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7/23/2019 lapkas marasmus jadi http://slidepdf.com/reader/full/lapkas-marasmus-jadi 1/48 Presenter : Rivhan Fauzan (100100236) Supervisor : DR. dr. Oker Rina Raa!ani" Sp.# ($ ) %#R#S%&S

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    Presenter :

    Rivhan Fauzan

    (100100236)

    Supervisor : DR. dr. Oker Rina

    Raa!ani" Sp.# ($)

    %#R#S%&S

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    'he ter arasus isderived ro the reekmarasmos,*hi+h eans

    *astin,. %arasus invo-vesinadeuate intake oprotein and +a-ories and is+hara+terized /!ea+iation.

    %arasus represents the

    end resu-t o starvation

    INTRODUCTION

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    %arasus is a serious *or-d*idepro/-e that invo-ves ore than 0i--ion +hi-dren !oun,er than !ears. #++ordin, to theor-d 4ea-th Or,anization (4O)"57 o the 10.5 i--ion deathso++urrin, in +hi-dren !oun,er than !ears in deve-opin, +ountries areasso+iated *ith P8%

    4i,h-! preva-ent in deve-opin,+ountries aon, 9 +hi-drensevere ors 1;107 < under*ei,ht20;507.

    Seen ost +oon-! in the rst

    !ear o -ie due to -a+k o /reasteedin and the use o di-ute ania-

    8P=D8%=O>O?

    http://www.who.int/en/http://www.who.int/en/
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    Nutrition InfectionSocio-economic factor

    ETIOLOGY

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    Very wasted Od man face !a""y #ants $i%otro%&y musce su'cutaneous fat t&innin" t&innin" &air and &air fa out easiy

    Se(ere "rowt& retardation No oedema

    @-ini+a- Features o

    %arasus

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    )arasmus is com%ensatedmanutrition or an ada%tation

    mec&anism of t&e 'ody to t&eac* of ener"y in a on" time+ Ina state of ac* of food, t&e 'odyis aways tryin" to maintainin"

    ife 'y meetin" 'asic needs orener"y

    ./ 'ody com%osition c&an"es,

    0/ meta'oic c&an"es, and 1/anatomic c&an es

    #2TO#$YSIOLOGY

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    $istory ta*in"

    #&ysica E3amination 2nt&ro%ometri La'oratory 4eatures

    DI2GNOSIS

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    TRE2T)ENT

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    @#S8 R8POR'

    Name 6 )G

    2"e6 0 years and 0 mont&s od

    Se36 )ae

    Date of 2dmission6 No(em'er,01rd07.8

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    @hie @op-aint 6 9ei"&t is not a"ea%%ro%riate

    It was reai:ed 'y &is mot&er in 1 mont&s, &is wei"&t wasa'out ; *" 1 mont&s a"o , t&e &i"&est wei"&t e(er ac&ie(ed'y &im was ered'y %atient a'out = mont&s a"o+

    Vomitin" was su>ered 'y %atient one day a"o, wit& fre?uencyonce %er day, t&e amount of (omitin" was not cear, (omitin"w&at &e eat and drin*, (omit contains 'ood and 'rownis&coor was denied 'y &is mot&er+

    Cou"& was su>ered 'y %atient since t&is wee*, %roducti(ecou"& -/, cou"& contain 'ood was denied 'y &is mot&er,&istory of contact wit& %eo%e wit& c&ronic cou"& was found,&is "randfat&er is dia"nosed wit& Tu'ercuosis and was ta*in"dru"s of tu'ercuosis+ $e i(ed wit& &is "randfat&er for Amont&s

    $istory of fe(er was su>ered 'y %atient since a'out . mont&

    4istor!6

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    4istor! o previous i--ness

    T&e %atient was treated 'y #ediatrician'efore t&e admission to $2) $os%itawit& dia"nose )arasmus and sus%ect$IV

    4istor! o dru,s

    Transfusion of #RC 87cc, Rin"er a*tat,InB 2m%iciin, InB+ Gentamycin, inc,Nystatin

    4ood Reca

    Eat once a day, wit& &af a %ate ofsma %ores wit& a (e"eta'es menuwit&out s& and meet+ Lacte"an mi* 8

    times a day .07cc+

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    Fai- 4istor!

    $is fat&er wor*ed as a farm wor*er inFam'i, $is mot&er is a &ousewife

    Pre,nant 4istor!

