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MARASMUS

A. Definition
Marasmus is one form of severe PEM arising from carbohydrate deficiency with weight
presentation of less than 60% without edema.

B. Etiology
Marasmus can occur at any age, but is often found in infants who are not getting enough
milk and are not given a replacement food or are often attacked by diarrhea. Marasmus can
occur due to various diseases such as infection, gastrointestinal tract disorders, congenital heart
defects, malabsorption, metabolic disorders, chronic kidney disease and central nervous
disorders.
Can also be caused by the inclusion of calories or protein or both that are not sufficient due
to deficiencies in the diet, and eating habits that are not feasible.

 Factors that cause marasmus


1. Dietary factors. A less energy diet will result in a marasmus sufferer.
2. The role of social factors. Abstinence to use certain foods that have been passed down
through generations.
3. The role of population density. Mc Laren (1982) estimates that marasmus is present in
large numbers due to an area too densely populated with poor hygiene.
4. Infection factors. There is a synergistic interaction between infection and malnutrition.
Severe infections can make the nutritional state worse through input impairment and
heighten the loss of essential nutrients.
5. Poverty Factor. With low incomes, the inability to buy foodstuffs plus the incidence of
many infectious diseases due to density of residence can accelerate the onset of PEM.

C. Pathophysiology
For tissue survival, a certain amount of energy which normally can be fulfilled from the
food provided. This need is not met on the less intake, therefore for the fulfillment of used
reserve protein as an energy source.
Destruction of tissue in calorie deficiency not only helps meet energy but also enables the
synthesis of glucose and other essential metabolites such as various amino acids. Therefore, in
marasmus sometimes still found normal levels of amino acids, so the heart can still form
albumin.

D. Clinical features
Marasmus clinical symptoms consist of:
 Looks very skinny, just bone wrapped in skin
 Face like a parent
 Criesy, cranky
 Skin wrinkles, subkutis fat tissue very little to none (baggy pant / wear loose pants)
 Concave abdomen
 - Often accompanied by: - infectious diseases (generally chronic over and over)
- Chronic diarrhea or constipation / difficult bowel movements

E. Diagnosis
Marasmus is established on the basis of clinical features, physical examination, and supported
by laboratory tests.

F. Management
Severe marasmus patients were hospitalized with routine treatment as follows:
1. Overcome / prevent hypoglycemia
2. Overcome / prevent hypothermia
3. Overcome / prevent dehydration
4. Correction of electrolyte balance
5. Treat / prevent infection
6. Micronutrient deficiency correction
7. Start feeding
8. Facilitation grows chase
9. Provide sensory stimulation and emotional / mental support.
10. Prepare follow-up after recovery

G. Prognosis
With adequate treatment, patients generally can be helped although it takes about 2 - 3
months to achieve the desired weight. At the perfect healing stage, physical growth is usually
only slightly less adrift than the average child. But sometimes his intellectual development will
experience persistent lags, especially mental disorders and perceptual deficiencies.
Developmental retardation will be even more obvious if the disease is suffered before the child
is 2 years old, when proliferation, myelinization and brain cell migration are still occurring.

Referensi:
1. Departemen Kesehatan RI. Pedoman Tatalaksana Kurang Energi-Protein pada Anak di
Puskesmas dan di Rumah Tangga. Jakarta. 2011
2. Buchanan, April. 2018. Pediatric nutrition and nutritional disorder. Page 110. Elsevier