<prompt> All of the following conditions are observed in Marasmus, except -HepatomegalyMuscle wastingLow insulin levelsExtreme weakness  <response>: 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. 