marasmus presentation
TRANSCRIPT
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MARASMUS
Compiled by
Apriany Cordias A. Silalahi 110100232
Johanna Sihombing 110100224
Supervised by
dr. Oke Rina Ramayani, Sp. A (K)
Case Report
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INTRODUCTION
Marasmus is the most common form of acutemalnutrition in nutritional emergencies and, inits severe form, can very quickly lead to death if
untreated.
Malnutrition is directly responsible for 300,000
deaths per year in children younger than 5 years.
Basic Health Research 2013 there is an
increased prevalence of malnutrition-less, namely19.6%, of which 5.7% severe malnutrition and
13.9% less nutritional status.
Marasmus is one of the 3 forms of serious
protein-energy malnutrition (PEM).
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LITERATURE REVIEW
Malnutrition is the result of deficiency of protein,energy, minerals as well as vitamins leading toloss of body fats and muscle tissues.
Aetiology & Risk Factor
Direct
Foods
Presence or absence ofinfectious disease
Indirect
Nutrient content
Purchasing power
Belief of food & healthof the mother
Presence or absence
healthcare
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PATHOPHYSIOLOGY
Lack of food
body is trying to preserve life
The bodys ability to store carbovery litte
Protein catabolism
During fasting fat tissue are broken down.
The body will defend itself not to break down proteins
again after losing roughly half of the body
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CLINICAL SIGN
Poor growth
Wasting
Alertness
AppetiteAnorexia
Diarrhoea
Anemia
Skin sores
Hair changes
Dehydration
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DIAGNOSIS
Clinical PresentationAnthropometry
(BW/BL)
Severe malnutrition Looked very thin < -3 SD **)
Mild-moderate
malnutrition
Looked thin - 3 SD < - 2 SD
Health Looked health - 2 SD 2 SD
Obesity Looked fat > 2 SD
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CONDITION OF MALNUTRITION
1stcondition
Found:
- Shock
- Lethargy
- Vomiting and/or diarrhoea or dehydration
2ndcondition
Found:
- Lethargy
- Vomiting and/or diarrhoea or dehydration
3rdcondition
Found:
- Vomiting and/or diarrhoea or dehydration
4thcondition
Found:
- Lethargy
5thcondition
Not found:
- Shock
- Lethargy
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Physical Examination, BW/BL, AC
Severe malnutrition
with complications
Severe malnutrition
without complications
Mild-moderate
malnutrition
Children with one or
more signs:
-Looked very thin
- BW/BL
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ANOTHER LABORATORYEXAMINATION
Blood glucose
Peripheral blood smear
Urinalysis
Stool examinationElectrolyte
Ferritin
Mantoux test
Chest X-ray
ECG
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MANAGEMENT
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Some important things we must attend
are:
Don't giveFe before 2ndweek(Fe is given in
rehabilitation and further management phase).Don't giveintravenous fluid dripunless the patient isinshock or severe dehydration.
Don't givehigh proteindiet instabilization phase.
Don't givediureticsto patients withkwashiorkor.
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PROGNOSIS
Getting treatment early generally leads togood results.
However, the child may be left with
permanent physical and mental problems.If treatment is not given or comes too late,this condition is life-threatening.
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CASE REPORT
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HISTORY OF DISEASE
KAP, a 2 years 5 months old girl, 7 kg of BW and 79cm of BH.
Her chief comlaint is di!c"lty of #reathing
haened for 2 days, and is not related $ith $eather
and acti%ity. &o"gh '(), #een e*erienced for 2 $eeks. At +rst it
$as dry, #"t then #ecame rod"cti%e. History ofrec"r co"gh since this ast 2 months.
Her grandmother also had rod"cti%e co"gh for a
month. History of fe%er $as 2 months ago, lasted forthis 2 $eeks. he temerat"re $as " and do$n.
iarrhea $as e*erienced for a day, $itho"t losing
$eight. omiting $as denied. /o history of familyha%ing the same condition.
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HISTORY OF PREGNANCY
Patient0s mother $as 27 years old d"ringregnancy1 aterm
history of fe%er d"ring regnant '-) History of co"gh
'-) History of " '-) History of taking dr"gs ortraditional drinks '-) History of tra"ma '-) History ofhyertension '-) History of 3 '-)
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HISTORY OF BIRTH, FEEDING,
AND IMMUNIZATION
Birth $as assisted #y a 4P
#orn sontaneo"sly and cried sontaneo"sly1#l"ish '-)
BW $as 27 gram, B6 $as 8 cm, headcirc"mference $as not meas"red
6 months of exclusive breast feeding, additional foodsince 7 months old and family food was given from 19th
week onward. mm"ni:ation;BCG, Polio 4 times, Hepatitis B 3times, DPT 3 times, and Measles.
