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SAM management

Station 4
A 9 month old boy was admitted to the pediatric ward presenting with diarrhea and cough for > 2
weeks and inability to feed for 5 days now. On physical exam, he is lethargic, afebrile (35.6 C)
severely wasted, moderately dehydrated, pale and has oral thrush. He is not in respiratory
distress but has bilateral coarse crackles. His weight is 6.7kg, length 74cm and found the Z score
of weight for height is <-3. You want to initiate management for severe malnutrition. Please
write down the steps that you should follow.

Marking sheet

Instructor: __________________ Candidate NO:_________

# Checklist Achieved Not achieved


1 Treat/prevent hypoglycaemia
2 Treat/prevent hypothermia
3 Treat/prevent dehydration
4 Correct electrolyte imbalance
5 Treat/prevent infection
6 Treat micronutrient deficiencies
7 Start cautious feeding
8 Achieve catch-up growth
9 Provide sensory stimulation and
emotional support
10 Prepare for follow-up after recovery

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