Slide Anak - Marasmus Ok

8/19/2019 Slide Anak - Marasmus Ok

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Case Report: MarasmusMona Claudya110100341

Yujinee Devi 110100468

Supervisor:dr. Hj. Tiangsa Se!iring" M.#ed $%ed&" Sp.'$#&


2/41

Protein

EnergyMalnutrition

4() o* +,e10.4 illion

dea+,s in-,ildren

/years

0) o* +,eorld2s

alnouris,ed-,ildren live

in 'sia

3 *ors:

Marasus

#as,ioror

Marasi-as,ioror

Suspe-+i!le+o in*e-+ion


3/41

Diagnos+i- *ea+ures:

• 5eig,+*orleng+,,eig,+

3SD $severe as+ed&• Midupper ar

-ir-u*eren-e 11/

• 7edea o* !o+, *ee+


4/41

S+a!ilia+ion %,ase

Transi+ional %,ase

9e,a!ili+a+ion %,ase

olloup %,ase

Treatment of PEM


5/41

.Objective

T,e ai o* +,is s+udy is +o repor+ a -ase o* a ( on+,sold !oy i+, diagnosis o* arasus and gas+roin+es+inal

!leeding


6/41

Case

'#" ( on+,s old !oy as adi++ed on 7-+o!er" 1/+, ;01/ i+,

-oplain+ o* losing appe+i+e and eig,+ loss.


7/41

•History of previous illness:He ,ad ever !een ,ospi+alied in Haji 'da MaliHospi+al on uly ;01/ ,en ,e as 6 on+,s old *or+,e !la- s+ool diarr,ea. '*+er !eing dis-,arged" ,e

never go+ +o -on+rol and go+ any edi-a+ion +o do-+or*or ,is illness. He su**ered *ro re-urren+ !la- s+oolin pas+ 8 days.

• History of immunization : no+ -lear


8/41

•History of nutrition: 6 on+, o* e=-lusive !reas+ *eeding" addi+ional *ood sin-e 6on+,s old

• History of obstetric: +,e o+,er as 38 years old ,en s,e as pregnan+" no,is+ory o* -onsuing drugs and ,er!s" no ,is+ory o* ,avingDM and ,yper+ension during pregnan-y

• History of growth an evelopment:

'+ +,e oen+" +,e pa+ien+ -ould si+ don i+, assis+an-e


9/41


10/41

Presence status

• Cons-iousness : aler+

•

Elood %ressure : (040 Hg• Hear+ 9a+e : 1;4 =i

• 9espira+ory 9a+e : 30 =i

•Eody Tepera+ure : 3"( oC

• 'nei- $@&


11/41

Local Status

•

Headoldan *a-e" iso-,ori- pupil" pale in*erior palpe!ra

-onjun-+iva" lig,+ re*le= on !o+, eyes. Bars nose ou+,:

i+,in noral lii+

• Neck

Go lyp, node enlargeen+

• Thorax

Sye+ri-al *usi*oris" in+er-os+al spa-e -learly visi!le" pro+ruding spine. H9: 1;0=i" regular" urur $&. 99:

;3=i" regular" ron-,i $&" !rea+, sound: vesi-ular"

addi+ional sound $&


12/41

• Abdomen

Soepel" noral peris+al+i-" liver and spleen

unpalpa!le" sin pin-, re+urns >ui-ly

• Extremities

Hypo+,rop,y us-le" su!-u+aneous *a+

+,inning. %ulse 1;0=i" regular" ade>ua+e pressure and volue" ar" C9T 3" no

pi++ing edea


13/41

"ifferential "iagnosis:

• Marasus @ Ias+roin+es+inal !leeding @

Haeor,agi- aneia• Marasus @ Ias+roin+es+inal !leeding @ 'neia

o* -,roni- disease

#or$ing "iagnosis:

• Marasus @ Ias+roin+es+inal !leeding @

Haeor,agi- aneia


14/41

Management:

•


15/41

"iagnostic Planning:• Cople+e Elood Tes+

• rine and *es-es analysis

•

eru %ro*ile• rine and es-es B=aina+ion

• %lain a!doinal =ray

• Eariu eal• 'l!uin


16/41

%aboratory &ining: October '(th ) *+'(

ro +,e +a!le a!ove" e *ound aneia and +,ro!o-y+openia.