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PHYSICAL EXAMINATION
.?&, H@; #m, @@; > *i,anemic '-), icteric '-), dysnea '(), cyanosis'-), edema '-).
Generalized Status
BW; 7 kg, B6; 79 cm,
BWage; C-score D-= 'se%erely $asted)
B6age; C-score D -= 'se%erely st"nted)
BWB6; C-scoreD-= 'se%erely $asted)
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LOCALIZED EXAMINATION
Head :Face: edema (-)Eyes:superior and inferior
palpebra edema(-), lightreflex +/+, isochoric pupil,no pale in inferior palpebralconjunctiva, no icteric insclera, Old man face (+),thin hair (+)
Ears, nose, mouth: withinnormal range
Neck :Lymph nodeenlargement (-)
Thorax: Symmetricalfusiform, retraction (+)HR: 100 bpm, regular,murmur (-); RR: 48x/i,regular, ronchi (+/+),intercosta clearly visible (-),vertebra protude (-)
Abdomen: normal, symmetric,normal peristaltic, liver andspleen: unpalpable
Extremities : pulse 100 bpm
regular,adequate p/v, feltwarm, CRT < 3 edemapretibial (-), pale (-)Thinning subcutaneous fat(+), hyperthropy muscle (-),baggy pants (-)
Anogenital : Female
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Diagnosisbronchopneumonia
Differential diagnosislung TB
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Test Result Unit References
Hemoglobin 10.40 g% 11.3-14.1
Erythrocyte 3.77 106/mm3 4.40-4.48
Leucocyte 18.13 103/mm3 6.0-17.5
Thrombocyte 732 103/mm3 217-497
Hematocrite 32.30 % 37-41
Eosinophil 1.0 % 1-6
Basophil 0.900 % 0-1
Neutrophil 62.90 % 37-80
Lymphocyte 27.50 % 20-40
Monocyte 7.70 % 2-8
Neutrophil absolute 11.41 103/L 1.9-5.4
Lymphocyte absolute 4.99 103/L 3.7-10.7
Monocyte absolute 1.39 103/L 0.3-0.8
Eosinophil absolute 0.18 103/L 0.20-0.50
Basophil absolute 0.16 103/L 0-0.1
MCV 85.70 fL 81-95
MCH 27.60 Pg 25-29
MCHC 32.20 g% 29-31
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LABORATORY FINDINGS
Test Result Unit References
Carbohydrate MetabolismBlood Glucose 151.0 mg/dL < 200
Electrolyte
Natrium 138 mEq/L 135-155
Potassium 4.3 mEq/L 3.6-5.5
Chloride 104 mEq/L 96106
Blood Gas Analysis
pH 7.320 7.35-7.45
pCO2
21.0 mmHg 38-42
pO2 183.0 mmHg 85-100
HCO3 10.8 mmol/L 22-26
Total CO2 11.4 mmol/L 19-25
Kelebihan basa
(BE)
6.3-14.0 mmol/L (-2)-(+2)
Sa O2 100.0 % 95-100
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RADIOLOGIC FINDING
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Therapy;
E26m
nF. 3eroenem mg> Fam
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FOLLOW-UP=rd- 8th*i, reg"lar, ronchi '(()
J*tremities ; hinning s"#c"taneo"s fat
A Bronchone"monia ( 3arasm"s
"#erc"losis
P
Body weight: 7 kg, Body length: 79cm, arm circumference 10 cmBW/age: Z-score < -3 (severelywasted)BL/age: -3 < Z-score < -2 (severelystunted)BW/BL: Z-score < -3 (severelywastedArm circumference : Z-score < -3
- O21L/m
- Inj. Meropenem 140 mg/8 hours
- Salbutamol 3x0,5 mg
-Ambroxol 3x5 mg
-As folat 1x1 mg
-Vit C 1x100 mg
-Vit B complex 1x1
-Vit A 1 x 100.000 IU
e em er
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e em er
< i!c"lty of #reathing '(), co"gh '(), diarrhea '()
E Fam
- th til 9th < t # 25
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>th"ntil 9th *i, reg"lar, ronchi '(()
J*tremities ; hinning s"#c"taneo"s fat '()
A Bronchone"monia ( 3arasm"s
"#erc"losis
P - E2 6m
- nF. 3eroenem mg> Fam
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SUMMARY
KAP, a 2 years 5 months old girl, $ith 7 kg of BW and 79 of BH,
came to @
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