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Presenter :
Rivhan Fauzan
(100100236)
Supervisor : DR. dr. Oker Rina
Raa!ani" Sp.# ($ )
%#R#S%&S
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• 'he ter arasus isderived ro the reekmarasmos, *hi+h eans
*astin,.• %arasus invo-vesinadeuate intake oprotein and +a-ories and is+hara+terized /!ea+iation.
• %arasus represents the
end resu-t o starvation
INTRODUCTION
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• %arasus is a serious *or-d*idepro/-e that invo-ves ore than 0i--ion +hi-dren !oun,er than !ears. #++ordin, to theor-d 4ea-th Or,anization (4O)"57 o the 10.5 i--ion deathso++urrin, in +hi-dren !oun,er than !ears in deve-opin, +ountries areasso+iated *ith P8%
•
4i,h-! preva-ent in deve-opin,+ountries aon, 9 +hi-drensevere ors 1;107 < under*ei,ht20;507.
• Seen ost +oon-! in the rst
!ear o -ie due to -a+k o /reasteedin and the use o di-ute ania-
8P=D8%=O>O?
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•Nutrition• Infection•Socio-economic factor
ETIOLOGY
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• Very wasted• Od man face• !a""y #ants• $i%otro%&y musce• su'cutaneous fat t&innin"• t&innin" &air and &air fa out easiy•
Se(ere "rowt& retardation• No oedema
@-ini+a- Features o
%arasus
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• )arasmus is com%ensatedmanutrition or an ada%tation
mec&anism of t&e 'ody to t&eac* of ener"y in a on" time+ Ina state of ac* of food, t&e 'odyis aways tryin" to maintainin"
ife 'y meetin" 'asic needs orener"y
• ./ 'ody com%osition c&an"es,
0/ meta'oic c&an"es, and 1/anatomic c&an es
#2TO#$YSIOLOGY
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• $istory ta*in"
• #&ysica E3amination• 2nt&ro%ometri• La'oratory 4eatures
DI2GNOSIS
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TRE2T)ENT
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@#S8 R8POR'
Name 6 )G
2"e6 0 years and 0 mont&s od
Se36 )ae
Date of 2dmission6 No(em'er,01rd 07.8
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@hie @op-aint 6 9ei"&t is not a"ea%%ro%riate
• It was reai:ed 'y &is mot&er in 1 mont&s, &is wei"&t wasa'out ; *" 1 mont&s a"o , t&e &i"&est wei"&t e(er ac&ie(ed'y &im was <+= *" at . year od+
• Diarr&ea was su>ered 'y &im 1 days a"o, wit& fre?uency was.7 times %er day, (oume a'out .77cc in e(ery diarr&ea,mucous @/, 'ood @/, &istory of diarr&ea @/, it was su>ered'y %atient a'out = mont&s a"o+
• Vomitin" was su>ered 'y %atient one day a"o, wit& fre?uencyonce %er day, t&e amount of (omitin" was not cear, (omitin"w&at &e eat and drin*, (omit contains 'ood and 'rownis&coor was denied 'y &is mot&er+
• Cou"& was su>ered 'y %atient since t&is wee*, %roducti(ecou"& -/, cou"& contain 'ood was denied 'y &is mot&er,&istory of contact wit& %eo%e wit& c&ronic cou"& was found,&is "randfat&er is dia"nosed wit& Tu'ercuosis and was ta*in"dru"s of tu'ercuosis+ $e i(ed wit& &is "randfat&er for Amont&s
• $istory of fe(er was su>ered 'y %atient since a'out . mont&
4istor!6
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4istor! o previous i--ness
•
T&e %atient was treated 'y #ediatrician'efore t&e admission to $2) $os%itawit& dia"nose )arasmus and sus%ect$IV
4istor! o dru,s
• Transfusion of #RC 87cc, Rin"er a*tat,InB 2m%iciin, InB+ Gentamycin, inc,Nystatin
4ood Reca
• Eat once a day, wit& &af a %ate ofsma %ores wit& a (e"eta'es menuwit&out s& and meet+ Lacte"an mi* 8
times a day .07cc+
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Fai- 4istor!
