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K
Spot Dx
2/F with swelling of limbs, skin peeling, and 'miserable' mood
Nutrition
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Case Presentation
A 2-year-old girl is brought to a health center because her legs and face have become swollen over the last month. Her mother reports she is 'always crying' and has lost her appetite for food. On examination, she has pitting edema up to her knees, thin reddish hair, and dark skin lesions on her thighs. Her heart rate is 85 bpm and her temperature is 35.5°C.
Question
Diagnosis? Identify indicators for need of antibiotic therapy in this case.
Answer
This child is classified as having Severe Acute Malnutrition (SAM). Her low heart rate (relative bradycardia) and hypothermia (35.5°C) are high-risk indicators of severe infection or metabolic collapse in a malnourished child, rather than signs of stability.
Clinical Pearl
In a child with SAM, standard vital sign thresholds for infection (like tachycardia or fever) may be absent; bradycardia and hypothermia are late indicators of severe sepsis or electrolyte derangement.