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Trimethoprim-sulfamethoxazole
Head: dry and brittle hair, marked alopecia; nonicteric sclerae, pale conjunctiva;
temporal muscle wasting; glossitis; no thrush or oral ulcerations
Abdomen: decreased bowel sounds and mild abdominal distention; palpation revealed no
tenderness or hepatosplenomegaly
Neurological: length-dependent decreased sensation in both feet; decreased biceps and patellar
deep tendon reflexes
Anorexia
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Systemic illness: hepatitis, congestive heart failure
Stool studies were negative for ova and parasites; cultures were negative for
bacteria
Chest X ray was negative (no evidence of congestive heart failure, tuberculosis, or
other pulmonary infection)
Based on the patient's history, physical examination, and available studies, a
diagnosis of malnutrition was made. According to the World Health Organization
(WHO), severe malnutrition in adults is defined by the presence of 3 criteria:
edema, weight-for-height index below 70% or MUAC <160 mm, and BMI <16.
The patient received albendazole for empiric treatment of intestinal worms,
amoxicillin for empiric treatment of bacterial infections, and oral rehydration
therapy and 3-phase nutritional supplementation according to WHO guidelines.
Two weeks later, at the time of discharge, her weight had increased to 38 kg and
she was able to ambulate without assistance.
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