrome.
  • Rare in Egyptian primary care.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - There is a risk of refeeding syndrome when reintroducing nutrition rapidly.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.