Acta Scientific Nutritional Health

Volume 2 Issue 5 May 2018

Case Report

Protein Energy Malnutrition Severe Acute Malnutrition, LRTI with KOCH’S

Ushakiran Sisodia*, Nirva Desai and Sonia Akerkar

Diet and Nutrition Department, Nanavati Super Speciality Hospital, Mumbai, India
*Corresponding Author: Ushakiran Sisodia, Diet and Nutrition Department, Nanavati Super Speciality Hospital, Mumbai, India.

Received: March 08, 2018; Published: April 21, 2018

Abstract
The few rare cases found in the developed world is result of ignorance of the nutritional needs of children, particularly in cases of
milk allergy. If under nutrition occurs during pregnancy, or before two years of age, it may result in permanent problems with physi-
cal and mental development. Extreme undernourishment, known as starvations that include; a short height, thin body, very poor
energy levels, and swollen legs and abdomen. Often get infections, frequently cold. 1 yr 8 months old male child 3rd birth by order
born of NCM admitted with case of cough, fever, and vomiting, poor appetite and weight loss since last two months. An episode of
pneumonia at the age of 6 months, following recurrent respiratory tract infections. Only on breast milk and cow’s milk 3 - 4 times a
day, poor weight gain since six months of age. Patient was started on F75 Diet I/v/o SAM which child tolerated well, diet progressed
to F100 Diet and F120 Diet with daily monitoring of weight. Iron and multivitamin drops were also started, Vitamin A- 2 lakh IU
given. Patient’s gradually improved, air entry improved, patient was gaining weight, pedal oedema decreased. Hemodynamically
stable, hence being discharged on oral medication. A large percentage of children that suffer from PEM also have other co-morbid
conditions, because of delayed weaning.

Keywords: Malnutrition; Infection; Antibiotics; Pneumonia; Diarrhoea; Tuberculosis; F75 Diet

Introduction breast milk and few spoons of cow’s milk 3 - 4 times a day; poor
weight gain since six months of age. Child has poor activity since
Severe acute malnutrition (SAM) is associated with increased
last two months. O2 by NP @ 2 litre/min was started as SPO2 was
severity of common infectious diseases, and death amongst chil-
90% on RA, after securing an iv line and sending required inves-
dren with SAM is almost always as a result of infection. The diag-
tigations patient was started on iv antibiotics (Inj. Amoxicillin +
nosis and management of infection are often different in malnour-
Clavulanate), Syp. Azithromycin, Syp. Cefixime, maintenance I. V
ished versus well-nourished children. Protein - energy malnutrition
fluids, nebulisation with Levosalbutamol and symptomatic treat-
(PEM) refers to a form of malnutrition which is defined as a range
ment. Blood culture was sent which was negative. Sputum cul-
of pathological conditions arising from coincident lack of protein
ture was sent which was s/o Klebsiella pneumoniae. HRCT Chest
and or energy in varying proportions PEM is fairly common world-
showed sub lobar consolidation. Based on physical and clinical
wide in both children and adults and accounts for 6 million deaths
signs though AFB and Mantoux was negative decision was taken to
annually.
start AKT. I/v/o, CT chest s/o tuberculosis. Patient was Afebrile on
Case Report admission, had 2 fever spikes on day 4, 2 spikes on day 8, 3 spikes
on day 9 and 1 spike on day 10 of admission.
We report one such case in hospital as 1 yr 8 months old male,
weight 3 kg child 3rd birth by order born of NCM admitted with Patient was started on F75 Diet i/v/o SAM which child toler-
Severe Acute Malnutrition, Bronchitis, Chronic LRTI with KOCH’S, ated well and gradually diet progressed to F100 Diet and F120 Diet
with supportive lung disease. Patient presented with cough, fever with daily monitoring of weight. Iron and multivitamin drops were
and vomiting, poor appetite weight loss since last two months. also started, Vitamin A- 2 lakh IU given. Chest physiotherapy was
done twice daily, chest x-ray was repeated which showed improve-
The child had an episode of pneumonia at the age of 6 months
ment. Patient’s symptoms gradually improved, air entry improved,
for which he was hospitalised and received parenteral antibiot-
occasional creps were positive, patient was gaining weight, pedal
ics. Following that the child has had recurrent respiratory tract
oedema decreased. Child is tolerating feeds well orally, is passing
infections. Child was taking homeopathic medications for above
urine adequately, afebrile and hemodynamically stable, hence be-
ailments but no relief from symptoms. The child is accepting only
ing discharged on oral medication.

Citation: Ushakiran Sisodia., et al. “Protein Energy Malnutrition Severe Acute Malnutrition, LRTI with KOCH’S”. Acta Scientific Nutritional Health 2.5
(2018): 19-20.
Protein Energy Malnutrition Severe Acute Malnutrition, LRTI with KOCH’S
20

Discussion Condition at Discharge

Protein - energy malnutrition affects children the most because Patient was afebrile, had No Respiratory Distress, SPO2 98% on
they have less protein intake. The most common co-morbidities RA. Weight on discharge - 5.82 kg.
are diarrhoea. However, a variety of other conditions have been
observed with PEM, including severe anaemia, bronchopneumo-
Conclusion
nia, tuberculosis rickets, and keratomalacia. These co-morbidities High Calorie, High protein diet chart was given with 150 Kcal/
tax already malnourished children and may prolong hospital stays kg body weight/day and 3 gm/kg body weight/day. The parents
initially for PEM and may increase the likelihood of death. High - were also educated about the various home-made weaning foods
resolution computed tomography (HRCT) is a type of computed for the child.
tomography (CT) with specific techniques to enhance image reso-
Funding Resource
lution. It is used in the diagnosis of various health problems, though
None.
most commonly for lung disease, by assessing the lung parenchyma
[1-6]. Conflict of Interest
Diet Counselling: Nutritional Course by Diet Department. We affirm that we do not have conflict of interest. We verify that
all the authors has access to data and role in writing manuscript.
Reference by Doctor: SOS to start AKT in evening, Supplement:
F75 -80 kcal/kg/d, Improve oral intake, 2g protein/kg/d. Accord- Bibliography
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Dinner Same as Lunch
Bed-time Milk* 1 cup
*Skim milk powder 2 tsp
Volume 2 Issue 5 May 2018
**Ghee 2 tsp
© All rights are reserved by Ushakiran Sisodia., et al.
Cheese 1 cube

Medications Administered

Sr. No Drug Name Sr. No Drug Name

1 T.Rifa - 1-6 Kid Forte 11 Syp. Ibugesic
2 T.Pyzina 12 Syp Coscopin.
3 T.Combutol 13 Viscyneral drop
4 T.Althrocin 14 Tonoferon drop.
5 T.Lanzol JR 15 Practin drop.
6 Vitamin A chewable tablet 16 Neb with levolin
7 Syp.Bethadoxin. 17 Inj. Augmentin
8 Syp Crocin 18 Inj. Emeset
9 Syp. Azee 19 IVF DNS
10 Syp. Zifi

Citation: Ushakiran Sisodia., et al. “Protein Energy Malnutrition Severe Acute Malnutrition, LRTI with KOCH’S”. Acta Scientific Nutritional Health 2.5
(2018): 19-20.