•
$is fat&er wor*ed as a farm wor*er in Fam'i, $is mot&er is a &ousewife
Pre,nant 4istor!
•
#atient is t&e second c&id in &is famiy+ $ismot&er "ot antenata care durin"%re"nancy+ T&ere was no &istory of fe(er,&y%ertension, dia'etic meitus, andconsum%tion of dru"s and &er'a medicine
!irt& $istory• #atient was aterm w&en dei(ered on
s%ontaneous a'or, attended 'y midwife+$e cried immediatey+ !irt& wei"&t was
0<77 "rams, 'irt& en"t& was 8 cm, andno &istor of c anosis was found durin t&e
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=unization 4istor!
•
Not com%ete
Feedin, 4istor!
• 4rom 'irt& to A mont&s 6 !reast mi*• 4rom A to .0 mont&s 6 !reast mi* @ rice
%orrid"e• 4rom .0 mont&s unti now6 daiy menu @
Lacta"en mi*4istor! o ro*th andDeve-opent• mont&s 6 sittin"• .8 mont&s 6 wa*in"•
0 yr 0 mo 6 Bust say Hmama mimimamam
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Ph!si+a- 8Aaination
Generalized status
• !ody wei"&t6 =,8*", !ody en"t&6;1 cm , )U#C6 <,< cm
• 9ei"&t for a"e 6 scoreJ -1 SD
• Len"&t for a"e 6 scoreJ -1 SD
• 9ei"&t for en"t& 6 scoreJ -1SD
Inter%retation 6 under nutrition
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Present statusConsciousness6 aert
!ood %ressure 7KA7 mm$",$R6 ..A '%m,
RR6 18 '%m,
'ody tem%erature6 1;oC,
'ody wei"&t 6 =,8 *",'ody en"t& 6 ;1 cm
2nemic @/, Icteric -/, Cyanosis -/, Edema -/,
Dys%nea -/+
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Head 6
• 4ace6 Od man face @/
• Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%+
conBuncti(a %ae @K@/, icteric scera -K-/+• $air6 easiy remo(ed
• )out&6 ora t&rus& @/+
• Nose and Ear were norma imit
Neck 6
•
TVF6 R-0 cm$0O, Lym%& node enar"ement -/+Thorax 6
• Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary(isi'e @/ $R 6 ..A '%m, re"uer, murmur -/, RR6 18 t%m, re"uar,raes -/+
Abdomen6
• Soe%e, Normo%eristatic+ Li(er, s%een and rena were un%a%a'e+
Extremities6
• !a""y %ants @/, %use ..A '%m, re"uar, ade?uate %ressure and(oume, warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar%amar %ae @K@/, oedem -K-/
Urogenital6•
a ora or! n n,s on osp a ove er
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a ora or! n n,s on osp a ove er2015)=D:Parameters Value Normal Value
Complete Blood Count
Hemoglobin 4,9 gr% 11,3 – 14,1
Hematocrite 15,3 % 37 – 41
r!t"roc!te 1,#$ 1&'
(mm3
4)5& – ')5& 1&'
(mm3
*eucoc!te 4)$&& (mm3 4)5&& – 13)5&&(mm3
Platelet 1$+)&&& (mm3 15&)&&& – 45&)&&& (mm3
CV #1 -l #l .$$ -l
CH +5,4 pg +7 – 31pg
CHC 31,4 g(dl 31 – 37 g(dl
/0 ++,'& % 1& – 15 %
0i--tel
• Neutrop"il 7+,$& 37 – #&
• *!mp"oc!te 14,1& +& – 4&
• onoc!te 13)& + – #
• osinop"il &)&& 1 – '
• Basop"il &)&&& & – 1
lectrol!te
Natrium
14+
135 . 155
2alium +,# 3,' – 5,5
C"loride
Blood lucose ad/andom
11'
#$
$' – 1&'
+&&
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Working Diagnosis:
)arasmus @ Sus%ect T! @ sus%ect $IV
Management:
Diet 4;= A<ccK1 &ours @ minera mi3 7,.cc
Vit 2 . 3 077+777 IU4oic 2cid . 3 =m" . 3 .m")uti(itamin wit&out 4e . 3 ct& MCotrimo3a:oe 0 3 ct& M
Diagnostic Planning:
C"ec Complete Blood Count, /6, *6, antou est, B8
9putum
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4OLLO9 U#No(em'er 08t& 07.8 Decem'er
.;t& 07.8
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Bove/er 25th 2015
S Diarr&ea -/, Vomitin" -/, 4e(er @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1;,< 7C + !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae@K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
..7'%m, re"uer, murmur -/, RR6 17 3Ki, re"uar, raes -/+
#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+8Atreiti
es
!a""y %ants @/, %use ..A '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure .77K;7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit# )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IVP . Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. Die 4;= 7ccK1&ours wit& minera mi3 .,7<cc#annin"6
Screenin" $IV
Consut Nutrition an )eta'oic Disease
Consut Res%iroo"y
Consut $ematoo"y-Oncoo"y
Consut 2er"i and Imunoo"y
)antou3 Test
Bove/er 2th 2015
