11 Gizi Kurang Dan Gizi Buruk

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    PrinciplePrinciple

    ManagementManagementofof

    Severe MalnutritionSevere Malnutrition

    Titis PrawitasariDiv. Nutrition & Metabolic DiseasesFaculty of Medicine University of Indonesia

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    What is Malnutrition?What is Malnutrition?

    Wt/Ht

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    MARASMICMARASMIC

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    KWASHIORKORKWASHIORKOR

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    MARASMIC - KWASHIORKORMARASMIC - KWASHIORKOR

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    Principle ManagementPrinciple Management

    of Severe Malnutritionof Severe Malnutrition

    Initial treatmentInitial treatment

    identify life-threatenin !roble"s

    treated in a hos!ital or a residential care facility

    ! Reha"ilitationReha"ilitation

    intensive feedin recover lost weiht

    e"otional and !hysical sti"ulation

    !re!are for dischare# trained to continue careat ho"e

    ! #ollo$-up#ollo$-up

    to !revent rela!se and assure the continued

    !hysical# "ental and e"otional develo!"ent

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    Refee%ing S&n%romeRefee%ing S&n%rome

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    'eh&%ration'eh&%ration

    Sun(en e&esSun(en e&es

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    'eh&%ration'eh&%ration

    )urgor *)urgor *

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    Oral reh&%ration salts +ORS,Oral reh&%ration salts +ORS,

    solutionsolution

    Severel& malnourishe% chil%renSeverel& malnourishe% chil%ren

    ! de$cient in !otassiu"# hih levels ofde$cient in !otassiu"# hih levels of

    sodiu"sodiu"! %eoMal' less sodiu"# "ore%eoMal' less sodiu"# "ore

    !otassiu"( !lus M# )n and *u to!otassiu"( !lus M# )n and *u to

    correct de$ciencies of these "ineralscorrect de$ciencies of these "inerals! +,-,, "l of %eoMal !er /0'+,-,, "l of %eoMal !er /0'

    enouh to restore nor"al hydrationenouh to restore nor"al hydration

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    Component

    Concentration+mmol.,

    /lucose 012

    So%ium 32

    Potassium 34

    Chlori%e 54

    Citrate 5

    Magnesium

    6

    7inc 486

    Copper 48432

    Osmolarit 644

    Composition ofComposition of

    ReSoMalReSoMal

    Ingre%ient

    Amount

    WHO-ORS 0 pac( for 0.or2 sachet for144ml

    Sugar 24 g

    Mineral-mi9

    14 ml

    Waterupto

    1444 ml

    Ho$ to ma(eHo$ to ma(e

    ReSoMalReSoMal

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    Ho$ to use MMHo$ to use MM??

    ! Mineral-mi9 is use% to ma(e *Mineral-mi9 is use% to ma(e *

    - Resomal- Resomal+Reh&%ration solution for+Reh&%ration solution for

    Malnutrition,Malnutrition,

    - #ormula #52 an% #044- #ormula #52 an% #044

    ! 14 ml of MM for each 0444 ml of14 ml of MM for each 0444 ml of

    Resomal: #52 an% #044Resomal: #52 an% #044

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    Ho$ to #ee% ?Ho$ to #ee% ?! Initial treatmentInitial treatment

    1nery' 2,-,, al33day

    Protein' -#4 ra"33day

    Fluid' 5, "l33day or ,, "l33day 6withoede"a7

    ! TransitionTransition

    1nery' ,,-4, al33day

    Protein' 8-5 ra"33day

    ! Reha"ilitationReha"ilitation

    1nery' 4,-88, al33day

    Protein' 5-9 ra"33day

    ! #ollo$-up#ollo$-up

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    A: la(i-la(i: 0 th: ;; < (g: P;A: la(i-la(i: 0 th: ;; < (g: P;

    56 cm56 cm

    Fase inisial'62,-,,7 al : ; < 92,-;,, al

    Fase transisi'

    6,,-4,7 al : ; < ;,,-=,, al

    Fase rehabilitasi'

    64,-88,7 al : ; < =,,-58, al

    /erdasaran //3T/ atau // ideal

    6,-8,7 al : =# < ,,-+8 al

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    )A;=. P=)>@>K P=M;=RIA #-52)A;=. P=)>@>K P=M;=RIA #-52

    >)>K>)>K

    AAK /I7I ;>R>K )APA ='=MAAAK /I7I ;>R>K )APA ='=MABB anak

    (kg)

    Volume F75/ 1 kali makan (ml)a) Total 80% daritotal a)

    Setiap !amb)

    (1" mkn)

    Setiap #!am c)

    (8 " mkn)

    Setiap $!am

    ( & mkn)

    Se'ari (1#0ml/kg)

    Se'ari

    (minimum)

    2.0 20 30 45 260 210

    2.2 25 35 50 286 230

    2.4 25 40 55 312 250

    2.6 30 45 55 338 265

    2.8 30 45 60 364 290

    3.0 35 50 65 390 310

    3.2 35 55 70 416 335

    3.6 40 60 80 468 375

    Buku I : Buku Bagan Tata Laksana Anak Gizi Buruk, hal

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    T>/1? [email protected] P1M/1%I>N F-+4T>/1? [email protected] P1M/1%I>N F-+4

