Dual Faces of Malnutrition : Managing a Pediatric Case of Marasmus Kwashiokor in a District General Hospital
DOI:
https://doi.org/10.25139/htc.v8i2.11011Keywords:
Marasmuskwashiorkor, Severeacutemalnutrition, Therapeuticfeeding, Infantmalnutrition, NutritionalrehabilitationAbstract
Marasmuskwashiorkoris a severeformof protein-energymalnutrition (PEM) combiningfeaturesofbothmarasmusandkwashiorkor, andposes a significantthreattochildhealth in low-resourcesettings. Thiscasereportaimstodescribetheclinicalprofileandmanagementoutcomeof a 6-month-old infantdiagnosedwithmarasmus-kwashiorkorat Dr. Soegiri General Hospital, Lamongan. The infantpresentedwithchronicdiarrhea, significantweightloss, generalized edema, hypoalbuminemia, andcharacteristicskinchanges. Managementwasinitiatedfollowingthe World HealthOrganization (WHO) protocolforsevereacutemalnutrition (SAM), includingcautiousrehydrationwithReSoMal, correctionofelectrolyteimbalances, antibiotics, andphasednutritionalrehabilitationusing F-75 and F-100 therapeuticmilks. Micronutrientsupplementationandinfectionpreventionmeasures were alsoadministered. The patientshowedprogressiveclinicalimprovement, withresolutionof edema bydaytenandweight gain at 5 g/kg/day. Thiscasehighlightsthecriticalimportanceofearlyidentificationandcomprehensive, guideline-basedtreatmentof SAM. Publichealthinterventionsaddressing maternal education, breastfeedingpractices, andfoodsecurity are essential
References
Ahsan, K.Z., El Arifeen, S., Al-Mamun, M.A., etal., 2021. Effectivenessofcommunity-basedmanagementofacutemalnutrition in Bangladesh. The American JournalofClinicalNutrition, 113(4), pp.844–853.
Bhutta, Z.A., Berkley, J.A., Bandsma, R.H.J., Kerac, M. andTrehan, I., 2022. Severechildhoodmalnutrition. NatureReviewsDiseasePrimers, 8(1), pp.1–21. https://doi.org/10.1038/s41572-022-00352-3
Black, R.E., Victora, C.G., Walker, S.P., etal., 2023. Maternal andchildundernutritionandhealthoutcomes in low- andmiddle-incomecountries: anupdatedsystematicreview. The Lancet Global Health, 11(2), pp.e150–e164.
Briend, A., Khara, T. and Dolan, C., 2022. Wastingandstunting—similaritiesanddifferences: policyandprogrammaticimplications. Food andNutritionBulletin, 43(1), pp.15–28.
Dewey, K.G. and Begum, K., 2021. Long-term consequencesofstunting in earlylife. Maternal &ChildNutrition, 17(S1), pp.e13063.
Duggan, C., Watkins, J.B. and Walker, W.A., 2021. Nutrition in pediatrics: basicscienceandclinicalapplications. 6th ed. Shelton, CT: PMPH USA.
Golden, M.H., 2021. The roleofhypoalbuminaemia in kwashiorkor. AnnalsofTropicalPaediatrics, 41(2), pp.73–79.
Kejo, D., Petrucka, P.M., Martin, H., etal., 2021. Prevalenceandfactorsassociatedwithundernutritionamongunder-fivechildren in Tanzania. BMC PublicHealth, 21(1), pp.1–9.
Khan, S., Zaheer, S. andSafdar, N.F., 2022. Determinantsofacutemalnutritionamongunder-fivechildren in developingcountries: a systematicreview. Frontiers in PublicHealth, 10, pp.1–10.
Latham, M.C., 2021. Human nutrition in thedevelopingworld. Rome: FAO.
Lelijveld, N., Beedle, A., Farhikhtah, A., etal., 2022. Community-basedtreatmentofsevereacutemalnutrition: adherenceto WHO protocolsandfactorsaffectingrecovery. BMC Nutrition, 8(1), pp.1–13. https://doi.org/10.1186/s40795-022-00549-8
Suskind, D.L. andLewinter, M.M., 2021. Clinicalnutrition in pediatrics. 6th ed. Chicago: Elsevier.
Tadesse, E., Worku, A., Berhane, Y. andEkström, E.C., 2021. Anemia amongunder-fivechildren in Ethiopia: impactofnutritionintervention. BMC Pediatrics, 21(1), pp.1–9.
UNICEF and World HealthOrganization, 2023. Levelsandtrends in childmalnutrition: keyfindingsofthe 2023 edition. Geneva: United Nations.
Waterlow, J.C., 1992. Protein-energymalnutrition. London: Edward Arnold.
Wells, J.C., Wibaek, R., Poullas, M.S. andRefsum, H.E., 2022. Protein-energymalnutritionanditsmetabolicconsequences. EuropeanJournalofClinicalNutrition, 76(8), pp.1040–1049.
World HealthOrganization, 2023. Guideline: Updatesonthemanagementofsevereacutemalnutrition in infantsandchildren. Geneva: WHO.
Yakoob, M.Y. and Lo, C.W., 2021. Nutrition in childrenanditseffectoninfectiousdiseases. InfectiousDiseaseClinicsofNorth America, 35(2), pp.307–324.
Kerac, M., McGrath, M., Connell, N., etal., 2021. Managementofacutemalnutrition in infantsagedunder 6 months: systematicreviewand meta-analysis. Maternal &ChildNutrition, 17(3), pp.1–12.
