Coarse tremors (Kwashi shakes) occurring in children recovering from severe acute malnutrition: Case series from a tertiary hospital in Sokoto

Kwashi tremors or Kwashi shakes are uncommon neurological complications of unknown etiology seen in edematous forms of severe acute malnutrition (SAM) during rehabilitation phase of treatment. Four patients with SAM seen in our facility within a 30-month period who developed coarse tremors are presented. The aim was to highlight this uncommon presentation of SAM in our setting. Of the four patients, 3 were male and 1 was a female. Their age ranged from 19 months to 2 years and they weighed between 5.5 and 8.7 kg. Their common clinical presentation included body swelling, loss of appetite, fever, and tremors which developed after discharge. All the patients had increased/overzealous protein intake while at home. The tremors resolved completely in all the patients, but more slowly in two of the patients with hypocalcaemia. In conclusion, Kwashi shakes occurring during rehabilitation of edematous SAM with increased protein intake and appears to be worsened with hypocalcemia