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Bove/er 2 2015S Diarr&ea -/, Vomitin" -/, 4e(er @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1;,< 7C + !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6..7'%m, re"uer, murmur -/, RR6 17 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..A '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure .77K;7 mm$", #antar %amar %ae @K
@/
enita- )ae, wit&in norma imit# )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IVP . Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. Die 4;= 7ccK1&ours wit& minera mi3 .,7<cc#annin"6
Bove/er 26th 2015
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S Diarr&ea -/, Vomitin" -/, 4e(er @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody Tem%erature 6 1;,< 7C +
!ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD
4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/
Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6.77'%m, re"uer,
murmur -/, RR6 0< 3Ki, re"uar, raes -/+
#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreities !a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra, CRT J 1, !ood
#ressure 7KA7 mm$", #antar %amar %ae @K@/
enita- )ae, wit&in norma imit
# )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. Diet 4;= 7ccK1&ours wit& minera mi3 .,7<cc
. IN$ %ro%&ya3is . 3 17m"
. Candistatin Ora dro%
Counsein" $IV resut6
$IV ris* factor from 'ood transfusion
#annin"6
4e %roeRa%id Test 1 met&ods
Bove/er 2Cth 2015
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S Diarr&ea -/, Vomitin" -/, 4e(er @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1;,< 7C + !ody wei"&t6 =,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+
#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/
enita- )ae, wit&in norma imit
# )arasmus @ Sus%+ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. IN$ %ro%&ya3is . 3 17m"
. Diet 4.77 7ccK1&ours wit& minera mi3 .,<cc
. Candistatin Ora dro%
)antou3 Test Resut6
Induration 7 mm
Bove/er 2th 2015
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S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,. *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD , )U#C6 cm
4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/
Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+
#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/
enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc day ./ (ia ora
. Candistatin Ora dro%
Bove/er 2th 2015
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S Diarr&ea -/, Vomitin" -/, 4e(er -/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,. *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD )U#C 6 cm4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a
%ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+
#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/
enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc day 0/ (ia ora
. Candistatin Ora dro% #annin"6
-
Bove/er 30th 2015
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S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,. *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreities
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/
enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ Sus%+ $IVP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3
0,Acc day1/ (ia ora
. Candistatin Ora dro%
. #RC transfusion 1=cc
La' Resut6
$'6 ,;, $t6 1.,0 L6=17 T6 .8777
De+e/er 1st 2015
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 28/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra onBuncti(a %ae
@K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro%
#annin"6-
De+e/er 2nd 2015
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 29/48
S Diarr&ea @/, Vomitin" -/, 4e(er -/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,8 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD )U#C 6 cm4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro%
#annin"6-
De+e/er 3rd 2015
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 30/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done -/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD, !LKa"e6
J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro%
#annin"6-
De+e/er 5th 2015S i & / i i / /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 31/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a
%ae @K@/$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreities
