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MARASMIC-KWASHORKOR

MARASMIC-KWASHORKOR. AUG, WIDELYN. GENERAL INFORMATION. ROOM No: IMCU to SVI ward AGE : 1 year old and 3 months DATE OF ADMISSION: January 31,2013 BIRTHDATE : 10/26 2011 SEX : Female ADDRESS : Tugbok ATTENDING PHYSICIAN: Dr. Buaya. SOCIO-ECONOMIC HX.

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MARASMIC-KWASHORKOR

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  1. MARASMIC-KWASHORKOR AUG, WIDELYN

  2. GENERAL INFORMATION ROOM No: IMCU to SVI ward AGE: 1 year old and 3 months DATE OF ADMISSION: January 31,2013 BIRTHDATE: 10/26 2011 SEX: Female ADDRESS: Tugbok ATTENDING PHYSICIAN: Dr. Buaya

  3. SOCIO-ECONOMIC HX MOTHER: 17 yo (Housewife) FATHER: Farmer HOUSE TYPE: Nipa MISSIONARY OF CHARITY • PT found by the missionary sisters placed on a table unattended. Subsequently stayed 3 days at Juna Children’s House before hospitalization.

  4. EdemaAfebrileDermatosisApathy ADMITTING DIAGNOSIS • Protein Energy Malnutrition, Kwashiorkor-Marasmic Mix

  5. PATHOPHYSIOLOGY

  6. ASSESSMENTS

  7. ANTHROPOMETRY Height: 75 cm. Weight 5.1 kilos with bipedal, orbital and abdominal oedema upon admission (1/31) Age: 1 year and 3 months CHILD GROWTH STANDARDS • Weight for age: (-3 SD) Severely Underweight • Height for age: Normal • Weight for height: (-3 SD) Severely Wasted

  8. CLINICAL ASSESSMENT a.) Oedema (bipedal and minimal abdominal) b.) Skin lesions (dermatosis) c.) Sparse hair and poor nails d.) Enlarged nodes f.) Decreased play and physical activity, apathetic g.) Muscle wasting h.) cough (sign of broncho-infection)

  9. DIETARY: DTY RX 1100 kcal-165- 40- 30 (Diet as tolerated, high protein)

  10. Feb. 6, 2012 Recur of orbital edema (puffy eyelid) • Unable to meet protein needs even with Specialized milk- diet • -Kcal based on computed normal needs is inadequate by 10% • -Cough gotten worse • SHORT TERM PLAN: • Correct Edema. • Address infection with Vit.A & C rich foods. • Continue PEDIASURE.

  11. SUPPLEMENTATION DTY RX 1100 kcal-165- 40- 30 (Diet as tolerated, high protein

  12. Feb. 7,8,9 (FEBRILE)

  13. DTY RX 1100 kcal-165- 40- 30 (Diet as tolerated, high protein

  14. Feb. 12, 2012(+) Broncho Pneumonia • SHORT TERM PLAN: • At least 1 Ponkan daily plus any fruit. • Yakult to improve appetite. • Continue PEDIASURE. • Manage Meds. • Promote protein intake. Edema still present.

  15. SUPPLEMENTATION

  16. Feb. 16, 2012(-) edema

  17. SUPPLEMENTATION

  18. DRUG AND NUTRIENT INTERACTION

  19. Ampicillin • Low fiber diet increase absorption. • Probiotic Microorganism prevent anti-biotic induced diarrhea • Reduce Vit. C Gentamycin • Interfere Vit. B6 metabolism

  20. Ceftriaxone • Intravenous Calcium and intravenous ceftriaxione is associated with neonatal deaths d/t precipitation of ceftriaxone-calcium salt in the lung and/or kidneys Salbutamol • Loss of appetite • Altered taste sensation

  21. Zinc Sulfate • Increase in calcium intake promotes excretion of zinc

  22. HOSPITAL DISCHARGE

  23. Weight Monitoring summary • 5.1 kilos with bipedal, orbital and abdominal oedema upon admission (1/31) • 5.5 kilos with bipedal and orbital oedema (2/6) • 5.8 kilos with bipedal oedema (2/8) • 5.8 kilos with minimal bipedal oedema 2/10 • 5.0 kilos without oedema 2/15 • 5.6 kilos without oedema upon discharge 2/21 (gained 1 1/3 lb after 6 days without oedema) IBW: 10 kilos Long Term Goal: Correct Muscle Wasting; Establish Oral Hygiene

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