Introduction: Severe acute malnutrition, is characterized by wasting (marasmus), oedema (as a result of kwashiorkor), or both (marasmic kwashiorkor), and occurs mostly in children. Globally, co morbidities such as diarrhoea, acute respiratory tract infections and Malaria, which results from a relatively defective immune status, remain the major causes of death among children with severe acute malnutrition. This study was carried out to find out co-morbidities such as infections and micronutrient deficiencies in children with severe acute malnutrition. Methods: In this hospital based descriptive type of observational study, 125 severe acute malnourished children were included. Patients undergo relevant investigation to find out associated infectious co morbidities. Micronutrient deficiencies assessed by clinical signs. Results: 42% had diarrhea and 27% had acute respiratory tract infections as co morbid condition. Tuberculosis was diagnosed in 13% of cases. Anemia was present in 86% cases. Signs of vitamin B and vitamin A deficiency were seen in 24% and 6% cases. 97% children have inadequate vitamin D levels. Conclusions: Timely identification and treatment of various co-morbidities is likely to break undernutrition-disease cycle, and to decrease mortality and improve outcome. Nearly all SAM patients have inadequacy of Vitamin D. So Vitamin D supplement should be given to all SAM patients.

Acute liver failure (ALF) is a severe and acute liver injury which presents infrequently. Hepatitis A virus (HAV) occurs commonly in resource poor regions like India. It is one of the commonest cause of acute hepatitis in India, but rarely progressed to ALF. Hypoglycemia in association with liver disease has generally been considered as uncommon entity occurring primarily in circumstances of rapid massive hepatic necrosis. Previous retrospective studies had emphasized rarity of hypoglycemia in viral hepatitis. We present a case of 2 year boy who developed resistant and prolonged hypoglycemia secondary to Hepatitis A induced acute liver failure. Along with difcult to manage hypoglycemia his disease was also complicated with Hepatic encephalopathy and prolonged cholestatic Jaundice. He had a stormy hospital course but survived without Sequelae. We report this case with the aim to raise awareness about this rare but fatal metabolic complication of Hepatitis A infection as viral hepatitis has become a global health-care problem.

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Acute necrotizing encephalopathy (ANE) is a para-infectious, pauci-inflammatory disorder predominantly reported among children younger than 5 years of age. The diagnosis is based on the typical clinical presentation, imaging findings, and exclusion of other mimicking conditions.Although the pathophysiology of ANE is not completely understood, it is considered to be immune-mediated after a viral infection.  Neurological manifestations of dengue are increasingly being recognized. These include encephalopathy, encephalitis, myelitis, myositis, Guillain-Barre syndrome and mononeuropathies. ANE following dengue fever has been reported earlier but rarely. We present a case of a boy who developed this condition with classical clinico-radiologic findings of ANE secondary to severe dengue infection. He had a stormy hospital course but survived without sequelae. We report this case with the aim to raise awareness about this fatal neurological complication of dengue infection as dengue has become a global health-care problem.

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