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GROUP 14
Tutor : dr. Hasta Handayani Idrus,
M. Kes
GROUP 14
SCENARIO
A baby girl, age 9 months, brought by her mother to the health center with
complaints of frequent diarrhea since last 1 month. A history of feeding:
breastfeeding is given up to three months, then given starch water until now.
Birth history: BBL 2800 g, PB 47 cm. On physical examination found: BB 3.4 kg,
PB 56 cm. Palms looked pale. Found bitot spot on the eye, edema dorsum of the
foot and edema pretibial. Also it appears the wasting and baggy pants.
Dehydration score 13 and hemoglobin 5 g / dl.
Difficult Words
Bitot spot :
whiteorgraytriangulardepositsonthebulbarconjunctivaadjacenttothelatera
lmarginofthecornea,aclinicalsignofvitaminAdeficiency.
Keywords
History of feeding: -
Dehydration score 13
Hemoglobin 5 g / dl
QUESTIONS
1. a. How to assess the nutrition status of the baby in scenario?
b.How the interpretation of dehydration score and hemoglobin of the baby in scenario?
2. How is the normal feeding to the 9 months baby?
3. What are the compositions of starch water and breastmilk?
4. How is the phatomechanism of all symptomps in scenario?
5. How to diagnose according to the problem of the baby in scenario?
6. Explain about Malnutrition :
7. How is the treatment steps for malnutrition according to WHO?
8. How is the treatment for the baby in scenario?
9. How is the islamic perspective of scenario?
1. a) How to assessment
nutritional status of the
baby in scenario?
Keputusan Menteri Kesehatan Republik Indonesia (Nomor:1995/MENKES/SK/XII/2010). Tentang Standar Antropometri Penilaian Status Gizi Anak.
0-6 months
Breastmilk
6-10 months
10-12 months
In the scenario, the baby only have breastfeeding up to three months, then
given starch water until now. The baby didnt get the normal feeding according to
her age.
Slide Kuliah Prof. Dr.dr. R. Satriono, M.Sc, Sp.A(K), Sp. GK(K) , Infant and Children Feeding
Fe (mg) 0.086
breastmilk
Composition
Energy (Kg kla)
Kolostrum
57,0
Transisi
63,0
Asi Matur
65,0
Laktosa (gr/100ml)
6,5
6,7
7,0
Lemak (gr/100ml)
2,9
3,6
3,8
Protein (gr/100ml)
1,195
0,965
1,324
Mineral (gr/100ml)
0,3
0,3
0,2
335,9
5,9
17,1
14,2-16,4
420-520
119,6
2,9
2,9
24,3-27,5
250-270
Immunoglobulin :
IgA (mg/100ml)
Ig G (mg/100ml)
IgM (mg/100ml)
Lisosim (mg/100ml)
Laktoferin
ANP N/
RETENTION
EDEMA
Referensi :
Sudoyo, Aru W, dkk. 2009. Buku Ajar Ilmu Penyakit Dalam jilid II. Edisi V. Jakarta : Interna Publishing. Hal 148.
Bitots Spot
Vitamin A (Retinoal)
ulceration,
necrosis,
keratomalasia,
and permanent
corneal scarring
metaplasia
conjunctival
epithelial cells
xeroftalmia
xerosis conjunctival
& cornea
Bitots Spot
Referensi :
Marcdante, Karen, Dkk. 2014. Nelson Ilmu Kesehatan Anak Esensial. Edisi 6. Singapore : Saunders Elsevier. Hal 132-133
Dry eyes
Diarrhea
Malabsorption
in the
intestines
Water was
drawn to the
intestinal
lumen
DIARRHEA
Intake lots of
sweet drinks
(carbohydrate)
Exceeds the
absorption
capacity of
the intestine
Referensi :
Marcdante, Karen, Dkk. 2014. Nelson Ilmu Kesehatan Anak Esensial. Edisi 6. Singapore : Saunders Elsevier. Hal 459
Glukoneogenesis
cortisol increases
Referensi :
Guyton and Hall. 2006. Buku ajar fisiologi kedokteran. edisi 9. Jakarta : EGC
Anamnesis
Identity
Main complaint : onset, duration
Additional complaint
Food History : food habit, include the kind of food, the frequency, the
portion / number, vitamin suplemen, etc.
Birth History :Birth weight, lenght
Immunization history
Growth and development history
Family history
Physical
Examination
Pemeriksaan
Penunjang
Laboratorium examination
Electrolyte
Radiology
asnjoer A, dkk. Kapita Selekta Kedokteran. Edisi III. Jilid II. FKUI. Jakarta. 2000; 514-18.
Classification
Keith P. West, Jr. 2006. Protein-Energy Malnutrition (PEM) and Undernutrition. The John Hopkins University.
