Marasmus Presentation

7/23/2019 Marasmus Presentation

1/29

MARASMUS

Compiled by

Apriany Cordias A. Silalahi 110100232

Johanna Sihombing 110100224

Supervised by

dr. Oke Rina Ramayani, Sp. A (K)

Case Report


2/29

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).


3/29

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


4/29

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


5/29

CLINICAL SIGN

Poor growth

Wasting

Alertness

AppetiteAnorexia

Diarrhoea

Anemia

Skin sores

Hair changes

Dehydration


6/29

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


7/29

CONDITION OF MALNUTRITION

1stcondition

Found:

- Shock

- Lethargy

- Vomiting and/or diarrhoea or dehydration

2ndcondition

Found:

- Lethargy


3rdcondition

Found:


4thcondition

Found:

- Lethargy

5thcondition

Not found:

- Shock

- Lethargy

-


8/29

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


9/29

ANOTHER LABORATORYEXAMINATION

Blood glucose

Peripheral blood smear

Urinalysis

Stool examinationElectrolyte

Ferritin

Mantoux test

Chest X-ray

ECG


10/29

MANAGEMENT


11/29


12/29

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.


13/29

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.


14/29

CASE REPORT


15/29

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.


16/29

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 '-)


17/29

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.


18/29

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)


19/29

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


20/29

Diagnosisbronchopneumonia

Differential diagnosislung TB


21/29

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


22/29

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


23/29

RADIOLOGIC FINDING


24/29

Therapy;

E26m

nF. 3eroenem mg> Fam


25/29

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


26/29

e em er

< i!c"lty of #reathing '(), co"gh '(), diarrhea '()

E Fam

- th til 9th < t # 25


27/29

>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

-


28/29

SUMMARY

KAP, a 2 years 5 months old girl, $ith 7 kg of BW and 79 of BH,

came to @


29/29

Documents

Marasmus Presentation