slide anak - marasmus ok
TRANSCRIPT
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Case Report: MarasmusMona Claudya110100341
Yujinee Devi 110100468
Supervisor:dr. Hj. Tiangsa Se!iring" M.#ed $%ed&" Sp.'$#&
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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
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Diagnos+i- *ea+ures:
• 5eig,+*orleng+,,eig,+
3SD $severe as+ed&• Midupper ar
-ir-u*eren-e 11/
• 7edea o* !o+, *ee+
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S+a!ilia+ion %,ase
Transi+ional %,ase
9e,a!ili+a+ion %,ase
olloup %,ase
Treatment of PEM
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.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
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Case
'#" ( on+,s old !oy as adi++ed on 7-+o!er" 1/+, ;01/ i+,
-oplain+ o* losing appe+i+e and eig,+ loss.
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•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
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•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
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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- $@&
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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 $&
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• Abdomen
Soepel" noral peris+al+i-" liver and spleen
unpalpa!le" sin pin-, re+urns >ui-ly
• Extremities
Hypo+,rop,y us-le" su!-u+aneous *a+
+,inning. %ulse 1;0=i" regular" ade>ua+e pressure and volue" ar" C9T 3" no
pi++ing edea
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"ifferential "iagnosis:
• Marasus @ Ias+roin+es+inal !leeding @
Haeor,agi- aneia• Marasus @ Ias+roin+es+inal !leeding @ 'neia
o* -,roni- disease
#or$ing "iagnosis:
• Marasus @ Ias+roin+es+inal !leeding @
Haeor,agi- aneia
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Management:
•
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"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
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%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
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Haemostasis Result ,ormal
%ro+,ro!in Tie
• %a+ien+
• Con+rol
se-onds
se-onds
1.;
13.8
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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
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&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
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1arium Meal: October '2th) *+'(
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Plain 3bominal 45ray : October '6th) *+'(
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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;/=
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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
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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=
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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+
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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=
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%
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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 : (;=
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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
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' Marasus
Ias+roin+es+inal !leeding
'neia
%
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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=
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%
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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
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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&
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• 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
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Trea+en+ o* severe alnu+ri+ion
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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=
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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
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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
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Thank You