Diet
Diet
Role
Role of
of free
free
Radicals
Radicals and
and
Aflatoxins
Aflatoxins
Etiology
of PEM
Biological
Biological
factors
factors
Social
Social and
and
Economic
Economic
factors
factors
Environmental
Environmental
Factors
Factors
Keith P. West, Jr. 2006. Protein-Energy Malnutrition (PEM) and Undernutrition. The John Hopkins University.
Clasification of PEM
Marasmus
Severely wasted (emaciated) & stunted
Very low WAZ
Balancedstarvation
Old Manface, wrinkled appearance, sparse
hair
No edema, fatty liver, skin changes
Too little breast milk or complementary foods
< 2 yrs of age
Keith P. West, Jr. 2006. Protein-Energy Malnutrition (PEM) and Undernutrition. The John Hopkins University.
Kwasiorkor
Edema
Mental changes
Hair changes
Fatty liver
Dermatosis (skin lesions)
Infection
Mod low WAZ, wasting
High case fatality
Low prevalence
1st to 3rd yrs of life
Keith P. West, Jr. 2006. Protein-Energy Malnutrition (PEM) and Undernutrition. The John Hopkins University.
Marasmic Kwashiorkor
There is varying degree of muscle wasting,
oedema along with hair and skin changes.
There is the presence of moderate anemia, and
along with it more than one vitamin deficiencies
are also found.
Vitamin A deficiency is associated with severe
malnutrition and may cause blindness.
Keith P. West, Jr. 2006. Protein-Energy Malnutrition (PEM) and Undernutrition. The John Hopkins University.
Marasmus
Kwashiorkor
Marasmic
Kwashiorkor
Severely
underweight
Severely stunted
Severely wasting
Edema dorsum of
foot and pretibial
+/-
Bitot spot
+/-
Diarrhea
+/-
+/-
+/-
Dehydration
+/-
+/-
+/-
Anemia
Tindakan
H 1-2
stabilitation
Transition Rehabilitation Tindak lanjut
H 3-7
H 8-14
2-6 mg
7-26mg
1. treat hypoglicemia
2. treat hypothermia
3. treat dehydration
4. treat decrease
electrolyte
5. treat infection
6. treat decrease of
mikronutrien
7. cautious feeding
8. catch-up growth
9. stimulation
10. Prepare for follow up
whithout Fe
+ Fe
Bagan Tata Laksana Anak Gizi Buruk. 2011. Kementrian Kesehatan Republik Indonesia Direktorat Jenderal Bina Gizi dan
Kesehatan Ibu Dan Anak.
Bagan Tata Laksana Anak Gizi Buruk. 2011. Kementrian Kesehatan Republik Indonesia Direktorat Jenderal Bina Gizi dan
Kesehatan Ibu Dan Anak.
Bagan Tata Laksana Anak Gizi Buruk. 2011. Kementrian Kesehatan Republik Indonesia Direktorat Jenderal Bina Gizi dan
Kesehatan Ibu Dan Anak.
Mothers shall suckle their children for two full years, that is for those who want to enhance
breastfeeding. And obligations of a father feeding and clothing the ma'ruf mothers manner.
Someone not burdened but according to levels of ability. No mother suffered misery for her son
and a father for his son, and heir shall be chargeable as .if both want wean (before two years)
with both willingness and consent, there is no blame on either of them. And if you want your
son feeded by others, then there is no sin on you if you make the payment according to the
worth. Your fear Allah and know that allah is seer of what ye do. (QS. Al-Baqarah: 233)
REFERENCE
Slide Kuliah Prof. Dr.dr. R. Satriono, M.Sc, Sp.A(K), Sp. GK , Infant and Children Feeding
Marcdante, Karen, Dkk. 2014. Nelson Ilmu Kesehatan Anak Esensial. Edisi 6. Singapore : Saunders Elsevier.
Hal 132-133
Marcdante, Karen, Dkk. 2014. Nelson Ilmu Kesehatan Anak Esensial. Edisi 6. Singapore : Saunders Elsevier.
Hal 459
Guyton and Hall. 2006. Buku ajar fisiologi kedokteran. edisi 9. Jakarta : EGC
Masnjoer A, et al. Capita Selecta Medicine. Edition III. Volume II. FKUI. Jakarta. 2000; 514-18.
Keith P. West, Jr. 2006. Protein-Energy Malnutrition (PEM) and Undernutrition. The John Hopkins University.
Bagan Tata Laksana Anak Gizi Buruk. 2011. Kementrian Kesehatan Republik Indonesia Direktorat Jenderal
Bina Gizi dan Kesehatan Ibu Dan Anak.