All are the criteria for the diagnosis of severe acute malnutrition(SAM) except:
Visible severe wasting is no longer a criteria to diagnose Severe acute Malnutrition (SAM) Severe acute malnutrition(SAM) in children of ages 6 to 59 months is defined by WHO as any of the following: Weight-for-length (or height) below -3SD of the WHO child growth standards Presence of bipedal edema Mid-Upper arm circumference <11.5cm The previous name Protein-Energy malnutrition is avoided, as it oversimplifies the complex multi-deficiency etiology. Clinical features: Treatment: The general treatment involves 10 steps in 2 phases Phases: Initial Stabilization Phase: Focuses on restoring homeostasis and treating medical conditions 2-7 days of inpatient treatment Rehabilitation Phase: Treat hypoglycemia (Blood Glucose level <54 mg/dl): If symptomatic give 10% Dextrose IV 5 ml/Kg. Feeding should be initiated with staer F-75 (Formula with 75 Kcal/100 ml of feed) Treat hypothermia (axillary <35oC or 95oF) : Skin-to-Skin contact with care ("Kangaroo technique") of dress in warmer clothes, cover head, wrap in a warmed blanket, and provide indirect heat. Treat dehydration: Hydrate with ReSoMal (45 mmol Na/L). It is a low-sodium rehydration solution for malnutrition. Correct electrolyte imbalance: There is a deficit of potassium and magnesium and excess sodium. Give extra potassium (3 to 4 mEq/Kg/day) and magnesium (4 mEq/Kg/day) for atleast 2 weeks. Treat infection: Staing on the first day, give broad-spectrum antibiotics to all children. Correct micronutrient deficiencies: Donot give iron in the stabilizing phase, because excess iron leads to free radical injury. Give iron 3mg/Kg/day once the child stas gaining weight after the stabilization phase. Give Vitamin A on day 1. Repeat on day 2 and day 14 Folic acid 1 mg (5 mg on day 1) Zinc (2 mg/Kg/day) Copper (0.3 mg/Kg/day) Sta caitious feeding: Give 8 to 12 small feeds of F75 to provide 130 mL/Kg/day, 100 Kcal/kg/day, and 1 to 1.5 g protein/Kg/day Rehabilitation: The indications of entry to this phase are reduced/minimal edema and the return of appetite Begining of feeding After 3 days, the transition to energy-dense feeding Stimulation of emotional and sensorial development Transfer to home-based diet Ref: Ghai Essential Pediatrics 9th edition Pgno: 97
Weight-for-length (or height) below -3SD
Mid Upper arm circunference <11.5cm
Bilateral edema
Visible severe wasting
Nutrition