    #atient is t&e second c&id in &is famiy+ $ismot&er "ot antenata care durin"%re"nancy+ T&ere was no &istory of fe(er,&y%ertension, dia'etic meitus, andconsum%tion of dru"s and &er'a medicine

    !irt& $istory #atient was aterm w&en dei(ered on

    s%ontaneous a'or, attended 'y midwife+$e cried immediatey+ !irt& wei"&t was

    0

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    =unization 4istor!

    Not com%ete

    Feedin, 4istor!

    4rom 'irt& to A mont&s 6 !reast mi* 4rom A to .0 mont&s 6 !reast mi* @ rice

    %orrid"e 4rom .0 mont&s unti now6 daiy menu @

    Lacta"en mi*4istor! o ro*th andDeve-opent mont&s 6 sittin" .8 mont&s 6 wa*in"

    0 yr 0 mo 6 Bust say Hmama mimimamam

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    Ph!si+a- 8Aaination

    Generalized status

    !ody wei"&t6 =,8*", !ody en"t&6;1 cm , )U#C6

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    Present statusConsciousness6 aert

    !ood %ressure 7KA7 mm$",$R6 ..A '%m,

    RR6 18 '%m,

    'ody tem%erature6 1;oC,

    'ody wei"&t 6 =,8 *",'ody en"t& 6 ;1 cm

    2nemic @/, Icteric -/, Cyanosis -/, Edema -/,

    Dys%nea -/+

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    Head 6

    4ace6 Od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%+

    conBuncti(a %ae @[email protected]/, icteric scera -K-/+ $air6 easiy remo(ed

    )out&6 ora t&rus& @/+

    Nose and Ear were norma imit

    Neck6

    TVF6 R-0 cm$0O, Lym%& node enar"ement -/+Thorax6

    Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary(isi'e @/ $R 6 ..A '%m, re"uer, murmur -/, RR6 18 t%m, re"uar,raes -/+

    Abdomen6

    Soe%e, Normo%eristatic+ Li(er, s%een and rena were un%a%a'e+

    Extremities6

    !a""y %ants @/, %use ..A '%m, re"uar, ade?uate %ressure and(oume, warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar%amar %ae @[email protected]/, oedem -K-/

    Urogenital6

    a ora or! n n,s on osp a ove er

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    a ora or! n n,s on osp a ove er2015)=D:Parameters Value Normal Value

    Complete Blood Count

    Hemoglobin 4,9 gr% 11,3 14,1

    Hematocrite 15,3 % 37 41

    r!t"roc!te 1,#$ 1&'

    (mm3

    4)5& ')5& 1&'

    (mm3

    *eucoc!te 4)$&& (mm3 4)5&& 13)5&&(mm3

    Platelet 1$+)&&& (mm3 15&)&&& 45&)&&& (mm3

    CV #1 -l #l .$$ -l

    CH +5,4 pg +7 31pg

    CHC 31,4 g(dl 31 37 g(dl

    /0 ++,'& % 1& 15 %

    0i--tel

    Neutrop"il 7+,$& 37 #&

    *!mp"oc!te 14,1& +& 4&

    onoc!te 13)& + #

    osinop"il &)&& 1 '

    Basop"il &)&&& & 1

    lectrol!te

    Natrium

    14+

    135 . 155

    2alium +,# 3,' 5,5

    C"loride

    Blood lucose ad/andom

    11'

    #$

    $' 1&'

    +&&

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    Working Diagnosis:

    )arasmus @ Sus%ect T! @ sus%ect $IV

    Management:

    Diet 4;= A

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    4OLLO9 U#No(em'er 08t&07.8 Decem'er

    .;t& 07.8

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    Bove/er 25th 2015

    S Diarr&ea -/, Vomitin" -/, 4e(er @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1;,< 7C + !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %[email protected]@/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    ..7'%m, re"uer, murmur -/, RR6 17 3Ki, re"uar, raes -/+

    #/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+8Atreiti

    es

    !a""y %ants @/, %use ..A '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure .77K;7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit# )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IVP . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . Die 4;= 7ccK1&ours wit& minera mi3 .,7

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    Bove/er 2 2015S Diarr&ea -/, Vomitin" -/, 4e(er @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1;,< 7C + !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6..7'%m, re"uer, murmur -/, RR6 17 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..A '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure .77K;7 mm$", #antar %amar %ae @K

    @/

    enita- )ae, wit&in norma imit# )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IVP . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . Die 4;= 7ccK1&ours wit& minera mi3 .,7

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    S Diarr&ea -/, Vomitin" -/, 4e(er @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody Tem%erature 6 1;,< 7C +

    !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD

    4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/

    Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6.77'%m, re"uer,

    murmur -/, RR6 0< 3Ki, re"uar, raes -/+

    #/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreities !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra, CRT J 1, !ood

