Severe acute malnutrition, a consequence of low socioeconomic status – clinical case series

Abstract

Severe malnutrition in childhood is considered a global burden. Micronutrient and protein-calorie deficiencies encompass a clinical spectrum from a minor nutritional problem to a myriad of life-threatening disorders. We present a series of three clinical cases of severe acute malnutrition with common complications and specific treatment. A 14-month-old boy (Case 1), a 16-month-old girl (Case 2) and a 19-month-old girl (Case 3) were admitted to our hospital for generalized edema. Physical examination revealed severe stunting and wasting (Z-score<-3, ac­cor­ding to WHO), with pallor, anasarca and severe neuro­develop­ment defects. Laboratory investigations showed severe ane­mia, hypoglycemia, hypoalbuminemia, altered coagu­la­tion, elevated liver enzymes, cholestasis and metabolic acidosis. Se­rology tests resulted negative for infections (human im­mu­no­deficiency virus, hepatitis B and hepatitis C viruses). After excluding other conditions, findings regarding physical and laboratory evaluations were attributed to severe mal­nu­trition. The treatment was started with a high-calorie and high-protein diet, intravenous albumin, antibiotics, vita­min K, blood transfusion and correction of micronutrient de­fi­ciencies, with favorable outcome. Even though the prevalence of malnutrition has reduced in the last years, the low socioeco­nomic status continues to be a significant risk factor in the developing countries.