Abstract Ref Number = APCP1169
A COMPLICATED CHRONIC SEVERE MALNUTRITION IN EAST NUSA TENGGARA - A CASE REPORT
Kartini Marpaung,Filjordan Lulupoy
General Practitioner in Ume Manekan Hospital SoE East Nusa Tenggara
Background : One third of the nearly 8 million deaths in children who are under 5 years attributable to malnutrition. In East Nusa Tenggara, 28,3 % of children under 5 years are malnutrition. Malnutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery.
Case Presentation Summary : This case report presents 24 months boy with chief complaint improper weight gain since 3 months ago, anorexia, history of fever for 3 days and cough for 2 weeks. Weight was 7,85 kg, height was 79,3 cm and mid upper arm circumference was 11 cm. The child was irritable and febrile. Sunken eyes and dry mouth mucosa was present. Multiple cervical lymph nodes enlargement were palpable. Ribs was clearly visible through the skin and coarse crackles were present in both lungs. There were eritematous rash in diaper area, dry and scaling skin, and slightly reduced skin turgor. Laboratory evaluation was significant for microcytic hypochromic anemia and elevated erythrocyte sedimentation rate. Blood smear showed plasmodium falciparum and chest x-ray suggested suprahilar lymphadenopathy. Patient was diagnosed with chronic severe malnutrition with mild to moderate dehydration, malaria falciparum, pulmonary TB and iron deficiency anemia. The patient was treated for 31 days in Therapeutic Feeding Centre at Ume Manekan Hospital and discharged after reached nutritional recovery.
Learning Points/Discussion : Chronic severe malnutrition was diagnosed based on clinical and antropometric indicator weight for height < -3 SD, height for age < -2 SD (stunted) and weight for age < -3 SD (wasted). Therapeutic feeding approaches for malnutrition including F75, F100, and ReSoMal for dehydration were given according to WHO guideline. Malaria falciparum was treated by 3 days Artemisinin-based Combination Therapies and single dose primaquine. Fixed Dose Combination was given for Pulmonary TB.
Keywords: Chronic Severe Malnutrition Malaria Pulmonary TB