Marasmus in children and its rubrics

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Marasmus is one of the syndrome of PEM (Protein rnergy Malnutrition)is manifested by stunted growth, loss of adipose tissue, generalized wasting of protein mass, and no edema, is thought to be due to the combined effects of protein and energy malnutrition.
The other one is kwashiorkor, manifested by growth failure, edema, hypoalbuminemia, fatty liver, and preservation of subcutaneous fat, is thought to be due to selective protein malnutrition.
In moderate PEM Children fail to gain height and weight; adults generally lose weight, although edema may mask weight loss.Triceps skin-fold thickness and mid-arm muscle area are reduced. In the absence of renal disease the ratio of 24-h urine creatinine to height is a sensitive indicator of protein malnutrition and should be measured at weekly intervals. Levels of albumin, transferrin, and prealbumin in serum may be low.Serum triiodothyronine is decreased, the level of reverse triiodothyronine is increased, and the metabolic rate is low. Peripheral lymphopenia may be present, and glucose tolerance may be impaired. The heart size tends to be small.

Severe PEM is characterized by more profound abnormalities in body composition and in laboratory findings. Decrease in muscle mass is evident on physical examination, as indicated by excavation of the intercostal spaces and wasting of the temporal muscles and extremities, and subcutaneous adipose tissue is decreased or absent. Listlessness, easy fatigability, sensation of coldness, dry cracked skin,drawn facies, and dyspigmentation of the skin and hair are common. Decubiti and skin ulcers occur in advanced stages. Blood pressure is low, the pulse is decreased, and temperature may be low. There is a global impairment of organ system function.
This is the generals rubric for marasmus in children

In Abrotanum Malnutrition is evident from progressive atrophy in spite of ravenous hunger.The prostration is so great that they cannot even hold up their heads

.They are very subject to alternate diarrhoea and constipation
In Aethusa with the emaciation we have immoderate vomiting of milk immediately after nursing

.The same emaciation, the same want of power to hold the head up(image)

are present but the great intolerance of milk should always be our guide in its selection.(image)

In Antimonium crudum we have the vomiting of food and drink, we have the watery diarrhoea, but the ugliness and peevishness of the child(image),

the want of animal heat and the heavy milky or the milk-white coating of the tongue should help us in our selection.
Baryta carb. is indicated when in addition to the general emaciation we have the immature and dwarfed mental condition of the child to think of.A general tendency towards swelling of cervical and other glands is also to be noticed in this remedy.(image)

In Calcarea carb. the emaciation is more marked in tissues other than adipose.
The muscles and the bones suffer before the fatty tissues are affected.There is a general deceptive appearance of plumpness about this child.Profuse sweat especially in the head, crusta lactea, engorgement of glands, especially the mesenteric, sour pungent clayey diarrhoea and great craving for eggs are prominent symptoms.
Iodium is indicated when the hunger is excessive and the child wants to eat constantly.In addition to this we have swelling and induration of the mesenteric glands(image)

.

Natrum mur., a great remedy at all times, is particularly indicated in marasmus when atrophy is more marked in the throat and neck of children.The emaciation is also seen in the buttock(image)

.The mapped tongue, herpes labialis, marked repugnance to bread, sadness, profuse sweating, palpitation and constipation are sure indications for Natrum mur.
Petroleum is indicated in marasmus when the patient is subject to a peculiar type of diarrhoea, harassing all day long but mostly absent at night time.The other prominent symptoms are a marked odour of garlic in the breath (image)

and feces of the patient, aversion to fresh air, a marked tendency for eczema, excoriating cracks and bleeding rhagades.
Sarsaparilla is generally called for in very pronounced cases of marasmus where the disease is fully developed. The emaciation is extreme, the face looks shriveled, the skin lies into folds, eruptions are prone to appear on tongue and roof of mouth.Offensive sweat about genitals, restlessness and crying before passing of urine, passing of great quantity of sand in the urine are also characteristic of this remedy.

Silicea is indicated in nervous, irritable, timid children who though wasting everywhere present an exceedingly large head.Malnutrition is marked everywhere in Silicea.A great aversion to mother's milk is also noticed.

Sulphur though coming last in this list is not second in importance to any.In fact it is used oftener than many of the other remedies mentioned in this list.No body can mistake a Sulphur baby.There is nothing inviting about him.The skin is dry, harsh and wrinkled giving the child an old man look. Eczema, itch, eruptions, enlargement of the glands, obstinate constipation and persistent diarrhoea, a never-to-be-forgotten nauseous smell, dirt and filth speak of an ugliness that is only to be encountered in Sulphur.