Abstract
A concise summary explaining marasmus as a severe form of protein energy malnutrition common nowadays, emphasizing its causative factor, pathophysiology, clinical features, diagnosis, and supportive role of homeopathic medicine alongside conventional treatment.
Keywords- Homeopathy, marasmus, malnutrition, remedy.
Introduction
Definition
• Under-nutrition due to famine remains endemic in some rural areas.
• WHO reports chronic under-nutrition causes half of childhood deaths globally.
• Clinical conditions:
1. Marasmus (marked muscle wasting).
2. Kwashiorkor (malnutrition with oedema).
• Caused by deficiency of protein, zinc, potassium, phosphorus, sulphur.
Etiology and risk factors
▪ Primary Causes:
Inadequate Food Intake: Chronic deprivation of calories and proteins due to poverty, famine, neglect, or ignorance.
Poor Breastfeeding Practices: Early weaning, use of diluted milk or inappropriate artificial feeding.
Chronic Diarrheal Diseases: Recurrent infections cause nutrient loss, poor absorption, and increased metabolic demand.
Parasitic Infections: Worm infestations lead to malabsorption and further nutritional loss.
Congenital Conditions: Conditions like congenital heart disease or malabsorption syndromes can lead to chronic malnutrition.
▪ Contributing Factors:
Socioeconomic status.
Lack of maternal education.
Poor sanitation and hygiene.
Inadequate healthcare access.
Natural disasters, famine, war situations.
Pathophysiology
Marasmus is essentially a state of adaptive starvation. The body utilizes all available fat stores, followed by muscle breakdown, to meet energy demands. There is a significant reduction in basal metabolic rate. Subcutaneous fat is completely depleted, and severe muscle wasting occurs. Immunity is severely compromised due to nutritional deficiency, leading to recurrent infections, which further deteriorate the child’s health.
Clinical features of marasmus
Severe Weight Loss: Body weight falls below 60% of the expected weight-for-age.
Emaciated Appearance: “Skin and bones” look. Loss of buccal fat pad, giving an old man’s face appearance.
Dry, Wrinkled Skin: Loss of skin elasticity due to subcutaneous fat loss.
Sunken Eyes: Prominent eyes due to orbital fat loss.
Failure to Thrive: Poor height gain, delayed milestones.
Irritability or Apathy: The child may be unusually quiet or excessively irritable.
Weakness and Lethargy: Due to muscle wasting and anemia.
Recurrent Infections: Particularly respiratory and gastrointestinal infections.
Hypothermia and Hypoglycemia: Due to loss of body mass and metabolic reserve.
Oedema (may occur without hypoalbuminemia)
Diminished tendon jerks.
Diagnosis
Clinical Diagnosis: Primarily based on history and physical examination.
Anthropometric Measurements:
Weight-for-Age: Below 60% of standard.
Mid Upper Arm Circumference (MUAC): Less than 11.5 cm. Body Mass Index (BMI): For older children.
Weight-for-Height Z-score: Less than -3 SD indicates severe wasting.
Laboratory Tests (Supportive):
Serum protein, albumin.
Hemoglobin.
Electrolyte imbalance.
Infection screening.
Plasma free fatty acids increased.
Blood count – lymphopenic, leucopenia, thrombocytopenia.
ECG – sinus bradycardia, low voltage.
Conventional Management
Nutritional Rehabilitation: F-75 and F-100 therapeutic formulas. Gradual introduction of energy-dense, protein-rich foods. Micronutrient supplementation (Vitamin A, zinc, iron).
Medical Treatment: Antibiotics for infections. Anthelmintics for parasitic infestations. Oral Rehydration Therapy (ORT) for dehydration.
Monitoring: Regular weight monitoring. Growth chart plotting. Addressing underlying social issues.
HOMEOPATHY MANAGEMENT :
ABROTANUM : Marasmus with extreme emaciation, especially of lower limbs; good appetite but loss of flesh; wrinkled skin; “old-man appearance.”
IODUM : Rapid weight loss despite voracious appetite; hyperactive, restless children; intense hunger.
NATRUM MURIATICUM : Emaciation of the neck and upper body; sensitive, reserved nature; craving for salt; poor assimilation.
CALCAREA PHOSPHORICA : Marasmus with poor bone development; delayed dentition; open fontanelles; anemia.
SILICEA : Poor assimilation of nutrients; pot-bellied children with thin limbs; delayed milestones; cold, sweaty feet.
CHINA OFFICINALIS: Debility after chronic diarrhea or fluid loss; pale, weak children; loss of vital fluids causing weakness.
LYCOPODIUM : Emaciation with weak digestion; bloated abdomen; weak constitution; irritable child craving sweets.
CALCAREA CARBONICA : Fat children who begin to emaciate after illness or dentition. Profuse sweating of the head. Pot-bellied, fair-skinned, flabby children. Craving for eggs, indigestible things.
ARSENICUM ALBUM : Marasmus with great restlessness and anxiety, especially at night. Burning pains, extreme prostration. Thirst for small sips frequently. Diarrhea with an offensive smell.
SULPHUR : Emaciation with heat, especially in chronic cases. The child looks dirty, offensive body odor. Hungry at 11 AM; ravenous appetite. Red lips, dry skin, eruptions. Lazy, messy, philosophical child.
BARYTA CARBONICA : Marasmus in mentally and physically underdeveloped children. Large abdomen with thin limbs. Delayed development and timidity.
Recurrent tonsillitis or glandular swelling.
TUBERCULINUM : For children with a family history of tuberculosis or wasting disease. Emaciation with a good appetite. Children catch colds easily; chronic
coughs. Craving for smoked meats, milk.
PSORINUM: Chronic marasmus with dirty, unhealthy-looking children. Skin eruptions with foul odor. Always chilly, cannot tolerate cold air. Extremely weak,
hungry at night.
PHOSPHORUS : Tall, thin children with nervous, sensitive constitutions. Craving for cold drinks, ice cream. Frequent diarrhea after eating. Bleeding tendencies,
burning sensations.
MERC SOLUBILIS : Marasmus with ulcerations, glandular swelling, or sweating. Offensive saliva, metallic taste. Night sweats, bone pains. Tongue flabby with imprint of teeth.
SEPIA: Emaciation in indifferent, sad, withdrawn children. Pale, yellowish face. Aversion to milk and meat. Weak, chilly, weepy.
FERUM PHOS : First stage of marasmus with anemia and weakness. Pale face, tendency to low-grade fever. Poor absorption of nutrients. Good for intercurrent use.
CONCLUSION :
Marasmus is a critical condition representing severe undernutrition and requires immediate attention through proper medical and nutritional interventions.
Homeopathy, when used as complementary therapy, can aid in improving digestion, assimilation, and constitutional health of the child, thereby assisting in recovery and preventing relapses. It is essential that homeopathy be practiced responsibly, alongside conventional medical care, especially in life-threatening conditions like marasmus.
REFERENCE :
- World Health Organization. Guidelines for the Management of Severe Acute Malnutrition.
- Davidson’s Principles and Practice of Medicine , Author: Brian R. Walker, Nicki R. Colledge, Stuart H. Ralston, Ian D. Penman (Editors) , Publisher: Elsevier , Latest Edition (as of 2025): 24th Edition (2023).
• Boericke, W. Pocket Manual of Homeopathic Materia Medica.
• Allen, H.C. Keynotes of the Materia Medica. • Materia Medica for Students: Drug Pictures & Materia Medica (Part I) , Author: Dr.Ritu Kinra, Publisher: B. Jain Publishers (Large Print edition).
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