Editing Kwashiorkor (section)

== Signs and symptoms ==
The defining sign of kwashiorkor in children is bilateral [[edema]] in the feet. Edema may also involve the hands, trunk, and face. Kwashiorkor is characterized by a fatty liver. This fatty liver of the undernutrition phenotype is often accompanied by evidence of inflammation and fibrosis. Whereas a fatty liver of undernutrition is a consistent feature of kwashiorkor, it is only encountered sometimes in children with marasmus. In addition to this characteristic [[hepatic steatosis]], kwashiorkor is marked by a parallel pattern of multi-organ dysfunction. Organs often affected in children with kwashiorkor include the kidneys, pancreas, heart, and nervous system.<ref name="Pham Alou Golden et al 2021"/>  Other findings that may be encountered on physical exam include a distended [[abdomen]], hair thinning, loss of teeth, skin or hair depigmentation, and [[dermatitis]]. Children with kwashiorkor often develop irritability and [[Anorexia (symptom)|anorexia]]. Generally, kwashiorkor is treated by introducing a high-quality source of protein to the diet. Ready-to-use therapeutic food (RUTF) as well as [[F-100 and F-75 (foods)|F-100 and F-75 milk powders]], which both include skim milk powder, are recommended for the treatment of kwashiorkor. These products are designed for use in low-resource settings. The limited number of kwashiorkor cases that occur in high resource settings, where there is good access to advanced therapeutic tools, are typically treated with partially hydrolyzed or [[Amino acid-based formula|elemental enteral formulas]], with parenteral nutrition provided in extreme cases.

=== Differential Diagnosis ===
While Kwashiorkor is primarily characterized by edema, growth failure, and dermatitis, it can sometimes be misdiagnosed as [https://www.ncbi.nlm.nih.gov/books/NBK441835/ Acrodermatitis Enteropathica (AE)], as both conditions present with similar dermatological symptoms.<ref name=":0">{{Cite book |last1=Khan Mohammad Beigi |first1=Pooya |url=https://link.springer.com/10.1007/978-3-319-17819-6 |title=Acrodermatitis Enteropathica: A Clinician's Guide |last2=Maverakis |first2=Emanual |date=2015 |publisher=Springer International Publishing |isbn=978-3-319-17818-9 |location=Cham |pages=43–53 |language=en |chapter=Diagnosis |doi=10.1007/978-3-319-17819-6}}</ref><ref>{{Cite journal |last1=Park |first1=Sarah E. |last2=Williams |first2=Madison |last3=Crew |first3=Ashley B. |last4=Hsiao |first4=Jennifer L. |date=2024-12-01 |title=Cutaneous Signs of Nutritional Deficiencies |url=https://link.springer.com/article/10.1007/s13670-024-00425-8 |journal=Current Geriatrics Reports |language=en |volume=13 |issue=4 |pages=189–199 |doi=10.1007/s13670-024-00425-8 |issn=2196-7865|doi-access=free }}</ref> However, AE is caused by zinc deficiency, not protein deficiency, and is associated with a significant decrease in serum zinc levels.<ref name=":0" /><ref>{{Cite journal |last1=Alwadany |first1=Muhannad M. |last2=Wadani |first2=Abdullah F. Al |last3=Almarri |first3=Fatimah H. |last4=Alyami |first4=Hadi S. |last5=Al-Subaie |first5=Muhammad A. |last6=Alwadany |first6=Muhannad M. |last7=Wadani |first7=Abdullah F. Al |last8=Almarri |first8=Fatimah H. |last9=Alyami |first9=Hadi S. |last10=Al-Subaie |first10=Muhammad A. |date=2023-04-18 |title=Acrodermatitis Enteropathica: A Rare Case With Lifelong Implications |journal=Cureus |language=en |volume=15 |issue=4 |pages=e37783 |doi=10.7759/cureus.37783 |doi-access=free |issn=2168-8184 |pmc=10198582 |pmid=37214014}}</ref> Unlike kwashiorkor, which is diagnosed based on clinical signs like [[edema]] and low [[serum albumin]] levels, AE requires additional diagnostic tests, such as zinc uptake tests and genetic screening, to differentiate it from other disorders with similar symptoms.<ref name=":0" /><ref>{{Cite journal |last1=Alwadany |first1=Muhannad M. |last2=Wadani |first2=Abdullah F. Al |last3=Almarri |first3=Fatimah H. |last4=Alyami |first4=Hadi S. |last5=Al-Subaie |first5=Muhammad A. |last6=Alwadany |first6=Muhannad M. |last7=Wadani |first7=Abdullah F. Al |last8=Almarri |first8=Fatimah H. |last9=Alyami |first9=Hadi S. |last10=Al-Subaie |first10=Muhammad A. |date=2023-04-18 |title=Acrodermatitis Enteropathica: A Rare Case With Lifelong Implications |journal=Cureus |language=en |volume=15 |issue=4 |pages=e37783 |doi=10.7759/cureus.37783 |doi-access=free |issn=2168-8184 |pmc=10198582 |pmid=37214014}}</ref> Therefore, while both conditions can present with [[dermatitis]], the underlying etiology helps distinguish the two.<ref name=":0" /><ref>{{Cite journal |last1=Alwadany |first1=Muhannad M. |last2=Wadani |first2=Abdullah F. Al |last3=Almarri |first3=Fatimah H. |last4=Alyami |first4=Hadi S. |last5=Al-Subaie |first5=Muhammad A. |last6=Alwadany |first6=Muhannad M. |last7=Wadani |first7=Abdullah F. Al |last8=Almarri |first8=Fatimah H. |last9=Alyami |first9=Hadi S. |last10=Al-Subaie |first10=Muhammad A. |date=2023-04-18 |title=Acrodermatitis Enteropathica: A Rare Case With Lifelong Implications |journal=Cureus |language=en |volume=15 |issue=4 |pages=e37783 |doi=10.7759/cureus.37783 |doi-access=free |issn=2168-8184 |pmc=10198582 |pmid=37214014}}</ref>