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
All of the following conditions are observed in Marasmus, except - 
Select and explain. 
A. Hepatomegaly, B. Muscle wasting, C. Low insulin levels, D. Extreme weakness
A: Hepatomegaly
Answer: A: Hepatomegaly 
Explanation: Ans. is 'a' i.e., Hepatomegaly Changes in body composition in P.E.M. o Fluid considerations? Total body water in malnourished children is increased to 70-80% of body weight as compared to 60% in age matched well noarished controls. Activity of the sodium pump* is reduced. o Metabolic alterations. B.M.R. is reduced by 30% and energy expenditure due to inactivity is very low Child may behave like poikilotherm. o Endocrine changes. Insulin levels are reduced (child has glucose intolerance) Coisol and growth hormone levels are increased. o Cardiovascular system Cardiac output and stroke volume are reduced Blood pressure is low and renal perfusion is compromised. o Renal function Glomerular.filtration rate and renal plasma flow are reduced in severe P.E.M. Urinary phosphate and sodium excretion are reduced.