Vision

A leading center of excellence in clinical nutrition

specialist program in 2025

Missions

Clinical Nutrition Specialist Program will provide a

comprehensive clinical training program that embodies the
following characteristic:
1. Uphold scientific and medical profession ethic
2. Meet national & international standard of clinical
competence
3. Implement research in contribution towards basic and
clinical nutrition science
4. Provide high quality clinical nutrition service
 CLINICAL NUTRITION CONFERENCE
Stella Maris Hospital, September 8th, 2022

dr. Nevi Dwi Handayani

dr. Maya Rosmaria Puspita
 Patient Identity
F. 12 Months. (Female)
MR number
.
584552
Date of birth September 07th, 2021
Admission Date September 2nd, 2022
Consultation Date September 6th, 2022

Medical diagnosis
Medical Nutrition Diagnosis : Weight for length -2SD To + 1 SD: Good Nutrition; Weight for Age -2SD to +1SD:
Normal weight; Height for Age -3SD to -2SD: Short Stature
Pediatric Diagnosis: Bronchopneumonia
 Subjective
(History taking)

Main Complaint
Since 1 weeks ago due to decreased of appetite due to
Decreased of oral intake History taking
Fever, getting worsed since 2 days ago because of fever
was getting worsed together with cough and common cold
Nausea & Vomiting
No Nausea, No vomiting
Swallowing Disorders and Swallowing Pain
Headache No History
No History
Fever and Seizure Epigastric and Abdominal pain
There was history of Fever 1 week ago and treated with No History
paracetamol, getting worsed 2 days ago.
No History of Seizure
Weight loss
Cough and Shortness of Breath
Cough and common cold since 2 days ago There was no weight loss
No History of Shortness of Breath
 Subjective
(History taking)

Defecation
Last defecation was 7 days ago Urination
Via diapers, it was changed 6 times/ day, yellowish, enough
impression
 Patient Family
Cerebrovascular disease Cerebrovascular disease
No History
No History
Cardiovascular, DM
No History Cardiovascular disease, DM
Hyperuricemia No history
No History
Kidney and urinary disease
Tuberculosis
No history
No History
Others Hyperuricemia, hypercholesterolemia
No history No history

• Birth weight 2500gr, enough month Malignancy

• History Of Breastfeeding since birth until No History
now, Complementary Food begin at 7
months years old but just want eating Others
cerelac No history
• Complete Immunization History
 History of PRESENT Illness

1 Weeks
The patient got Fever, and treated with paracetamol
ago

4 days The patient got Fever, the fever was not disappear with paracetamol. The
ago patient got Cough and common cold too. The patient brought to Stella Maris
Hospital and was adviced to be hospitalized.

2 days
The patient got fever, the temperature was getting more and more high. The
ago
patient don’t want to eating.
Dietary History
Food Recall 24 Hours Via Oral :
Breast Milk 3 times in a day
 OBJECTIVE
MODERATE ILLNESS

GCS on E4V5M6

Vital signs Anthropometry

01 02
Pulse : 130 beats/minute Body Length : 67 cm
Respiratory rate : 26 times/minute Actual Body Weight : 7,5 kg
Temperature : 38,9 °C Ideal Body Weight : 7,5 kg
 Physical examination
HEAD AND NECK
Conjunctiva was anemic, Sclera was not icteric
Oxygen support and NGT were not inserted
There was no enlargement of lymph nodes and thyroid gland

CHEST
Inspection : Symmetric. There was no loss of subcutaneous fat
Palpation : No tenderness
Percussion : Sonor
Auscultation : Vesicular breathing sound. There were no Ronchi
& no wheezing
Cardiac Sound : regular heart sounds and no murmurs

ABDOMEN
Inspection : flat
Auscultation : Normal Bowel Sound
Palpation : No Tenderness, Liver and Spleen were not
palpable, there was no
pain on palpation
Percussion : Tympanic
 Physical examination
EXTREMITY
There was no wasting at extremities and no
pitting
edema
 MEDICATION FROM OTHER DIVISION

Pediatric Division (September 2nd, 2022)

• IVFD KaEN 3B 10 drops/ minute
• Ceftriaxon 600mg/24 hours/iv
• Paracetamol 80mg/6 hours/iv
• Nebulizer combivent 1 respulse/12 hours
• Dexamethason 1,5mg/8hours/iv
• Colsancetine 100mg/6 hours/iv
 LABORATORY FINDINGS

