30th April 2024

A 3-year-old female child, recently relocated from a resource-limited setting, presents with a history of poor appetite, failure to thrive, and generalised swelling.

A 3-year-old female child, recently relocated from a resource-limited setting, presents with a history of poor appetite, failure to thrive, and generalised swelling. Her mother reports that the child’s diet is predominantly carbohydrate-based with minimal protein intake. On examination, the child appears lethargic with noticeable pitting oedema of the lower limbs and a distended abdomen. Her skin is dry with areas of hyperpigmentation and desquamation.

Which investigation is most appropriate to support the diagnosis of kwashiorkor?