<prompt> All of the following conditions are observed in Marasmus, exceptHepatomegalyMuscle wastingLow insulin levelsExtreme weakness  <response>: Changes in body composition in P.E.M. Fluid considerations-Total body water in malnourished children is increased to 70-80 of body weight as compared to 60 in age-matched well-nourished controls.The activity of the sodium pump is reduced.Metabolic alterations.B.M.R. is reduced by 30 and energy expenditure due to inactivity is very lowThe child may behave like poikilotherm.Endocrine changes.Insulin levels are reduced child has glucose intoleranceCortisol and growth hormone levels are increased.Cardiovascular systemCardiac output and stroke volume are reducedBlood pressure is low and renal perfusion is compromised.Renal functionGlomerular filtration rate and renal plasma flow are reduced in severe P.E.M.Urinary phosphate and sodium excretion are reduced. 