Symptoms of hypotrophy

Symptoms of hypotrophy, in the frequency of each of the three main clinical and pathogenetic variants of hypotrophy: marasmus, kwashiorkor and transitional variant - marasmus-kwashiorkor - are characterized not only by their own characteristics, but also by common features. In the clinical picture of any form of hypotrophy, the following main clinical syndromes can be distinguished:

• inadequate fatness;
• trophic disorders;
• decreased food tolerance;
• changes in the functional state of the central nervous system;
• disturbances of immunological reactivity.

Marasmus is the result of heavy protein and energy starvation, often accompanied by a deficiency of essential vitamins and minerals. Due to the active utilization of muscle proteins to maintain an adequate concentration of visceral proteins, the disease is clinically manifested by severe depletion. The skin of such patients acquires a gray shade, becomes cyanotic , dry, completely loses its elasticity, ulcers and bedsores easily appear. Mark the complete absence of the subcutaneous fat layer. Due to the absence of fatty lumps of Bisha, the face acquires a triangular shape, becomes wrinkled, hollow cheeks are visible. Similar changes clinicians of the past described a capacious definition - "the face of Voltaire". In such patients, the phenomenon of cheilitis and mucositis is noted, intestinal loops that are filled with gases are contoured through the thinned abdominal skin. The severity of the marked clinical manifestations depends on the degree of severity of the hypotrophy.

The main symptoms of malnutrition - alimentary marasmus in young children

		Degree of hypotrophy
Clinical signs	I	II	III
Deficiency of body weight	11-20%	21-30%	Over 30%
Weight to length ratio	P25-P10	P10-P3	Less P3
Skin condition:
Colour	Pale	Pale gray	Greyish-cyanotic
Humidity	Slightly reduced	Moderately reduced	Sharply reduced
Elasticity	Normal	Decreased	Sharply reduced
Subcutaneous fat layer	Stretched on the belly	Missing on the trunk and extremities	Is absent everywhere, even on the face ("Voltaire's face")
Turgor of tissues	Slagha reduced	Moderately reduced	Sharply reduced
Appetite	Not violated	Moderately reduced	Anorexia
Character of the chair	Not changed	Unstable (diarrhea, constipation)	"Hungry" (dry, crumb-boned, with putrefactive odor)
Regurgitation and vomiting	Rarely	Often	Often
Emotional tone	Anxiety	Anxiety and Oppression	Oppression, apathy
Physiological reflexes	Not violated	Moderate hyporeflexion	Significant hyporeflection
Psychomotor development	Matches age	Lags behind the norm	Disappear acquired skills
Immunobiological resistance	Normal or slightly reduced	Significantly reduced	Transient secondary immunodeficiency
Muscle tone	Light hypotension	Moderate hypotension	Severe hypotension

Typical symptoms of hypotrophy - kwashiorkor are characterized by the Jelly-lamp tetrad, which includes:

1. swelling;
2. lag in physical development;
3. Atrophy of muscles with preservation of the subcutaneous fat layer;
4. lag in the neuropsychological development.

Usually, swelling first appears on the back surface of the feet, then they spread to other parts of the body. Due to a violation of the production of melanotropic hormone, hypopigmentation of the skin is noted, which is also manifested in stages. First, hypopigmentation appears in the elbows and inguinal folds, then on the face, then the skin of the trunk is affected and the child acquires a characteristic appearance - a "red child". Simultaneously, areas of hyperpigmentation with uneven contours (elbows, external hips surfaces), phenomena of epidermal detachment, thinning of mucous membranes, angular stomatitis, perianal cracks are noted. In addition, these patients often develop symptoms of hypotrophy, such as depigmentation of hair, hepatitis (due to fatty infiltration and edema) and splenomegaly. Characterized by hypothermia (body temperature below 35.6 ° C), apathy, inhibition, "a mask of suffering," marked lethargy, lethargic stupor. Patients lie in the fetal position to reduce heat loss. The condition of patients with a kwashiorkor progressively worsens due to pronounced anorexia, which closes the vicious circle.

Marasmus-kwashiorkor combines signs of marasmus and kwashiorkor in the form of pronounced atrophy and edema. Changes in skin and hair are moderately expressed, characterized by fatty liver infiltration. The disease develops as a result of severe protein and energy starvation when the infection stratifies.

[1], [2], [3], [4], [5]