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/
enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ Sus%+ $IVP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro% $asi La'6
4erritin6 =0A,0, 4e6 80, TI!C .<7
De+e/er th 2015i & / i i / /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 32/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a
%ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV @ 2nemia Iron Deciency
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m". )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet Soft food .777**a @ .0"r %rotein
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro% #annin"6
De+e/er 6th 2015S Di & / V iti / 4 / Di t i d /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 33/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, Diet is done @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis @ Sus%+ $IV @ 2nemia Iron Deciency
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet Soft food .777**a @ .0"r %rotein
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro% #annin"6
De+e/er Cth 2015S Di & / V iti / 4 / di t i d /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 34/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a %ae
@K@/$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis@ Sus%+ $IV @ 2nemia Iron Deciency
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet Soft food .777**a @ .0"r %rotein
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro% #annin"6
De+e/er th 2015S Di & / V iti / 4 / di t i d @/
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 35/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/
O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,< *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-1SD,
!LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'ra conBuncti(a
%ae @K@/$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+
'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e @/ $R 6
.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doen Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreiti
es
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume, warm acra,
CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K@/enita- )ae, wit&in norma imit
# )arasmus @ Tu'ercuosis@ Sus%+ $IV @ 2nemia Iron Deciency
P . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet Soft food .777**a @ .0"r %rotein
. Diet 4.77 .17ccK1&ours wit& minera mi3 0,Acc
. Candistatin Ora dro% #annin"6
De+e/er th 2015S Di & / V iti / 4 / di t i d /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 36/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,< *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis@ Sus%+ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one
177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 .
ct&
. 4DC R$ .3.ta'
. !A .3.7m"
. Diet Soft food .777**a @ .0"r %rotein
. Diet 4.77 .17ccK1&ours wit& minera
mi3 0,Acc
. Candistatin Ora dro%
De+e/er 10th 2015S Di & / V iti / 4 / di t i d /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 37/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,= *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one
177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 .
ct&
. Diet Soft food .777**a @ .0"r %rotein
. Diet 4.77 .17ccK1&ours wit& minera
mi3 0,Acc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
. Sta(udin %u( 03Am"
De+e/er 11th 2015S Di & / V iti / 4 / di t i d /
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 38/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done -/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,= *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 .
ct&
. Vit 2 . 3 07+777 IU
. Diet Soft food .777**a @ .0"r
%rotein
. Diet 4.77 .17ccK1&ours wit& minera
mi3 0,Acc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
De+e/er 12th 2015S Diarr&ea / Vomitin" / 4e er / diet is done @/
7/23/2019 lapkas marasmus jadi
http://slidepdf.com/reader/full/lapkas-marasmus-jadi 39/48
S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. Diet 4.77 .=7ccK1&ours wit&
minera mi3 1cc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
. Sta(udin %u( 03Am"
. Ne(ira%in 03A8m"
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De+e/er 15th 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/
