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Mortalityinhospitalisoften30%
Objectives
Learntorecogniseseveremalnutrition LearntomanageALL theproblemspresentin thesechildren Understandnewapproachestofeedingand recognise i i itasthe h primary i treatment.
DefinitionsofSeverePEM(1)
WHOClassification:
+ Oedema <70% weight for height (WHZ <-3) Severe wasting g + oedema* No oedema
Severe wasting
DefinitionsofSeverePEM(2)
WHOClassification:
+ Oedema <70% weight for height (WHZ <-3) Severe wasting + oedema oedema* No oedema
Severe wasting
WeightforAge WAZ
WeightforAge WAZ(2)
Earlyoutpatient treatmentmay yhave preventedthisweight pattern Thisboynowhasa WAZmuch<3 Iftheboyisillandhas clinicalsignsofsevere malnutritionhemay needinpatient treatment
ClinicalDiagnosis Youmustlook!
Checktheseverityofoedema Feet knee, knee sacrum, sacrum face Feet, Oedema canmakeWAZlookOK
Severemalnutrition
Severemalnutrition
Electrolyte/MineralDeficiencies
Potassium:
Potassiumsupplementshelp reduce oedema
Whatotherproblemsdothesechildren commonlyhave?
10StepApproach
Hypoglycaemia Hypothermia Monitoring g Dehydration Electrolytes Infection Micronutrients Initiate feeding g Catch-up growth Sensory stimulation Discharge preparation
HypoglycaemiaandHypothermia
Allnewadmissionswithmalnutrition p warmuntiltherearesigns g of shouldbekept recovery. ivorngtglucoseforthosewhoare unconsciousorveryseverelyillwithno glucosemeasurement. measurement Immediatengtfeedingforconscious childrenwithbloodglucose<3mmol/l
Dehydration
Sh Shock kis i treated dwith i hspecial i lfl fluid idplans l and d HalfStrengthDarrowswith5%dextrose. OralrehydrationiswithRESOMAL. Feeding gmustbeintroducedduring gthefirst 12hoursoftreatingdehydration.
OralrehydrationinSevereMalnutrition
Resomal5ml/kgevery30minsfor2hours
Simplifiedto10mls/kgeveryhour.
Electrolytes&Minerals
Ifprepackaged k dF75/F100/RTUFareNOT available
Allshouldreceiveanextra4mmol/kg/dayoforal potassium (afterstoppingORS). AllshouldreceiveZincideallyaspartofmineral mixcontainingCu,Se,Mgetc
Infection
Upto1/3rd childrenwithmalnutritionwhodie havesepticaemia/bacteraemia Feverandothersignsofinfectionarenothelpful inidentifyinginfectioninthesechildren ALL sickchildrenwithseveremalnutritionin hospitalshouldbestartedonPenicillin(or Ampicillin)andGentamicin foratleast5days. days Inadditiontheyreceive:
Oralmetronidazole Treatmentforthrushifpresent TEOifthereareredeyes. y
VitaminAdeficiency
Vitamins
VitaminA:
WithEyesigns:200,000iuonadmission,onDay2 andonDay14(100 (100,000 000iuifaged<12months). months) WithoutEyesigns: statdoseappropriateforage
Questions?
Summary.
Theriskofdeathinchildrenwithsevere malnutritionisveryhigh. Thechildrenhavemanyproblemsandeach needstreating. The Th 10stepsapproach hallows ll each hproblem bl to betreated Feedingshouldnotbeahighproteindiet.