Haematology Result ,ormal

Haeoglo!in gdF -.++ 11.1 J 14.4

Bri+ro-y+e ;.43 3.1 4.;/

Feu-o-y+e 1/.83 6.0 1./

Haea+o-ri+e ) ;;.0 3/ 41

T,ro!o-y+e '(/ ;1 J 4(

MC? *F (0./0 8; 100

MCH pg ;8.80 ;4 30

MCHC g ) 31.80 ;8 3;

9D5 ) ;1.40 14.( 18.

Geu+ro*il ) 66.30 3 80

Fip,o-y+e ) 1(.10 ;0 40

Mono-y+e ) 11.;0 ; 8

Bosino*il ) 3.30 1 6

Easo*il ) 0.100 0 1


17/41

Haemostasis Result ,ormal

%ro+,ro!in Tie

• %a+ien+

• Con+rol

se-onds

se-onds

1.;

13.8


18/41

0rinalysis Complete 0rine Result ,ormal

Color Yello -lear Yello

Ilu-ose Gega+ive Gega+ive

Eiliru!in Gega+ive Gega+ive

#e+on Gega+ive Gega+ive

Spesi*i- gravi+y 1.000 1.00/ J 1.030

pH .0 / 8

%ro+ein Gega+ive Gega+ive

ro!ilinogen Gega+ive Gi+ri+ Gega+ive Gega+ive

Feu-o-y+e Gega+ive

Elood Gega+ive Gega+ive

rine Sedien+Bry+ro-y+e F%E 01 3

Feu-o-y+e F%E 01 6

Bpi+el F%E 01

Cas+s F%E Gega+ive Gega+ive

Cris+al F%E Gega+ive


19/41

&esces Result ,ormal

Ma-ros-opi-

Color Eron

Consis+en-y 5a+ery

Elood Gega+ive Gega+ive

Mu-us Gega+ive Gega+ive

Mi-ros-opi-

Bgg or F%E Gega+ive Gega+ive

'oe!a F%E Gega+ive Gega+ive

Bry+ro-y+e F%E 01

Feu-o-y+e 01


20/41

1arium Meal: October '2th) *+'(


21/41

Plain 3bominal 45ray : October '6th) *+'(


22/41

S Fos+ appe+i+e" !loody voi+ $@& and !loody s+ool $@&

7

Sens : 'ler+" T : 3"( C" E5 : 4"(g" EH : 64-

Head: eye re*le-+ @@" iso-or" pale -onj. palpe!ra in*erior@@"

BarGoseMou+,: noral

Ge-: ?% 9@; - H;7

T,ora= : Sye+ri-al *usi*or" re+ra-+ion $&" H9 : 1;/=


23/41

P 78&" "(9 ,aCl +)**(9 *+gtti ;micro<

&olic aci '!' mg

8itamin 1 Comple! '!' tab 8itamin C '!' tab

"iet &-( /+ cc= hours > ')2 cc mineral mi!

?ransfusion PRC *( cc*@ jam

7nj Ceftria!one *(+ mg'* hoursiv

Consul+ gas+ro,epa+ology division

Consul+ ,ea+oon-ology division

Consul+ nu+ri+ion and e+a!oli- disease division

Cople+e urine and *es-es analysis

C,e- iron pro*ile

%erip,eral !lood sear

Eariu Meal


24/41

S Fos+ appe+i+e" !loody voi+ $&" !loody s+ool $&" *ever $@&

7

Sens : 'ler+" T : 3" C" E5 : 4"(g" EH : 64-Head: eye re*le-+ @@" iso-or" pale -onj. %alpe!ra in*erior" BarGoseMou+,:

noral

Ge-: ?% 9@; - H;7

T,ora= : Sye+ri-al *usi*or" re+ra-+ion $&" H9 : 100=


25/41

P 78&" "(9 ,aCl +)**(9 *+gtt7 ;micro<

&olic aci '!'mg

8itamin 1 Comple! '!' tab

8itamin C '!(+mg

"iet &-( /+cc= hours > ')2cc mineral mi!

