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Patients with bilateral generalized edema ( ) Acute phase should remain until the reduction of


IDENTIFY non-responses to treatment

It is usually only patients with treatment failure criteria that must have a thorough clinical
examination and laboratory. Time and trained personnel resources should be used in good èchent:
for training, supervision, diagnosis and treatment of patients not responding to standard treatment.

The absence or failure to standard treatment is a diagnosis in itself. Criteria for treatment failure.

For the CNAS, the main reasons are social and psychological in general; this may also be the case for
patients NITC but less commonly.

Table 32: Diagnosis of "the" treatment failure "for patients CNTI


No improvement or return of appetite Day 4
Total absence of loss of edema Day 4
Oedema still present Day 10 :
Does not fulfill the criteria for transfers CNTI (or Day 10 :
Phase Rehabilitation CNTI)
AFTER clinical deterioration admission Anytime

transition phase

This phase prepares the patient in the rehabilitation phase CNTI or its transfer to the outpatient
CNAS. The transition phase lasts from 1 to 5-days but it may be longer, in particular when another
condition is associated as TB and HIV / AIDS.

Nutrition therapy

The only difference with Acute phase is the change in dietary regimen: one passes using the F75 or
F100 has ATPE- if RUTF N4EST NOT ACCEPTED BY THE PATIENT. It is best to use RUTF during the
transition phase. Sick patients will continue treatment as an outpatient should get used to the RUTF
before returning to their home.

use RUTF

Gives the total volume of RUTF for the day according to Table 33;

Table 33: Amount of RUTF for the day according to the table

Weight class Pate grams Pate bags Bars bars Total kcal

Using the F100

If RUTF is not available, or if the patients do not take the RUTF (young children and about 10% of
older children often prefer a liquid therapeutic product):

 Use the F100 (130ml = 130 Kcal). When the F100 is used, the volume of meals remain the
same in Transition phase and Acute phase.
 Ask the mother to breastfeed, 30 minutes before meals;
 Prepare food from small bags F100 (114g), add 500ml of drinking boiled water, warmed, or
from large bags F100 (456g) add 2 liters of water.
 Leave 6 (or 5) meals a day.
 Note the CNTI scorecard gives volume and taken.

Warning. The F100 should not be keep in its liquid form at room temperature for more than three
hours before consumption;

Table 34: Amount of F100 has give in transition

Weight class 6 meals a day 5 meals a day


With RUTF or F100 milk, increases the energy intake of 100 kcal / kg / day to 130 Kcal / kg / day

This is sufficient to enable the patient to gain weight.

Patient monitoring is identical to that of phase 1.

Criteria for returning the transition to Phase 1

We must always iron the patient Acute phase if present:

 A rapid increase in liver volume and sensitivity,

 The development of overload signs (increased respiratory rates)
 A weight gain of more than 10 g / kg / day (excess fluid retention)
 The development of abdominal distention (this indicates abnormal peristalsis, bacterial
overgrowth of the small intestine, and can be an excess intake of complex carbohydrates)
 The appearance of a refeeding diarrhea with weight loss
 The development of a complication requiring IV infusion (malaria, dehydration, etc.). A
deteriorating patient condition.
 An increase in edema (evaluate whether there was an unexpected sodium intake, particularly
if there has been shared with the meal of the parent / carer or medicinal substances if
sodium external sources is found, it is necessary to eliminate as quickly as possible and
patients with a good appetite should remain in trans phase.)
 Sile patient without OEDEMA suddenly develops into (investigate all possible sources of
sodium intake)

If the patient has an increased number of bowel movement when changing diet, this should be
ignored if it does not lose weight. Several watery stools without weight loss is not a passing criterion
of transition to the Acute Phase

Transfer criteria of the Transition phase at CNAS

For a patient moves from the transition phase CNAs requires:

 A good appetite (at least 90% of the ration)
 What edema have melted completely for kwashiorkor patients;
 No other medical problems;
 If the transition phase begins with the F100, he passes the test of appetite for RUTF.

3. Rehabilitation phase (phase 2) internally

In exceptional cases (lack of CNAS in the area, or the presence of serious social problems) that
require patient survi in the CNT in phase 2, the same criteria as the transfer to the CNAS are used for
passage the transition phase the phases 2 internally