Hypoglycemia

1

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2
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3
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4
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• ????? Hypoglycemia
• ????? Hyperglycemia
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5
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• Extreme wasting in marasmus
• This affects all body tissues and the marked loss
  of subcutaneous fat and skeletal muscle results
  in a skin and bone appearance . Body weight may
  be reduce to only 40 or so of the normal mean
  for age. The prognosis is especially grave in
  those cases with 50 or more loss of body weight.

6
Monkey face or The old man face
7
Marasmus

• The same patients after 3 months of treatment .
  The diet should be introduced step-wise to
  provide eventually about 200 kcal and 3-5 kg
  protein /kg/day. Catch up growth is usually slow
  during the first month but rapid thereafter

8
Marasmus

• Main daccoucheur
• The characteristic contraction of the hands in
  this marasmic infant is indicative of
  accompanying tetany. This may be due to calcium .
  Magnesium deficiency or a combination of both

9
Gastro intestinal tract in Marasmus

• Gastro intestinal series 2 weeks after admission
  demonstrates large stomach and separate loops of
  small intestine with thickened valvulae
  conniventes

10
Gastro intestinal tract in marasmus

• Four weeks after the original study when the
  patient was well a repeat intestinal series shows
  the small intestine to be normal