1 1/2 yrs ,MCH,s sugarcane's cutter by occupation,noticed swelling increased over daytime since 8 days hands ,wrist ,foot,ankle ,legs lethargic @Dr. Pruthviraj Pruthviraj



1.5 yrs 7.9kg economically poor Normal urine R analysis S. creatinine N SGPT N Hypoalbuminimia Pathetic look & irritable Diagnosis is PEM Kwashiorkor Plz get CBC & anthropetric measurment R/o bacterial infection elsewhere Mgt Tt of infection HPD Iron supplements Multivitamins nd trace elements Parental Counseling

Dear Doc. Give proper history. Wher did the swelling start ? What r the associated history ?? Any positive renal or cardiac or liver or nutritional history ?

1 1/2 yrs 7.9 kg, MCH,Father's occupation Sugarcane cutting ,swelling noticed 8 days before,first foot and hands gradually increasing over daytime,gradually increases over foot,hands,abdomen,no h/o crying during micturition/frequency/vomiting S1S2 normal serum creatinine+urine R/M + SGPT- normal

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Allergic dermatitis

Nephropathy??? Anaemia?? Ascites??? Elephantitis??? Obstructive lymphadenopathy ??? Local allergic dermatitis ??? Thyroid function test Ascites with hepatitis and renal involvement

PEM... KWASHIORKOR PEM may be secondary to renal disease. Should be investigated in that direction.

Swelling appears 1st on legs n hand.r/0 Elephentiasis, local reaction

Why you have not described the skin changes over lower limbs and scalp hair changes like Pigmentation, Pluckable, loss of luster/ oily etc ?

Allergic dermatitis (urticaria )


Urine Exam?

Urine WNL/serum creatinine normal/SGPT normal

Nephrotic syndrome. Advised CBC, urine , liver kidney and thyroid profile.

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