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Malnutrition-different faces of it!

I have been dealing with a lot of mallnutrition cases overtly.
There are the usual ,obvious cases that glare at you from the paediatric out-patient and then there are others which are there because they have not been eating due to other reasons.
We get a lot of cases of starvation.There is a common myth in the villages which says that patients who have enteric fever have to be put off food.
So a vicious cycle resumes.Patients are not given food ....and then later their stomach shrinks over time and then they lose their appetite.
We had a twenty five year old cachectic lady come in with a history of  fever.
We screened her for everything one could think of in a cacechtic person and she came negative except for enteric fever.She had clinical features pointing towards the diagnosis.She had been treated with various antibiotics so we put her on Multi-drug therapy for enteric fever and her fever crashed by the second day.However her blood pressure continued to crash inspite of adequate hydration.So we put her on pressors and supported her with steroids.
However she continued to have the ups and downs.
We transferred her to the ACU and one afternoon the patient looked like she was going to have a funny turn.
I walked up to her and she told me she was having palpitations.We attatched her to the cardiac monitor and she was having intermittant VTs, it looked like torsades pointes.
I immediately started her on magnessium drip.
Twelve hours later she looks a different person.She sat up and started eating the high nutrition pack dalia which our community health people have made.We have stopped her pressors.
I thank God for ways in which the Lord helps us to deal with cases which can be found only in the peripheries.

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