Medical Nutrition Therapy in Confirmed Covid-19 With Cervical Carcinoma on Chemotherapy and Severe Protein Energy Malnutrition Marasmus Type: A Case Report

OBJECTIVES: This report aims to help develop more effective rational treatment strategies for Severe Protein Energy Malnutrition marasmus type, confirmed Covid-19 and Carcinoma Cervical on Chemotherapy. These patients have hyperinflammation characterized by high levels of pro-inflammatory cytokines, particularly Interleukin (IL)-6, and other acute-phase proteins, including creative protein (CRP), fibrinogen, and ferritin that correlate with impaired T-cell response in women, with epithelial cervical carcinoma advanced stage. METHODS: 32-year-old woman with Severe Protein Energy Malnutrition body mass index 12.44 kg/m(2) with a history of cervical carcinoma stage III and confirmed with covid 19. Oral food intake decreased due to nausea and stomach fullness. The patient showed loss of subcutaneous fat, wasting in all extremities and edema on the dorsum pedis. Laboratory results found Normochromic Normocytic Anemia 10.4, Leukocytosis 20.200, Severe Depletion of the Immune System (404), moderate hypoalbuminemia 2.5 and moderate hyponatremia 125.9. The patient had undergone chemotherapy in 2 cycles due to cervical carcinoma. RESULTS: Medical nutrition therapy was given with total energy expenditure of 1600 Kcal and increased gradually to 2100 kcal, Protein 1.5 g/Ideal Body Weight/day 19% using high protein formula, carbohydrates 50% and 31% of fat. To improve the immune system and antioxidants, supplementation was given in the form of Zivit Zinc(R), Hi-D(R) 5000 IU, curcuma extract, Vitamin C and Pujimin(R). After 8 days of treatment, the results of oral food intake reached the target of 1600 kcal (100%) accompanied by clinical and laboratory improvements. In addition, there was an increase in handgrip strength from 8.2 to 9.7 during 8 days of treatment indicating an improvement in the patient's physical function during nutritional treatment and a moderate post Covid-19 diagnosis. CONCLUSIONS: Cervical cancer patients who are infected with the Sars Cov2 virus will further worsen the patient's condition, both in terms of clinical, metabolic and immune system depletion so that they are vulnerable to death. Adequate nutrition will facilitate the healing process and avoid worsening malnutrition. FUNDING SOURCES: Institution from Department of Nutrition, Faculty of Medicine, Hasanuddin University