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Lapkas Marasmus Jadi
Lapkas Marasmus Jadi
Presenter :
Rivhan Fauzan
(100100236)
INTRODUCTION
The term marasmus is
derived from the Greek
marasmos, which means
wasting.
Marasmus involves
inadequate intake of
protein and calories and is
characterized by
emaciation.
Marasmus represents the
end result of starvation
EPIDEMIOLOGY
Marasmus is a serious worldwide
problem that involves more than 50
million children younger than 5
years. According to the
World Health Organization (WHO),
49% of the 10.4 million deaths
occurring in children younger than 5
years in developing countries are
associated with PEM
Highly prevalent in developing
countries among <5 children;
severe forms 1-10% & underweight
20-40%.
Seen most commonly in the first
year of life due to lack of breast
feeding and the use of dilute animal
ETIOLOGY
Nutrition
Infection
Socio-economic factor
Clinical Features of
Marasmus
Very wasted
Old man face
Baggy Pants
Hipotrophy muscle
subcutaneous fat thinning
thinning hair and hair fall out easily
Severe growth retardation
No oedema
PATOPHYSIOLOGY
Marasmus is compensated
malnutrition or an adaptation
mechanism of the body to the
lack of energy in a long time. In
a state of lack of food, the body
is always trying to maintaining
life by meeting basic needs or
energy
(1) body composition changes,
(2) metabolic changes, and (3)
anatomic changes
DIAGNOSIS
History taking
Physical Examination
Anthropometri
Laboratory Features
TREATMENT
CASE REPORT
Name : MG
Age: 2 years and 2 months old
Sex : Male
Date of Admission: November,
23rd 2014
History of drugs
Food Recall
Famil History
His father worked as a farm worker in
Jambi, His mother is a housewife
Pregnant History
Patient is the second child in his family. His
mother got antenatal care during
pregnancy. There was no history of fever,
hypertension, diabetic mellitus, and
consumption of drugs and herbal medicine
Birth History
Imunization History
Not complete
Feeding History
From birth to 6 months : Breast milk
From 6 to 12 months : Breast milk + rice
porridge
From 12 months until now: daily menu +
Lactagen of
milkGrowth and
History
Development
9 months : sitting
14 months : walking
2 yr 2 mo : just say mama mimi
mamam
Physical Examination
Generalized status
Body weight: 5,4kg, Body length:
73 cm , MUPC: 8,8 cm
Weight for age : Zscore< -3 SD
Lenght for age : Zscore< -3 SD
Weight for length : Zscore< -3
SD
Interpretation : under nutrition
Present status
Consciousness: alert
Blood pressure 90/60 mmHg,
HR: 116 bpm,
RR: 34 bpm,
body temperature: 37oC,
body weight : 5,4 kg,
body length : 73 cm
Anemic (+), Icteric (-), Cyanosis (-), Edema (-),
Dyspnea (-).
Head :
Face: Old man face (+)
Eye: Isochoric pupil (3mm/3mm), light reflex (+/+), inferior palp.
conjunctiva pale (+/+), icteric sclera (-/-).
Hair: easily removed
Mouth: oral thrush (+).
Nose and Ear were normal limit
Neck :
TVJ: R-2 cmH2O, Lymph node enlargement (-).
Thorax:
Symmetrical fusiformis, Chest retraction (-), intercostal space clearly
visible (+) HR : 116 bpm, reguler, murmur (-), RR: 34 tpm, regular,
rales (-).
Abdomen:
Soepel, Normoperistaltic. Liver, spleen and renal were unpalpable.
Extremities:
Baggy pants (+), pulse 116 bpm, regular, adequate pressure and
volume, warm acral, CRT < 3, Blood Pressure 90/60 mmHg, Plantar
palmar pale (+/+), oedem (-/-)
Urogenital:
4,9 gr%
11,3 14,1
Hematocrite
15,3 %
37 41
Erythrocyte
1,89 x 106/mm3
Leucocyte
4.900 /mm3
4.500 13.500/mm3
Platelet
192.000 /mm3
MCV
81 fl
8l -99 fl
MCH
25,4 pg
27 31pg
MCHC
31,4 g/dl
31 37 g/dl
RDW
22,60 %
10 15 %
Difftel
Neutrophil
72,90
37 80
Lymphocyte
14,10
20 40
Monocyte
13.0
28
Eosinophil
0.00
16
Basophil
0.000
01
Natrium
142
135 - 155
Kalium
2,8
3,6 5,5
Chloride
116
96 106
89
<200
Electrolyte
Working Diagnosis:
Marasmus + Suspect TB + suspect HIV
Management:
Diet F75 68cc/3 hours + mineral mix 0,1cc
Vit A 1 x 200.000 IU
Folic Acid 1 x 5mg 1 x 1mg
Multivitamin without Fe 1 x cth
Cotrimoxazole 2 x cth
Diagnostic Planning:
Check Complete Blood Count, RFT, LFT, Mantoux Test, BTA
Sputum
FOLLOW UP
November 24th 2014 December
17th 2014
S
O
Planning:
Consult Hematology-Oncology
Screening HIV
Consult Alergi and Imunology
Consult Nutrition an Metabolic Disease
Mantoux Test
Consult Respirology
Planning:
Sens: Alert, Anemic (+). Icteric (-). Edema (-). Cyanosis (-) Dyspnoe (-). Body Temperature : 37,8 0C .