    UNTUA >N>A BI)I /U%UAUNTUA >N>A BI)I /U%UA

    C>NB 1D1M> /1%>TC>NB 1D1M> /1%>T

    BB anak

    (kg)

    Volume F75/ 1 kali makan (ml)a) Total 80% daritotal a)

    Setiap !amb)

    (1 " mkn)

    Setiap #!am c)

    (8 " mkn)

    Setiap $!am

    ( & mkn)

    Se'ari(100ml/kg)

    Se'ari

    (minimum)

    3.0 25 40 50 300 240

    3.2 25 40 55 320 255

    3.4 30 45 60 340 270

    3.6 30 45 60 360 290

    3.8 30 50 65 380 3054.0 35 50 65 400 320

    4.2 35 55 70 420 335

    4.4 35 55 75 440 350

    /uu I ' /uu /aan Tata ?asana >na Bii /uru# hal

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    T>/1? [email protected] P1M/1%I>N F-,,T>/1? [email protected] P1M/1%I>N F-,,

    UNTUA >N>A BI)I /U%UAUNTUA >N>A BI)I /U%UA

    BB anak(kg)

    Batas volume pemberianmakan !100

    "er 4 #am (6 kali se$ari)

    Batas volumepemberian 100%alam se$ari

    &inimum

    (ml)

    &aksimum(ml)

    &inimum

    150ml'kg'$ari

    &aksimum220

    ml'kg'$ari

    2.0 50 75 300 440

    2.2 55 80 330 484

    2.4 60 90 360 528

    2.6 65 95 390 572

    2.8 70 105 420 616

    3.0 75 110 450 660

    /uu I ' /uu /aan Tata ?asana >na Bii /uru# hal 8

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    Constituent #-52 #-044=nerg& 52 (cal 044 (cal

    Protein 48 g 18 g

    .actose 086 g 381 g

    Potassium 68.AMO'I#ICA)IO of WHO #ORM>.A

    F>1 T>/I?I>I T%>NII %1E>/I?IT>I

    Bahan Makanan F+4

    I

    F+4

    II

    F+4

    III

    M F,, M M II F54 M III

    usu si" bubu 67 84 - - ,, - ,, ,, - -

    usu full crea" 67 - 54 - - , - - 84 8,

    usu sa!i sear 6"l7 - - 5,, - - - - - -

    Bula !asir 67 +, +, +, 4, 4, 4, 4, +4 +4Te!un beras 67 54 54 54 - - - - 4, -

    Te"!e 67 - - - - - - - 4, -

    Minya sayur 67 8+ + + 84 5, 4, - ;, -

    Mararin 67 - - - - - - 4, - 4,

    ?arutan eletrolit

    6"l7

    8, 8, 8, - 8, - - 8+ -

    Ta"bahan air s3d6"l7

    ,,, ,,, ,,, ,,,

    ,,, ,,, ,,, ,,, ,,,

    For Persistent diarrhea dan Disentri G7 M < Modiso

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    Reha"ilitation PhaseReha"ilitation PhasePrinciples of managementPrinciples of management

    to encourae to eat as "uch as !ossibleto encourae to eat as "uch as !ossible

    to re-initiate3encourae /F as necessaryto re-initiate3encourae /F as necessary

    to sti"ulate e"otional & !hysical devto sti"ulate e"otional & !hysical dev

    to !re!are the "other or carerto !re!are the "other or carer

    !The child should re"ain in hos!ital for theThe child should re"ain in hos!ital for the

    $rst !art of the rehabilitation !hase$rst !art of the rehabilitation !hase

    after that transfer to nutritionafter that transfer to nutrition

    rehabilitation centrerehabilitation centre

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    Reha"ilitation PhaseReha"ilitation Phase

    ! Durin the $rst few days of rehabilitationDurin the $rst few days of rehabilitation

    children with oede"a "ay not ainchildren with oede"a "ay not ain

    weiht# des!ite an adeHuate intaeweiht# des!ite an adeHuate intae Proress is seen as decreased oede"aProress is seen as decreased oede"a

    rather than ra!id weiht ainrather than ra!id weiht ain

    ! F-,, should be continued until - DF-,, should be continued until - D

    6=,7 of the "edian reference values for6=,7 of the "edian reference values for

    03E03E

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    =motional F Ph&sical=motional F Ph&sical

    StimulationStimulation

    ! Delayed develo!"ent occurredDelayed develo!"ent occurred

    if not treated# can beco"e the "ostif not treated# can beco"e the "ost

    serious lon-ter" result of "alnutritionserious lon-ter" result of "alnutrition

    ! ti"ulation throuh !lay !rora"sti"ulation throuh !lay !rora"s

    start durin rehabilitation & continuestart durin rehabilitation & continue

    after dischareafter dischare

    can substantial