Dr / Badr
Nutrition SNQs & Cases
Case no. 1 :
1- A 10 month old infant presented to ER with bilateral edema of the LL with pallor .
The mother gave history of recurrent attacks of vomiting and diarrhea with stopping of
feeding giving the child rice water and caraway . On examination , weight 7.5 Kg , Bilateral
LL pitting edema , wasting of muscles of the thigh , ulcerations in the buttocks and a
diaper rash . Abdominal examination revealed enlarged liver 3 cm below the costal margin
, firm in consistency .
 What is the probable diagnosis ?

Actual weight
Expected weight for age
=
7.5
8.5
X 100 = 88%
 So , Weight is > 80 % + edema + Clinical manifestations
 According to welcome classification , The most probable diagnosis is KWO
 Investigations
 Dietetic management
Case no. 2 :
2- A 1.5 year old boy presented with generalized edema and rash over the buttocks and
extremities , temperature 36.5 , RR 50 per min , weight 8 kg with enlarged firm liver .
 What is the probable diagnosis ?

Actual weight
Expected weight for age
=
8
11
X 100 = 72%
 So , Weight is 80 - 60 % + edema + Clinical manifestations
 According to welcome classification , The most probable diagnosis is KWO
 Investigations
 Management
 Enumerate the complications
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Dr / Badr
Nutrition SNQs & Cases
Case no. 3 :
3- A 1 year old boy was admitted to hospital because of convulsions . On examination , he was
5 Kg in weight , MAC 11 cm , pale . He had pitting edema in hands and feet . His mother
gave history of recurrent gastroenteritis .
 What is the probable diagnosis ?

Actual weight
Expected weight for age
5
= X 100 = 55 %
9
 So , Weight is ≤ 60 % + edema
 According to welcome classification , The most probable diagnosis is Marasmic KWO
 Management
Case no. 4 :
4- A 7 Kg infant aged 1.5 years presented with LL edema .
 What is the probable diagnosis ?
 Management
Case no. 5 :
5- An irritable 12 month old child with diarrhea and poor weight gain each time he has
cereals in diet . Examination revealed an infant 4 Kg with abdominal distension , MAC 9 cm
, No edema or leg ulcers .
 What is the probable diagnosis ?

Actual weight
Expected weight for age
4
= X 100 = 44 %
9
 So , Weight is ≤ 60 % without edema
 According to welcome classification , The most probable diagnosis is Marasmus due
to Celiac disease
 Investigations ?
3
Dr / Badr
Nutrition SNQs & Cases
Case no. 6 :
6- Ahmed is a 12 months old infant presented to ER with lethargy and refusal to suck or feed .
On examination , he had marked muscle wasting , temperature 36 and his chest revealed
coarse rales ( crepitations ) , weight 5 Kg , Chest x ray showed multiple pneumatoceles .
 What is the probable diagnosis ?

Actual weight
Expected weight for age
5
= X 100 = 55 %
9
 So , Weight is ≤ 60 % without edema
 According to welcome classification , The most probable diagnosis is Marasmus
complicated by chest infection ( pneumonia )
 Prognosis ? very bad → Properly septic shock
 Management ?
Case no. 7 :
7- A 10 months old female infant brought to clinic for routine health evaluation . Her diet
consists of ordinary food and lot of fresh whole milk . On examination , she is pale , Hb 7.5 .
 What are your concerns about her diet?
 Her diet is deficient in :
 Vitamin D
 Iron
 Ca/P ratio
 ↑ risk of infection
 What are the expected nutritional problems ?
 KWO
 Vitamin D deficiency rickets
 Iron deficiency anemia
 ↑ risk of Gastroenteritis
 Scurvy
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Nutrition SNQs & Cases
Dr / Badr
Case no. 8 :
8- A 14 months old infant , 9.5 Kg , brought to clinic due to poor weight gain and delayed
walking . History revealed exclusive breast feeding with little baby food . On examination ,
he has large head , distended abdomen and palpable swellings at costochondral junction .
 What is your diagnosis ?
 The most probable diagnosis is Vitamin D ↓ rickets
 What are your recommended investigations ?
 Enumerate the complications of this illness .
Case no. 9 :
9- An exclusive breast fed infant of 2 years old , is brought to ER with pain in his right leg
after a fall . Physical examination reveals a small child with 3 cm anterior fontanelle , a
flattened occiput , a prominent forehead , significant dental caries , bumpy ribs and
bowed extremities . Xray showed greenstick fracture along with fraying at distal end of
femur .
 What is your diagnosis ?
 The most probable diagnosis is Vitamin D ↓ rickets
 How would you treat such a case ?
Case no. 10 :
10A 14 months old infant brought to you with delayed sitting and teething . On
examination , you found that anterior fontanelle was 3 finger width . He had a previous
ophthalmic surgery for buphthalmos . He didn’t recognize his mother . He was 5 Kg weight ,
MAC 10 cm . ABG showed PH 7.2 , HCO3 11 , pCo2 22 . Urine analysis was +ve for glucose
and was of alkaline PH .
 What is your diagnosis ?
 The most probable diagnosis is Lowe syndrome ( Renal Tubular rickets )
 What are your recommended investigations ?
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Nutrition SNQs & Cases
Dr / Badr
Case no. 11 :
11A 1 year old infant is complaining of delayed sitting and repeated chest infection . On
examination , there is prominent costochondral junction , frontal bossing and delayed
teething . He received multiple injections for treatment with no improvement .
 What is your diagnosis ?
 The most probable diagnosis is Vitamin D resistant rickets
 What is your work up ?
Case no. 12 :
12A 2 year old child presented with bowing of LL , frontal bossing , pallor and short
stature . His serum Ca 8 mg , Serum Ph 7.5 mg , alkaline ph 700 IU .
 What is your diagnosis ?
 The most probable diagnosis is Renal glomerular rickets
 What is your treatment ?
Case no. 13 :
13A working mother of 6 months old breast fed infant needs to return to work that starts
from 9 am to 2 pm .
 What to feed the baby while the mother isn’t home ? why ?
 Expressed breast milk by pump
 Humanized formula
 How much to feed ?
 How to prepare the feed ?
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