Marasmus (patient information)
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# Overview
Marasmus is a form of malnutrition that results when subcutaneous fat and muscle are lost because of mobilization of all available energy and nutrients. Deficiency of protein as well as energy nutrients (that is carbohydrates and fats) in the diet may lead to marasmus. Marasmus typically occurs in children below the age of 1 year.

# Causes
Kwashiorkor is most common in areas where there is:
- Famine
- Limited food supply
- Low levels of education (when people do not understand how to eat a proper diet)
This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition. Marasmus is very rare in children in the United States. There are only isolated cases. However, one government estimate suggests that as many as 50% of elderly people in nursing homes in the United States do not get enough protein in their diet. When marasmus does occur in the United States, it is most often a sign of child abuse and severe neglect.

# Symptoms
Symptoms include:
- Patient appears like an 'elderly man'
- Dry and flaking/peeling skin but no changes in color
- Loss of muscle mass
- Sunken eyes
- Protruded cheeks
- Loss of fullness near the mouth area giving rise to 'monkey-like' facies
- Swelling of body (edema) is generally not seen in marasmus
- Sunken belly
- Diarrhea
- Failure to gain weight and grow
- Fatigue
- Hair changes (change in color or texture)
- Increased and more severe infections due to damaged immune system
- Irritability
- Lethargy or apathy
- Rash (dermatitis)
- Shock (late finding)
- Swelling (edema)

# Diagnosis
The physical exam may show an enlarged liver (hepatomegaly) and general swelling. Tests may include:
- Arterial blood gas
- BUN
- Complete blood count (CBC)
- Creatinine clearance
- Serum creatinine
- Serum potassium
- Total protein levels
- Urinalysis

# Treatment
Getting more calories and protein will correct marasmus, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth.
Treatment depends on the severity of the condition. People who are in shock need treatment right away to restore blood volume and maintain blood pressure. Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.
Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly.
Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzyme lactase so that they can tolerate milk products.

# Outlook (Prognosis)
Getting treatment early generally leads to good results. Treating marasmus in its late stages will improve the child's general health. However, the child may be left with permanent physical and mental problems. If treatment is not given or comes too late, this condition is life threatening.

# Complications
Complications may include:
- Coma
- Permanent mental and physical disability
- Shock

# When to Contact a Medical Professional
Call your health care provider if your child has symptoms of marasmus.

# Prevention
To prevent marasmus, make sure the diet has enough carbohydrates, fat (at least 10% of total calories), and protein (12% of total calories).

# Alternative Names
Protein malnutrition; Protein-calorie malnutrition; Malignant malnutrition