MARASMUS AND HOMEOPATHIC MANAGEMENT

                                                           NUTRITIONAL MARASMUS

DEFINITION:-

Nutritional marasmus is a deficiency syndrome occurring in infants and young children caused by continued deficiency of all the elements of food (i.e., a state of continued semi starvation). It is another extreme form of protein energy malnutrition (PEM) in which there is a gross deficiency of proteins as well as calories.

AETIOLOGY:-

-          It is mainly caused by deficiency of protein and all calories in body.

-          This disease mostly affects infants below one year of age. In India, it is at least 3 times more common than kwashiorkor.

-          Infants born of poor parents living in slum areas of towns and cities are more commonly affected.

-          Extreme poverty and repeated pregnancies are the prime factors responsible for marasmus in this country.-

-          EARLY WEANING:- early weaning is forced on the infant mostly due to successive pregnancy. The infant is deprived of breast milk rather too early. The mother refuses to continue breast feeding since it would spoil her ‘feminine figure’.

-          WEANING WITH INSUFFICIENT FOOD:-  due to sheer poverty, economical poor, weaning in most cases is done with little barley water or rice gruel with small quantity of diluted cow milk or no milk at all, with a meager family income and large number of members to feed.

-          RECURRENT DIARRHOEA AND INFECTIONS: - recurrent gastroenteritis and other forms of diarrhoea as well as recurrent childhood infections are important precipitating factors.

SYMPTOMS:-  

-          Loss of weight up to less than 60% of the standard weight.

-          Gross wasting of muscles – the arm circumference (measured by a tape just above the elbow joint) is under 12.5 cm (normal – 13.5 cm or more).

-          Thin skin which can easily be pinched up due to loss of subcutaneous fat. The infant looks like a ‘little old man’ made up of just ‘skin and bones’. The face is shrunken (‘monkey face’).

-          Growth retardation.

TREATMENT:-

-          Initially, the diet must contain 30-60 calories and 1-1.5 gm of protein per kilogram of body weight.

-          Gradually, it should be increased to contain 100-120 calories and 3-4 gm of protein per kilogram of body weight.

-          Anaemia should be treated with blood transfusion.

-          Associated fluid and electrolyte deficiencies must be corrected, vitamin supplement should be provided.

HOMEOPATHIC TREATMENT:-

1.       ABROTANUM:-

A very useful remedy in marasmus, especially of lower extremities only, yet with good appetite. Rheumatism following checked diarrhoea. Wrinkled, cold, dry, pale face. Blue rings around dull-looking eyes. Indigestion, with vomiting of large quantities of offensive fluid.

2.       ACETIC ACID:-

This drug produces a condition of profound anaemia, with some dropsical symptoms, great debility, frequent fainting, dyspnoea, weak heart, vomiting, profuse urination and sweat. Pale, waxen, emaciated face. Eyes sunken, surrounded by dark rings. Vomits after every kind of food. Frequent watery stools, worse in morning. Burning, dry, hot skin, or bathed in profuse sweat.

3.       AETHUSA:-

Expression anxious, full of pain; linea nasalis marked. Intolerance of milk; vomiting as soon as swallowed or in large curds. Vomiting, with sweat and great weakness, accompanied by anguish and distress followed by sleepiness. Undigested, thin, greenish preceded by colic, with tenesmus, and followed by exhaustion and drowsiness. Weakness of lower extremities.

4.       NATRUM MUR:-

Emaciation most notable in neck. Great debility; most weakness felt in the morning in bed. Feels bruised, with headache in school children. Numbness and tingling in fingers and lower extremities.

5.       SILICEA:-

Some of other drugs are apis, ars alb, belladonna, cal phos, iodum, lycopodium, mag carb, nux moschatae, nux vom, sarasaparilla and sulphur.