7/23/2019 lapkas marasmus jadi
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S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A,A *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. Diet 4.77 .=7ccK1&ours wit&
minera mi3 1cc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
. Sta(udin %u( 03Am"
. Ne(ira%in 03A8m"
De+e/er 1th 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/
7/23/2019 lapkas marasmus jadi
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S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 A, *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. Diet 4.77 .=7ccK1&ours wit&
minera mi3 1cc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
. Sta(udin %u( 03Am"
. Ne(ira%in 03A8m"
De+e/er 16th 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/
7/23/2019 lapkas marasmus jadi
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S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 ;,0 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. Diet 4.77 .=7ccK1&ours wit&
minera mi3 1cc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
. Sta(udin %u( 03Am"
. Ne(ira%in 03A8m"
De+e/er 1Cth 2015S Diarr&ea / Vomitin" / 4e(er / diet is done @/
7/23/2019 lapkas marasmus jadi
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S Diarr&ea -/, Vomitin" -/, 4e(er -/, diet is done @/O Sens6 2ert, 2nemic @/+ Icteric -/+ Edema -/+ Cyanosis -/ Dys%noe -/+ !ody
Tem%erature 6 1A,< 7C + !ody wei"&t6 ;,0 *", !ody en"t&6 ;1 cm+ !9Ka"e6 J-
1SD, !LKa"e6 J-1SD, !9K!L6 J-1SD4ead 4ace6 od man face @/
Eye6 Isoc&oric %u%i 1mmK1mm/, i"&t ree3 @K@/, inferior %a%e'raconBuncti(a %ae @K@/
$air6 easiy remo(ed
Nose and ear were wit&in norma imit+ )out&6 ora t&rus& @/Be+k VF#6 R-0 cm$0O, Lym%& node enar"ement -/+'horaA Symmetrica fusiformis, C&est retraction -/, intercosta s%ace ceary (isi'e
@/ $R 6.77'%m, re"uer, murmur -/, RR6 0< 3Ki, re"uar, raes -/+#/doe
n
Soe%e+ Normo%eristatic+ Li(er, s%een and rena un%a%a'e+
8Atreit
ies
!a""y %ants @/, %use ..7 '%m, re"uar, ade?uate %ressure and (oume,
warm acra, CRT J 1, !ood #ressure 7KA7 mm$", #antar %amar %ae @K
@/enita- )ae, wit&in norma imit# )arasmus @ Tu'ercuosis @ $IV @ 2nemia Iron DeciencyP . InB+ Ceftria3one 177m"K.0&rKIV
. Cotrimo3sa:oe syr 0 3 M ct&
. 4oic 2cid . 3 .m"
. )uti(itamin wit&out 4e . 3 . ct&
. Vit 2 . 3 07+777 IU
. 4DC R$ .3.ta'
. Diet 4.77 .=7ccK1&ours wit&
minera mi3 1cc
. Candistatin Ora dro%
. Lami(udin %u( 0308m"
. Sta(udin %u( 03Am"
. Ne(ira%in 03A8m"
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Discussion
For a dia,nosis o %arasus a+ase ust /e:1. 4itor! takin, (des+reas o
*ei,ht" ood dieter!"previous i--ness" anoreAia)
2. Ph!si+a- 8Aaination: ver!*asted" o-d an a+e"/a,,! pants" inter+osta- is+-ear-! visi/-e" hipotroph!us+-e
3. #ntrhopoetr!: *ei,ht or
hei,ht ust /e 9 ;3SD(4O)" %&P@ 9 11"+"ver! *asted.
5. >a/oratoriu (#neia"4ipo,-i+he!"hiponatrei)
@-ini+a- ndin,s :ei,ht is not a,e appropriate"anoreAia" de+reas o *ei,ht
Ph!si+a- eAaination : ver!
*asted" o-d an a+e (E)"/a,,! pants" inter+osta- is+-ear-! visi/-e" h!potroph!us-e.
#ntrophoetr!: *ei,ht or
hei,ht 9 ;3SD" %&P@: "+"and ver! *asted" oede (;)
>a/oratoriu: 4/ 5",d-(#neia)
)G, mae, 0 years and 0 mont&s od, was re>ered to RSU# $2) atNo(em'er 01 t& 07.8 from #ediatrician wit& t&e dia"nosed of
)arasmus and sus% $IV+
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8tio-o,! o%arasus:1.Butrition
2.=ne+tion ('G"pneuonia"diarrhea" 4=H)3.So+io8+onoi+
=n this patiens:'he etio-o,! arenutrition and
ine+tion" *hopatient had /addieter!" and thepatient had /een
dia,nosed *ith 4=Hand tu/er+u-osis
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Concusion T&e concusion of t&is %a%er is a 'oy, 0 years and 0 mont&s
od, dia"nosed wit& )arasmus, $IV, Tu'ercuosis, 2nemia irondeciency+ T&e %atient recei(ed 6
• InB+ Ceftria3one 177m"K.0&rKIV
• Cotrimo3sa:oe syr 0 3 M ct&
• 4oic 2cid . 3 .m"
• )uti(itamin wit&out 4e . 3 . ct&
• Vit 2 . 3 07+777 IU
• 4DC R$ .3.ta'
• !A .3.7m"
•Diet 4.77 .=7ccK1&ours wit& minera mi3 1cc
• Candistatin Ora dro%
• Lami(udin %u( 0308m"
• Sta(udin %u( 03Am"
• Ne(ira%in 03A8m"
7/23/2019 lapkas marasmus jadi
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