Body weight: 5,4 kg, Body length: 73 cm. BW/age: <-3SD, BL/age: <-3SD, BW/BL: <-3SD
Head
Neck
Thorax
Symmetrical fusiformis, Chest retraction (-), intercostal space clearly visible (+) HR :100bpm, reguler,
murmur (-), RR: 28 x/i, regular, rales (-).
Abdomen
Extremities Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral, CRT < 3, Blood
Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Genital
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Susp. Tuberculosis + Susp. HIV
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
INH prophylaxis 1 x 30mg
Diet F100 90cc/3hours with mineral mix 1,8cc
Candistatin Oral drop
Mantoux Test Result:
Induration 0 mm
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis + Susp. HIV
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet F100 130cc/3hours with mineral mix 2,6cc (day 1) via oral
Candistatin Oral drop
Diet F100 130cc/3hours with mineral mix 2,6cc (day 2) via oral
Candistatin Oral drop
Planning:
-
Lab Result:
Hb: 9,7, Ht: 31,2 L:5930 T: 194000
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis + Susp. HIV
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
-
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis + Susp. HIV
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
-
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis + Susp. HIV
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
-
Hasil Lab:
Ferritin: 526,2, Fe: 42, TIBC 180
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis + Susp. HIV + Anemia Iron Deficiency
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet Soft food 1000kkal + 12gr protein
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis + Susp. HIV + Anemia Iron Deficiency
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet Soft food 1000kkal + 12gr protein
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis+ Susp. HIV + Anemia Iron Deficiency
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet Soft food 1000kkal + 12gr protein
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
Baggy pants (+), pulse 110 bpm, regular, adequate pressure and volume, warm acral,
CRT < 3, Blood Pressure 90/60 mmHg, Plantar palmar pale (+/+)
Male, within normal limit
Marasmus + Tuberculosis+ Susp. HIV + Anemia Iron Deficiency
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet Soft food 1000kkal + 12gr protein
Diet F100 130cc/3hours with mineral mix 2,6cc
Candistatin Oral drop
Planning:
Discussion
MG, male, 2 years and 2 months old, was reffered to RSUP HAM at
November 23 th 2014 from Pediatrician with the diagnosed of
Marasmus and susp HIV.
For a diagnosis of Marasmus a
case must be:
1. Hitory taking (descreas of
weight, food dietery,
previous illness, anorexia)
2. Physical Examination: very
wasted, old man face,
baggy pants, intercostal is
clearly visible, hipotrophy
muscle
3. Antrhopometry: weight for
height must be < -3SD
(WHO), MUPC < 11,5cm,
very wasted.
4. Laboratorium (Anemia,
Hipoglichemy,
hiponatremi)
Clinical findings :
Weight is not age appropriate,
anorexia, decreas of weight
Physical examination : very
wasted, old man face (+),
baggy pants, intercostal is
clearly visible, hypotrophy
musle.
Antrophometry: weight for
height < -3SD, MUPC: 8,8cm,
and very wasted, oedem (-)
Laboratorium: Hb 4,9g/dl
(Anemia)
Etiology of
Marasmus:
1.Nutrition
2.Infection (TB,
pneumonia,
diarrhea, HIV)
3.SocioEconomic
In this patiens:
The etiology are
nutrition and
infection, who
patient had bad
dietery, and the
patient had been
diagnosed with HIV
and tuberculosis
Conclusion
The conclusion of this paper is a boy, 2 years and 2 months
old, diagnosed with Marasmus, HIV, Tuberculosis, Anemia iron
deficiency. The patient received :
Inj. Ceftriaxone 300mg/12hr/IV
Cotrimoxsazole syr 2 x cth
Folic Acid 1 x 1mg
Multivitamin without Fe 1 x 1 cth
Vit A 1 x 20.000 IU
FDC RHZ 1x1tab
B6 1x10mg
Diet F100 150cc/3hours with mineral mix 3cc
Candistatin Oral drop
Lamivudin pulv 2x24mg
Stavudin pulv 2x6mg
Nevirapin 2x64mg