Ni Nengah Tuti Arianthi, I Made Dwi Payana, I Putu Oka Kresna Jayadi

Terapi nutrisi bertahap pada marasmus dengan campak: laporan kasus anak 23 bulan

Introduction

Terapi nutrisi bertahap pada marasmus dengan campak: laporan kasus anak 23 bulan. Pelajari terapi nutrisi bertahap untuk marasmus berat pada balita 23 bulan dengan campak dan hiperpireksia. Stabilisasi & tanpa komplikasi refeeding.

Abstract

Background: Severe marasmus in toddlers is frequently complicated by measles and hyperpyrexia, raising the risks of electrolyte imbalance, rehydration failure, and early refeeding complications. This case report aims to describe the application of a stepwise nutrition protocol in marasmus “condition 5” with concurrent measles and hyperpyrexia, and to summarize the patient’s early clinical response. Case Presentation: A 23-month-old boy with marasmus (condition 5) complicated by measles and hyperpyrexia. Management prioritized stepwise nutritional rehabilitation calculated on ideal body weight (IBW: 10.5 kg): fluids: ±800 mL/day, energy: 100 kcal/kg IBW/day (±1,040 kcal), and protein: 1.5 g/kg IBW/day (±15.6 g). Feeding was small, frequent: soft/porridge meals 3 times a day (±250 kcal/meal); high-energy, high-protein formula (Pediasure) 3×150 mL, plus two 150-mL snack feeds and one 150-mL night feed. Micronutrients included vitamin A 200,000 IU on days 1, 2, and 15; zinc daily for 6 weeks; and folic acid 5 mg on day 1, then 1 mg daily for 6 weeks. Refeeding prevention relied on gradual energy escalation, close monitoring of intake–output, vital signs, and electrolytes when available; mild dehydration was corrected non-aggressively. Over the first 48–72 hours, oral intake improved with adequate urine output and progressive defervescence, without evident refeeding complications. Conclusion: In measles-associated hyperpyrexia with advanced marasmus, a structured stepwise nutrition strategy with vigilant monitoring can achieve early stabilization and improved intake without evident refeeding complications, supporting its feasibility in resource-constrained settings. Background: Marasmus (gizi buruk berat) pada balita kerap diperberat infeksi seperti campak dan hiperpireksia, yang meningkatkan risiko ketidakseimbangan elektrolit, kegagalan rehidrasi, serta sindrom refeeding pada fase awal perawatan. Tujuan laporan kasus ini adalah mendeskripsikan penerapan protokol terapi nutrisi bertahap pada marasmus yang disertai campak dan hiperpireksia, serta respons klinis awal pasien. Presentasi Kasus: Anak laki-laki 23 bulan dengan marasmus disertai campak dan hiperpireksia. Terapi difokuskan pada rehabilitasi gizi bertahap berbasis BBI 10,5 kg: kebutuhan cairan ±800 mL/hari, energi: 100 kkal/kgBBI/hari (±1.040 kkal), dan protein: 1,5 g/kgBBI/hari (±15,6 g). Pola pemberian porsi kecil-sering: makanan lunak/“bubur” 3 kali per hari (±250 kkal/porsi); formula energi-protein tinggi (Pediasure) 3×150 mL, ditambah 2 kali susu 150 mL sebagai selingan dan 1 kali susu malam 150 mL. Pemberian mikronutrien meliputi vitamin A 200.000 IU pada hari ke-1, 2, dan 15; zink harian 6 minggu; dan asam folat 5 mg hari pertama lalu 1 mg/hari 6 minggu. Pencegahan refeeding dilakukan dengan peningkatan bertahap densitas energi, pemantauan ketat intake–output, tanda vital, dan evaluasi elektrolit bila tersedia; koreksi dehidrasi ringan dilakukan tanpa agresif. Dalam 48–72 jam awal, asupan meningkat, diuresis adekuat, defervescence bertahap, tanpa tanda gagal sirkulasi/komplikasi refeeding yang nyata. Kesimpulan: Pada marasmus yang disertai campak dan hiperpireksia, penerapan terapi nutrisi bertahap yang terstruktur dengan pemantauan ketat memungkinkan stabilisasi klinis awal, kontrol gejala, dan perbaikan asupan tanpa komplikasi refeeding yang nyata. Pendekatan ini relevan untuk konteks layanan dengan sumber daya terbatas.

Review

This case report provides a valuable insight into the management of a critically ill child presenting with severe marasmus complicated by concurrent measles and hyperpyrexia, a challenging scenario frequently associated with high morbidity and mortality, particularly concerning refeeding syndrome. The authors meticulously detail a stepwise nutritional rehabilitation protocol, emphasizing a structured approach to fluid, energy, and protein management, alongside targeted micronutrient supplementation. The primary contribution lies in demonstrating the successful early clinical stabilization and improved oral intake without apparent refeeding complications, underscoring the feasibility and potential efficacy of such a protocol even in resource-constrained environments. A key strength of this report is the precise outlining of the nutritional intervention. The authors specify energy and protein requirements calculated based on ideal body weight, detailing the feeding schedule with both staple meals (porridge) and high-energy/protein formula (Pediasure), alongside snack and night feeds. The clear description of micronutrient administration, including vitamin A, zinc, and folic acid, adds practical utility. Crucially, the emphasis on refeeding prevention strategies—gradual energy escalation, vigilant monitoring of intake–output, vital signs, and careful rehydration—is particularly commendable. The positive early clinical response, marked by improved intake, adequate urine output, and progressive defervescence within 48–72 hours, without signs of refeeding complications, reinforces the effectiveness of the described protocol. While this is a single case report and thus generalizability is inherently limited, it offers a crucial proof-of-concept for managing highly complex cases of severe acute malnutrition compounded by acute infections. The mention of electrolyte monitoring being performed "when available" highlights the real-world challenges in resource-limited settings, yet the positive outcome achieved under these conditions strengthens the argument for the protocol's adaptability. Future research could build upon this by conducting larger case series or comparative studies to validate these findings across a broader population and explore long-term outcomes. Nevertheless, this report serves as an excellent practical guide and encourages the adoption of structured, monitored stepwise nutritional strategies for similar high-risk pediatric patients.

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