?ransfusion PRC *(cc*@jam

7nj ceftria!one *(+mg'*hoursiv

S-,eduled *or '!doinal Kray

B=pe-+ing Eariu Meal resul+


26/41

S Fos+ appe+i+e" !loody s+ool $&" *ever $&

7 Sens : 'ler+" T : 3"/ C" E5 : 4"(g" EH : 64-

Head: eye re*le-+ @@" iso-or" pale -onj. %alpe!ra in*erior"

BarGoseMou+,: noral

Ge-: ?% 9@; - H;7

T,ora= : Sye+ris *usi*oris" re+ra-+ion $&" H9 : 100=


27/41

%


28/41

S Eloody s+ool $&" *ever $@&

7 Sens : 'ler+" T : 3"6 C" E5 : 4"(g" EH : 64-

Head: eye re*le-+ @@" iso-or" pale -onj. %alpe!ra in*erior @@"

BarGoseMou+,: noral

Ge-: ?% 9@; - H;7

T,ora= : Sye+ri-al *usi*or" re+ra-+ion $&" H9 : (;=


29/41

7 9esul+ *ro Gu+ri+ion and e+a!oli- disease division:

ood re-all ;4 ,ours:

Morning: porridge1; por+ion @ -arro+ L pie-e'*+ernoon: porridge L por+ion @ po+a+o L pie-e

Gig,+: porridge L por+ion @ -arro+ L pie-e

Ereas+ *eeding on deand.

T,erapy : die+ / 80--3 ,ours @ 1"6-- ineral i=

?i+. ' 100.000 uni+ $1=& ?i+.E -op 1=1 +a!

?i+.- 1=/0g

Co+rio=aole ;= L +spn


30/41

' Marasus

Ias+roin+es+inal !leeding

'neia

%


31/41

S Fos+ appe+i+e" !loody s+ool $&" *ever $&

7 Sens : 'ler+" T : 3 C" E5 : /g" EH : 64-Head: eye re*le-+ @@" iso-or" pale -onj. %alpe!ra in*erior @@"

BarGoseMou+,: noral

Ge-: ?% 9@; - H;7

T,ora= : Sye+ris *usi*oris" re+ra-+ion $&" H9 : (8=


32/41

%


33/41

Dis-ussion

M'9'SMS

De*i-ien-y calories and energy" o--urainly a+ +,e +ieo* eaning $/yo&

,utritional status$E5EH&

5H7 ;006: /years

CDC ;000: /years

Clinical Manifestation

7ld an *a-e" irri+a!le" us-le,ypo+rop,y" su!-u+aneous *a+loss" pianosign" !aggypan+s


34/41

Des-reasedin p,ysi-al

a-+ivi+ylethargy

De-reased !asal energye+a!olis

Alowing ofgrowth

#eight loss

Gega+ive energy !alan-e

De-reased energy in+ae

Foss o* inges+ed -alories $eesis"

diarr,ea" !urns&


35/41

• Eody *luid -opar+en+

Hig, +o+al !ody a+er" signi*i-an+ redu-+ion in adipose and lean

ass" us-le -ell a+rop,y ar -ir-u*eren-e

• Me+a!oli- adap+a+ion

siilar +o s+arva+ion" redu-ed energy e+a!olis ris o*

,ypo+,eria

• Diges+ive +ra-+

villous a+rop,y o* jejunal u-osa" de-reased HCl e=-re+ion"

sloing peris+alsis !a-+erial overgro+,

• Bndo-rine sys+e

*ree plasa level o* -or+isol N in ,ypoal!uineia

• Cardiovas-ular

saller and +,inner -ardia- us-le" loer s+roe volue"

!radi-ardia and ,ypo+ension


36/41

Trea+en+ o* severe alnu+ri+ion


37/41


38/41

Case:

Day 1 J day $+,e s+a!ilia+ion and +ransi+ion

p,ase &

80-- / every 3 ,ours and 1"6-- ineral

i=

Day 8 $s+ar+ re,a!ili+a+ion p,ase&

-a+-,up *eeding 100 80-- every 3 ,ours and

1"6-- ineral i=


39/41

Moni+oring

• %oor $ / gg per day&" reassessen+

• Modera+e $/J10 gg per day&" -,e- in+ae

+arge+s are !eing e+ or in*e-+ion

• Iood $ 10 gg per day&

Case:Poor: +,e eig,+ gain 1gr on re,a!ili+a+ion p,ase


40/41

Suary

'#" ( on+,s old !oy as adi++ed on 7-+o!er" 1/ +, ;01/ i+,-oplain+ o* losing appe+i+e" eig,+ loss" ,aving !la- s+ool.

%a+ien+ as diagnosed i+, Marasus @ Ias+roin+es+inal

!leeding @ 'neia pos+ ,eorr,agi-. %a+ien+ as given


41/41

Thank You

Slide Anak - Marasmus Ok

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