    #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/

    enita- )ae, wit&in norma imit

    # )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . Diet 4;= 7ccK1&ours wit& minera mi3 .,7

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    S Diarr&ea -/, Vomitin" -/, 4e(er @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1;,< 7C + !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+

    #/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/

    enita- )ae, wit&in norma imit

    # )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . IN$ %ro%&ya3is . 3 17m"

    . Diet 4.77 7ccK1&ours wit& minera mi3 .,

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,. *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD , )U#C6 cm

    4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/

    Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+

    #/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/

    enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc day ./ (ia ora

    . Candistatin Ora dro%

    Bove/er 2th 2015

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,. *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD )U#C 6 cm4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a

    %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+

    #/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/

    enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc day 0/ (ia ora

    . Candistatin Ora dro% #annin"6

    -

    Bove/er 30th 2015

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,. *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/$air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreities

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/

    enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ Sus%+ $IVP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3

    0,Acc day1/ (ia ora

    . Candistatin Ora dro%

    . #RC transfusion 1=cc

    La' Resut6

    $'6 ,;, $t6 1.,0 L6=17 T6 .8777

    De+e/er 1st 2015

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra onBuncti(a %ae

    @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro%

    #annin"6-

    De+e/er 2nd 2015

  • 7/23/2019 lapkas marasmus jadi

    29/48

    S Diarr&ea @/, Vomitin" -/, 4e(er -/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD )U#C 6 cm4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro%

    #annin"6-

    De+e/er 3rd 2015

  • 7/23/2019 lapkas marasmus jadi

    30/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done -/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD, !LKa"e6

    J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro%

    #annin"6-

    De+e/er 5th 2015S i & / i i / /

  • 7/23/2019 lapkas marasmus jadi

    31/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a

    %ae @[email protected]/$air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreities

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/

    enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ Sus%+ $IVP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro% $asi La'6

    4erritin6 =0A,0, 4e6 80, TI!C .

  • 7/23/2019 lapkas marasmus jadi

    32/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a

    %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV @ 2nemia Iron Deciency

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m". )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet Soft food .777**a @ .0"r %rotein

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro% #annin"6

    De+e/er 6th 2015S Di & / V iti / 4 / Di t i d /

  • 7/23/2019 lapkas marasmus jadi

    33/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/$air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'ercuosis @ Sus%+ $IV @ 2nemia Iron Deciency

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet Soft food .777**a @ .0"r %rotein

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro% #annin"6

    De+e/er Cth 2015S Di & / V iti / 4 / di t i d /

  • 7/23/2019 lapkas marasmus jadi

    34/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a %ae

    @[email protected]/$air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'[email protected] Sus%+ $IV @ 2nemia Iron Deciency

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet Soft food .777**a @ .0"r %rotein

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro% #annin"6

    De+e/er th 2015S Di & / V iti / 4 / di t i d @/

  • 7/23/2019 lapkas marasmus jadi

    35/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/

    O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,< *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,

    !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'ra conBuncti(a

    %ae @[email protected]/$air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+

    'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6

    .77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreiti

    es

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,

    CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @[email protected]/enita- )ae, wit&in norma imit

    # )arasmus @ Tu'[email protected] Sus%+ $IV @ 2nemia Iron Deciency

    P . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet Soft food .777**a @ .0"r %rotein

    . Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc

    . Candistatin Ora dro% #annin"6

    De+e/er th 2015S Di & / V iti / 4 / di t i d /

  • 7/23/2019 lapkas marasmus jadi

    36/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,< *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'[email protected] Sus%+ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one

    177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 .

    ct&

    . 4DC R$ .3.ta'

    . !A .3.7m"

    . Diet Soft food .777**a @ .0"r %rotein

    . Diet 4.77 .17ccK1&ours wit& minera

    mi3 0,Acc

    . Candistatin Ora dro%

    De+e/er 10th 2015S Di & / V iti / 4 / di t i d /

  • 7/23/2019 lapkas marasmus jadi

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,= *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one

    177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 .

    ct&

    . Diet Soft food .777**a @ .0"r %rotein

    . Diet 4.77 .17ccK1&ours wit& minera

    mi3 0,Acc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    . Sta(udin %u( 03Am"

    De+e/er 11th 2015S Di & / V iti / 4 / di t i d /

  • 7/23/2019 lapkas marasmus jadi

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,= *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 .

    ct&

    . Vit 2 . 3 07+777 IU

    . Diet Soft food .777**a @ .0"r

    %rotein

    . Diet 4.77 .17ccK1&ours wit& minera

    mi3 0,Acc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    De+e/er 12th 2015S Diarr&ea / Vomitin" / 4e er / diet is done @/

