Symptoms of hypotrophy

Symptoms of hypotrophy, in particular each of the 3 main clinical and pathogenetic variants of hypotrophy: marasmus, kwashiorkor and the 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:

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

Marasmus is the result of severe 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 exhaustion. The skin of such patients acquires a gray tint, becomes cyanotic , dry, completely loses elasticity, ulcers and bedsores easily occur. A complete absence of the subcutaneous fat layer is noted. Due to the absence of Bish's fat lumps, the face acquires a triangular shape, becomes wrinkled, sunken cheeks are noticeable. Clinicians of the past described such changes with a capacious definition - "Voltaire's face". Such patients experience cheilitis and mucositis, intestinal loops filled with gases are outlined through the thinned abdominal skin. The severity of the noted clinical manifestations depends on the severity of the hypotrophy.

The main symptoms of malnutrition - alimentary marasmus in young children

		Degree of hypotrophy
Clinical signs	I	II	III
Underweight	11-20%	21-30%	More than 30%
Body mass to length ratio	P25-P10	P10-P3	Less than P3
Skin condition:
Color	Pale	Pale grey	Grayish-cyanotic
Humidity	Slightly lowered	Moderately reduced	Sharply reduced
Elasticity	Normal	Reduced	Sharply reduced
Subcutaneous fat layer	Thinned on the stomach	Absent on the trunk and limbs	Absent everywhere, even on the face ("Voltaire's face")
Tissue turgor	Slightly reduced	Moderately reduced	Sharply reduced
Appetite	Not violated	Moderately reduced	Anorexia
Character of stool	Not changed	Unstable (diarrhea, constipation)	"Hungry" (dry, crumbly, with a putrid smell)
Regurgitation and vomiting	Rarely	Not infrequently	Often
Emotional tone	Anxiety	Anxiety and depression	Depression, apathy
Physiological reflexes	Not violated	Moderate hyporeflexia	Significant hyporeflexia
Psychomotor development	Age appropriate	Lagging behind the norm	Acquired skills disappear
Immunobiological resistance	Normal or slightly reduced	Significantly reduced	Transient secondary immunodeficiency
Muscle tone	Mild hypotension	Moderate hypotension	Severe hypotension

Typical symptoms of malnutrition - kwashiorkor are characterized by the Djeli-far tetrad, which includes:

1. swelling;
2. delay in physical development;
3. muscle atrophy with preservation of the subcutaneous fat layer;
4. delay in neuropsychic development.

Edema usually first appears on the dorsum of the feet, then spreads to other areas of the body. Due to the disruption of melanotropic hormone production, skin hypopigmentation is observed, which also manifests itself in stages. First, hypopigmentation appears in the elbow 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". At the same time, areas of hyperpigmentation with uneven contours (elbows, outer surfaces of the thighs), phenomena of epidermal detachment, thinning of the mucous membranes, angular stomatitis, perianal fissures are noted. In addition, these patients often develop symptoms of hypotrophy such as: hair depigmentation, hepato- (due to fatty infiltration and edema) and splenomegaly. Hypothermia (body temperature below 35.6 °C), apathy, lethargy, "mask of suffering", severe weakness, and lethargic numbness are characteristic. Patients lie in the fetal position to reduce heat loss. The condition of patients with kwashiorkor progressively worsens due to severe anorexia, which closes the vicious circle.

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

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