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7/23/2019 lapkas marasmus jadi

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Presenter :

Rivhan Fauzan

(100100236)

Supervisor : DR. dr. Oker Rina

Raa!ani" Sp.# ($ )

%#R#S%&S



• '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



• %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/



•Nutrition• Infection•Socio-economic factor

ETIOLOGY



• 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



• )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



• $istory ta*in"

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

DI2GNOSIS





TRE2T)ENT



@#S8 R8POR'

Name 6 )G

2"e6 0 years and 0 mont&s od

Se36 )ae

Date of 2dmission6 No(em'er,01rd 07.8



@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 <+= *" at . year od+

• Diarr&ea was su>ered 'y &im 1 days a"o, wit& fre?uency was.7 times %er day, (oume a'out .77cc in e(ery diarr&ea,mucous @/, 'ood @/, &istory of diarr&ea @/, it was su>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



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+



Fai- 4istor!

•

$is fat&er wor*ed as a farm wor*er in Fam'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<77 "rams, 'irt& en"t& was 8 cm, andno &istor of c anosis was found durin t&e



=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



Ph!si+a- 8Aaination

Generalized status

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

• 9ei"&t for a"e 6 scoreJ -1 SD

• Len"&t for a"e 6 scoreJ -1 SD

• 9ei"&t for en"t& 6 scoreJ -1SD

Inter%retation 6 under nutrition



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 -/+



Head 6

• 4ace6 Od man face @/

• Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%+

conBuncti(a %ae @K@/, icteric scera -K-/+• $air6 easiy remo(ed

• )out&6 ora t&rus& @/+

• Nose and Ear were norma imit

Neck 6

•

TVF6 R-0 cm$0O, Lym%& node enar"ement -/+Thorax 6

• 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 @K@/, oedem -K-/

Urogenital6•

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



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&'

+&&



Working Diagnosis:

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

Management:

Diet 4;= A<ccK1 &ours @ minera mi3 7,.cc

Vit 2 . 3 077+777 IU4oic 2cid . 3 =m" . 3 .m")uti(itamin wit&out 4e . 3 ct& MCotrimo3a:oe 0 3 ct& M

Diagnostic Planning:

C"ec Complete Blood Count, /6, *6, antou est, B8

9putum



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

.;t& 07.8



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 @K@/, inferior %a%e'ra conBuncti(a %ae@K@/

$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 @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<cc#annin"6

Screenin" $IV

Consut Nutrition an )eta'oic Disease

Consut Res%iroo"y

Consut $ematoo"y-Oncoo"y

Consut 2er"i and Imunoo"y

)antou3 Test

Bove/er 2th 2015



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 @K@/, inferior %a%e'raconBuncti(a %ae @K@/

$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"


. Vit 2 . 3 07+777 IU

. Die 4;= 7ccK1&ours wit& minera mi3 .,7<cc#annin"6

Bove/er 26th 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-1SD

4ead 4ace6 od man face @/

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

$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 @K@/

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"


. Vit 2 . 3 07+777 IU

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

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

. Candistatin Ora dro%

Counsein" $IV resut6

$IV ris* factor from 'ood transfusion

#annin"6

4e %roeRa%id Test 1 met&ods

Bove/er 2Cth 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,


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

@K@/

$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 -/+


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 @K@/


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



. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

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

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


)antou3 Test Resut6

Induration 7 mm

Bove/er 2th 2015



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


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 @/


@K@/

$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 -/+




8Atreiti

es




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



. 4oic 2cid . 3 .m"


. 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


Bove/er 2th 2015



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



!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 @K@/, inferior %a%e'ra conBuncti(a

%ae @K@/

$air6 easiy remo(ed





8Atreiti

es







. 4oic 2cid . 3 .m"


. 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



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




@K@/$air6 easiy remo(ed


.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 @K@/

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


. 4oic 2cid . 3 .m"


. 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


. #RC transfusion 1=cc

La' Resut6

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

De+e/er 1st 2015





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


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

@K@/

$air6 easiy remo(ed




8Atreiti

es


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




. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"

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


#annin"6-

De+e/er 2nd 2015



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


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 @/


@K@/

$air6 easiy remo(ed




8Atreiti

es






. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"



#annin"6-

De+e/er 3rd 2015



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


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 @/


@K@/

$air6 easiy remo(ed




8Atreiti

es






. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"



#annin"6-

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



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




%ae @K@/$air6 easiy remo(ed



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 @K@/

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


. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"


. Candistatin Ora dro% $asi La'6

4erritin6 =0A,0, 4e6 80, TI!C .<7

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



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





%ae @K@/

$air6 easiy remo(ed




8Atreiti

es



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



. 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



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












8Atreiti

es



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



. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"




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



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









8Atreiti

es



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



. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"




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



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


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



%ae @K@/$air6 easiy remo(ed




8Atreiti

es



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



. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. !A .3.7m"




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



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-



$air6 easiy remo(ed


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

n


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@ Sus%+ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one

177m"K.0&rKIV


. 4oic 2cid . 3 .m"

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

ct&

. 4DC R$ .3.ta'

. !A .3.7m"


. Diet 4.77 .17ccK1&ours wit& minera

mi3 0,Acc


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




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



$air6 easiy remo(ed



n


8Atreit

ies



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

177m"K.0&rKIV


. 4oic 2cid . 3 .m"


ct&



mi3 0,Acc


. Lami(udin %u( 0308m"

. Sta(udin %u( 03Am"

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




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



$air6 easiy remo(ed



n


8Atreit

ies



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


. 4oic 2cid . 3 .m"


ct&

. Vit 2 . 3 07+777 IU

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

%rotein


mi3 0,Acc



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



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-



$air6 easiy remo(ed



n


8Atreit

ies





. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'

. Diet 4.77 .=7ccK1&ours wit&

minera mi3 1cc




. Ne(ira%in 03A8m"



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




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



$air6 easiy remo(ed



n


8Atreit

ies





. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'


minera mi3 1cc




. Ne(ira%in 03A8m"





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



$air6 easiy remo(ed



n


8Atreit

ies





. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'


minera mi3 1cc




. Ne(ira%in 03A8m"





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



$air6 easiy remo(ed



n


8Atreit

ies





. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'


minera mi3 1cc




. Ne(ira%in 03A8m"

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




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



$air6 easiy remo(ed



n


8Atreit

ies





. 4oic 2cid . 3 .m"


. Vit 2 . 3 07+777 IU

. 4DC R$ .3.ta'


minera mi3 1cc




. Ne(ira%in 03A8m"



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)" %&P@ 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" %&P@: "+"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+



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



Concusion T&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"