  • 7/23/2019 lapkas marasmus jadi

    39/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . Diet 4.77 .=7ccK1&ours wit&

    minera mi3 1cc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    . Sta(udin %u( 03Am"

    . Ne(ira%in 03A8m"

  • 7/23/2019 lapkas marasmus jadi

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    De+e/er 15th 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/

  • 7/23/2019 lapkas marasmus jadi

    41/48

    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . Diet 4.77 .=7ccK1&ours wit&

    minera mi3 1cc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    . Sta(udin %u( 03Am"

    . Ne(ira%in 03A8m"

    De+e/er 1th 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 A, *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . Diet 4.77 .=7ccK1&ours wit&

    minera mi3 1cc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    . Sta(udin %u( 03Am"

    . Ne(ira%in 03A8m"

    De+e/er 16th 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 ;,0 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . Diet 4.77 .=7ccK1&ours wit&

    minera mi3 1cc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    . Sta(udin %u( 03Am"

    . Ne(ira%in 03A8m"

    De+e/er 1Cth 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/

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    S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody

    Tem%erature 6 1A,< 7C + !ody wei"&t6 ;,0 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-

    1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/

    Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @[email protected]/, inferior %a%e'raconBuncti(a %ae @[email protected]/

    $air6 easiy remo(ed

    Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e

    @/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe

    n

    Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+

    8Atreit

    ies

    !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,

    warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K

    @/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV

    . Cotrimo3sa:oe syr 0 3 M ct&

    . 4oic 2cid . 3 .m"

    . )uti(itamin wit&out 4e . 3 . ct&

    . Vit 2 . 3 07+777 IU

    . 4DC R$ .3.ta'

    . Diet 4.77 .=7ccK1&ours wit&

    minera mi3 1cc

    . Candistatin Ora dro%

    . Lami(udin %u( 0308m"

    . Sta(udin %u( 03Am"

    . Ne(ira%in 03A8m"

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    Discussion

    For a dia,nosis o %arasus a+ase ust /e:1. 4itor! takin, (des+reas o

    *ei,ht" ood dieter!"previous i--ness" anoreAia)

    2. Ph!si+a- 8Aaination: ver!*asted" o-d an a+e"/a,,! pants" inter+osta- is+-ear-! visi/-e" hipotroph!us+-e

    3. #ntrhopoetr!: *ei,ht or

    hei,ht ust /e 9 ;3SD(4O)" %&[email protected] 9 11"+"ver! *asted.

    5. >a/oratoriu (#neia"4ipo,-i+he!"hiponatrei)

    @-ini+a- ndin,s :ei,ht is not a,e appropriate"anoreAia" de+reas o *ei,ht

    Ph!si+a- eAaination : ver!

    *asted" o-d an a+e (E)"/a,,! pants" inter+osta- is+-ear-! visi/-e" h!potroph!us-e.

    #ntrophoetr!: *ei,ht or

    hei,ht 9 ;3SD" %&[email protected]: "+"and ver! *asted" oede (;)

    >a/oratoriu: 4/ 5",d-(#neia)

    )G, mae, 0 years and 0 mont&s od, was re>ered to RSU# $2) atNo(em'er 01 t&07.8 from #ediatrician wit& t&e dia"nosed of

    )arasmus and sus% $IV+

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    8tio-o,! o%arasus:1.Butrition

    2.=ne+tion ('G"pneuonia"diarrhea" 4=H)3.So+io8+onoi+

    =n this patiens:'he etio-o,! arenutrition and

    ine+tion" *hopatient had /addieter!" and thepatient had /een

    dia,nosed *ith 4=Hand tu/er+u-osis

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    ConcusionT&e concusion of t&is %a%er is a 'oy, 0 years and 0 mont&s

    od, dia"nosed wit& )arasmus, $IV, Tu'ercuosis, 2nemia irondeciency+ T&e %atient recei(ed 6

    InB+ Ceftria3one 177m"K.0&rKIV

    Cotrimo3sa:oe syr 0 3 M ct&

    4oic 2cid . 3 .m"

    )uti(itamin wit&out 4e . 3 . ct&

    Vit 2 . 3 07+777 IU

    4DC R$ .3.ta'

    !A .3.7m"

    Diet 4.77 .=7ccK1&ours wit& minera mi3 1cc

    Candistatin Ora dro%

    Lami(udin %u( 0308m"

    Sta(udin %u( 03Am"

    Ne(ira%in 03A8m"

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