Protein energy malnutrition physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Physical Examination

Patients with kwashiorkor usually appear retarded in growth in the late breast-feeding, weaning, and post weaning ages, with changes in skin and hair color and edema in the most dependent areas of the body ascending upward toward the head. Physical examination of patients with kwashiorkor is usually remarkable for rounded prominence of the cheeks known as the moon face, hyperkeratosis and hyperpigmentation of the skin, and distended abdomen due to an enlarged liver.

Appearance of the Patient

Patients with kwashiorkor are usually apathetic and have a listless affect, with a round face with prominent cheeks known as the moon face. Despite this looks, they have very thin extremities and edema of the dependent areas such as the feet and sacral areas of the back. there is a marked discoloration of the skin and hair with a fluffy texture.

Vital signs

• Normal body temperature/ Hypothermia
• Hypotension
• Bradycardia

Skin

Thin, dry, peeling skin with confluent areas of hyperkeratosis and hyperpigmentation

HEENT

• Abnormalities of the head/hair may include presence of sparse and discoloured hair.
• Eyes are jaundiced
• There is pursed appearance of the mouth

Neck

Hepatojugular reflex may be present because of the hepatomegaly.

Lungs

• Decreased chest expansion
• Distant breath sounds maybe present

Heart

• Bradycardia

• Hypotension

• Presence of heart failure in severe cases

Abdomen

• Hepatomegaly
• Anorexia
• Digestive upset
• Diarrhoea
• Mild steatorrhoea

Back

Presacral edema

Genitourinary

• Reduced glomerular filtration rate
• Reduced capacity of the kidney to excrete sodium
• Excess acid
• Reduced water load
• Urinary tract infections

Extremities

• Pitting edema of the lower extremities
• Muscle atrophy

Neuromuscular

• Patient is usually oriented to persons, place, and time
• Altered mental status / mental retardation may be seen
• Hyporeflexia / areflexia
• Generalised muscle weakness