DASAWISMA

Gizi buruk

Anak

a. klinis

b. komplikasi

c. pengobatan

d. perawatan

e. diet

f. mental

g. pemantauan

Orang tua

- mampu beli mkn

- dapat merawat

- ortu cerai

Pemantauan

Lingkungan

Perilaku

A

B C

1. Petugas kesehatan

2. Lintas sektoral

D

Disease states often associated with protein-energy malnutrition in children

Low birth weight infants

Short bowel syndrome

Cystic fibrosis

Mucosal disease

Celiac disease

Milk protein enteropathy

Tropical sprue

Allergic gastroenteritis

Intractable diarrhea

Immune deficiency disorders

Chronic liver disease

Inflammatory bowel disease

Burns and trauma

Anorexia nervosa

Cancer

Common

Lymphoid

Precorsor

Prothymocyte Thymocyte Peripheral T Lymphocyte

Human PEM

Zinc

Thymic

Epithelium

Hormone

Murine PEM

Pyridoxine Iron

Pre B Cell B Cell Plasma Cell

IgG

IgM

IgA

IgE

Magnesium

Vitamin E

Antigen Presenting

Cell

Suppressor T Cells

Helper T Cells

Cytotoxic T Cells

Vitamin A

Murine PEM

Copper

? Selenium

Vitamin C

Vitamin A

Localization of the specific effects of nutrient on the immunologic network. Dashed arrow, site or specific cell

type affected by various nutrients list for effect elicited by nutrient deprivation or, in a few instance, by excess.

DASAWISMA

1. balita > 2

2. ibu KEP

3. ortu PHK

4. ortu †

5. BBLR

6. cacad bawaan

7. tidak dapat ASI

8. KMS: 2 T

9. tdk kontrol Posy.

10. gizi buruk

KEWASPADAAN

11. <4 bln disapih

12. ibu bekerja

13. sering sakit

14. tdk dpt vit. A

15. kena Tb/campak

16. kel. diare

17. tdk dpt beli mkn

18. perilaku sehat (-)

Effects of trace element deficiencies

Effect Zn Cu Se Cr

Growth retardation + +

Anemia + + -

Integumental lesions + + -

Impaired immunity + + + -

Intestinal/pancreatic “atrophy” + + + -

Hepatic necrosis - -

Cardiac changes - + + -

Altered metabolism of

Carbohydrate/energy + + - +

Nitrogen and protein + - - +

Lipid + +

+, prominent effect; , marginal or needing confirmation; -, not reported.

Data derived from clinical and experimental studies in humans and from

animal models.

The heart in PEM; cardiac pathology

Gross

Small, pale, flabby myocardium

Absent epicardial fat

Pericardial effusion (if edematous)

Normal coronary arteries, valves, and endocardium

Light microscopy

Atrophy of myofibers, tightly packed

Increase in connective tissue

Fragmentation of myofibrils

Loss of striations

Patchy necrosis

Interstitial edema (kwashiorkor)

Electron microscopy

Foci of atrophy

Loss of myofibrils and glycogen

Decreased mitochondria

Swelling of matrix and disruption of cristae

Cardiovascular events during recovery from PEM

First week

Congestive heart failure

Excessive loading of atrophic myocardium

Infection

Anemia

Fluid and electrolyte disturbances

Protein loading

Sudden death

Conduction disturbances secondary to sudden shifts in fluid and

electrolytes

Increased cardiac size

Later

“Hyperkinetic circulatory state”

Increased cardiac output

Shortened circulation time

Lower vascular resistance

Narrow arteriovenous oxygen difference

Composition of mineral mix solution

Substance Amount

Potassium chloride 89.5 g

Tripotassium citrate 32.4 g

Magnesium chloride (MgCl2-6H2O) 30.5 g

Zinc acetate 3.3 g

Copper sulfate 0,56 g

Sodium selenate* 10 mg

Potassium iodide* 5 mg

Water to make 1000 ml

* If it is not possible to weigh very small amounts accurately, this substance

may be omitted

Composition of vitamin mix

Vitamin Amount per litre of liquid diet

Water-soluble:Thiamine (vitamin B1) 0.7 mg

Riboflavin (vitamin B2) 2.0 mg

Nicotinic acid 10 mg

Pyridoxine (vitamin B6) 0.7 mg

Cyanocobalamin (vitamin B12) 1 g

Folic acid 0.35 mg

Ascorbic acid (vitamin C) 100 mg

Pantothenic acid (vitamin B5) 3 mg

Biotin 0.1 mg

Fat-soluble:Retinol (vitamin A) 1,5 mg

Calciferol (vitamin D) 30 g

-Tocopherol (vitamin E) 22 mg

Vitamin K 40 g

Bagan Pengelolaan Gizi Buruk

NO FASE STABILISASI TRANSISI REHABILITASI

Hari ke-1-2 Hari ke-2-7 Minggu ke-2 Minggu ke-3-7

1. Hipoglikemi

2. Hipotermi

3. Dehidrasi

4. Elektrolit

5. Infeksi

6. Mulai pembe-

rian makanan

7. Tumbuh kejar/

peningkatan

pemberian ma-

kan

8. Mikronutrien

9. Stimulasi

10. Tindak lanjut

Tanpa Fe Dengan Fe

komplikasi >>

kematian >>

- perawatan intensif

- belajar makan F75

- masa kritis lewat

- anak

- mau makan F100,

bubur

- infeksi (-)

- mau makan

- jarang infeksi

Menghidupkan

Menggemukkan

Mempertahankan

Fase Stabilisasi

Fase Transisi

Fase Rehabilitasi

Fase Follow-up

Formula F 75 dan F 100

Bahan per 100 ml F 75 F 100

Susu skim bubuk (g) 25 85

Gula pasir (g) 100 50

Minyak sayur (g) 30 60

Larutan elektrolit (ml) 20 20

Tambahan air s.d. (ml) 1000 1000

F 75 : Setiap 100 ml mengandung 75 kalori.

F 100 : Setiap 100 ml mengandung 100 kalori.

RESOMAL

Terdiri dari:

Air 2 liter

Bubuk WHO-ORS untuk 1 liter 1 pak

Gula pasir 50 gram

Larutan elektrolit/mineral 40 cc

Alternatif (bila tidak ada larutan elektrolit):

Air 2 liter

Bubuk WHO-ORS untuk 1 liter 1 pak

Gula pasir 50 gram

Bubuk KCl 4 gram