September
Laboratory Normal Value
2nd, 2022

WBC 14.120 4,0 - 11,0 x 103/μL

TLC 7650 1.5 - 4 x 103/μL

PLT 283.000 150-400 x 103 /μL

HGB 10.7 13.0 -16.0 gr/dl

MCV 65.8 80 – 100 μm3

MCH 21.8 27.0 – 34.0 pg

MCHC 33.1 31.0-36.0 g/dl

NLR 0.62 <3.13

 RADIOLOGIC FINDINGS

 Ro. Thorax PA/AP (September 3rd , 2022)

 Bronchopneumonia dextra
 Assesment
Metabolical status

September 2nd,2022
• Microcytic Hypocrom Anemia ( 10.7)
• Leukositosis (14.120)

GI- Tract status Functional

HYDRATION STATUS Normovolemia
 Diagnosis & Prognosis

Medical Nutrition Diagnosis : Weight for length -2SD To + 1 SD: Good Nutrition; Weight for Age
-2SD to +1SD: Normal weight; Height for Age -3SD to -2SD: Short Stature
Pediatric Diagnosis: Bronchopneumonia

Prognosis
Vitam: ad bonam
Functionam: Dubia ad bonam
Sanactionam: Dubia ad bonam
 Planning
Fluid requirements = 1050 cc + 13% = 1200ml/24 hours
Basal Energy Expenditure = 353,3 Kcal
Total Energy Expenditure = 551,1 Kcal ~ 550kcal(1.2/1.3)

Macronutrient Composition:
• Protein 3 g/kgBW/day = 22,5 g (16.4%)
• Carbohydrate 60% = 82.5 g
• Fat 23,6% = 14.4 g

• Medical nutrition therapy is given 50% TEE (275 Kcal) via oral and Parenteral :

 Breast milk On Demand

 Cerelac 5x 45 Kcal

Parenteral Nutrition:
 KaEN 3B 500ml/24 hours/intravenous
 Planning

• Suplementation via oral :

- Vicalcin syrup 1x1 teaspoon

• Nutrition Education :
- Nutrition according to the schedule
- Suggest installing NGT : the Parents refused
FOLLOW UP
 Subjective Objective Assessment Planning
Nutrition intake via General Condition : Moderate Illness , GCS E4M5V6 Fluid requirements 1050 cc + 13% = 1200ml/24
oral and parenteral. Metabolic Status hours
there was cough, Vital sign :
common cold and September 2nd,2022
Pulse : 100 beats/minute Medical nutrition therapy is given 50% EET via oral
fever. no Respiratory rate : 28 times/minute, SpO2 99% • Microcytic Hypocrom Anemia ( 10.7) and Parenteral :
shortness of breath, Temperature : 39 °C  Mother’s Milk on Demand
no seizures • Leukositosis (14.120)  Cerelac 3 x 45 Kcal
Anthropometry :  Milna biscuit 2x 45 Kcal
Defecation : Body Length : 67 cm Clinical Nutrition Diagnosis :
Last defecation was  Weight for length -2SD To + 1 SD: Good
Body weight : 7,5 kg Nutrition; Parenteral Nutrition:
8 days Ideal Body Weight : 7,5kg
Urination :  Weight for Age -2SD to +1SD: Normal  KaEN 3B 500 cc/24 hours/intravenous
weight;
She urinated via Fluid requirements = 1050 cc + 13% = 1200ml/24 hours  Height for Age -3SD to -2SD: Short stature Supplementation via oral:
diapers, it was  Vicalcin Syrup 1 1 teaspoon
changed 5 times/ Basal Energy Expenditure = 353,3 Kcal Pediatric Diagnosis :  Zinc 20mg/24 hours
day Total Energy Expenditure = 551,1 Kcal ~ 550kcal (1.2/1.3)  Bronchopneumonia  Vitamin C 50 mg/24 hours
Macronutrient Composition:
1stday Monitoring & evaluation:
• Protein 3 g/kgIBW/day = 22.5 g (16.4%)  Vital sign
Follow Up • Carbohydrate 60% = 82.5 g Gastrointestinal Tract status :
(September 7th,  Daily Intake
• Fat 23,6% = 14.4 g Functional  Gastrointestinal tolerance
2022)
Physical Examination: Nutritional education: nutrition according to
HEAD AND NECK schedule
Conjunctiva was anemic, sclera was not icteric; Oxygen was not
inserted; Nasogastric tube was not Inserted; There was no Laboratorium: -
enlargement of lymph nodes and thyroid gland
CHEST
Symmetric, there are ribs xylophone; No Tenderness; Sonor;
bronchovesicular breathing sound, there was no rhonchi and no
wheezing with regular heart sounds and no murmurs
ABDOMEN
Protuberant appearance; Increased peristalsis; Liver and Spleen
was not palpable; there was no pain on palpation; Percussion
Tympani
EXTREMITY
There was no muscle wasting and no edema in all extremities
Thank you