This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'All of the following conditions are observed in Marasmus, except – \nSelect and explain. \nA. Hepatomegaly, B. Muscle wasting, C. Low insulin levels, D. Extreme weakness', 'role': 'user'}, {'content': 'Answer: A \nExplanation: Changes in body composition in P.E.M. \nFluid considerations-\n\nTotal body water in malnourished children is increased to 70-80% of body weight as compared to 60% in age-matched well-nourished controls.\nThe activity of the sodium pump* is reduced.\n\nMetabolic alterations.\n\nB.M.R. is reduced by 30% and energy expenditure due to inactivity is very low\nThe child may behave like poikilotherm.\n\nEndocrine changes.\n\nInsulin levels are reduced (child has glucose intolerance)\nCortisol and growth hormone levels are increased.\n\nCardiovascular system\n\nCardiac output and stroke volume are reduced\nBlood pressure is low and renal perfusion is compromised.\n\nRenal function\n\nGlomerular filtration rate and renal plasma flow are reduced in severe P.E.M.\nUrinary phosphate and sodium excretion are reduced.', 'role': 'assistant'}]