Question

Passage: A one and a half year old girl, fed mostly on dilute cow's milk, develops diarrhea that persists for 10 days. This is followed by swelling on her feet.

The likely diagnosis is

• A. Kwashiorkor
• B. Acute renal failure
• C. Congestive cardiac failure
• D. Indian childhood cirrhosis

Hint:

Think about what a diet of watered down milk is missing, and what low albumin does to fluid balance.

Answer 1

The Correct Option is A

The clue here is the diet: dilute cow's milk is watered down and gives very little protein, even if some calories are supplied. Let's check what this diet leads to against each option.

1. Kwashiorkor: A diet short on protein lowers blood albumin. Low albumin lets fluid leak out of blood vessels into the tissues, which shows up as swelling, classically starting at the feet. Long diarrhea on top of this makes protein loss even worse. This matches the case closely.
2. Acute renal failure: This would be expected to show reduced urine output and deranged kidney blood tests, which are not mentioned, so it does not fit as well.
3. Congestive cardiac failure: This usually comes with fast breathing, a rapid pulse, and liver enlargement, none of which appear in this history.
4. Indian childhood cirrhosis: This liver disease is tied to high copper intake, often from copper or brass utensils, and shows up with liver enlargement and jaundice rather than a story of dilute milk feeding.

The combination of a protein poor milk diet, long diarrhea, and feet swelling from low albumin points squarely at Kwashiorkor.

Let's summarize:

• Dilute cow's milk is low in protein even when calories are near normal.
• Low protein leads to low albumin, and low albumin causes the fluid to leak out as edema.

So the likely diagnosis in this child is Kwashiorkor.