Question

A 2-year-old child weighing 6.7 kg has Hb 6 g/dl, total protein 3 g/dl, low albumin, and a distended abdomen but no proteinuria. What is the diagnosis?

• A. Marasmus
• B. Kwashiorkor
• C. Indian childhood cirrhosis
• D. None

Hint:

Low albumin plus a swollen belly but no urine protein in a toddler, edematous malnutrition.

Answer 1

The Correct Option is B

Read the labs as a story of protein starvation, not protein loss. Total protein and albumin are very low, yet there is NO proteinuria, so the kidney is not leaking protein and nephrotic syndrome is off the table. Low intake plus low albumin drops oncotic pressure, fluid leaks out, and the toddler develops the distended, oedematous belly described, the signature of kwashiorkor, an oedematous severe acute malnutrition. Contrast with marasmus, which is non-oedematous wasting with a 'skin and bones' look and comparatively spared albumin, so it does not fit a swollen abdomen with hypoalbuminaemia. Indian childhood cirrhosis is a progressive liver disease with marked hepatomegaly, not this protein-deficiency oedema syndrome. Therefore the child has kwashiorkor.