MSF Nutrition Guidelines

Question 1

What are the admission parameters for SAM based on MUAC?

Answer 1

< 115mm if only admitting pure SAM

<125mm if also including MAM + complications

Question 2

Oedema +++

Answer 2

Automatic stand alone admission criteria

Question 3

Oedema 2+ or less

Answer 3

Admission criteria if combined with other anthropomorphic measurements.

WHZ <3

WHZ <2 and/or MUAC <125mm

Question 4

Fits one of the anthropomorphic standards for SAM plus…

Answer 4

Medical complication

and/or

Anorexia/failed appetite test

Question 5

Discharge from ITFC is a clinical criteria rather than…

Answer 5

An anthropometric criteria

Question 6

Define discharge criteria for ITFC (6 items)

Answer 6

Clinically well

Consumes RUFT readily - good appetite

Reduction in oedema <3+

Medical complications resolved. Not requiring ongoing treatment.

Vaccines up to date (or plan to get them soon)

Caretaker ready

Question 7

Discharge question 1…

Answer 7

Are they well?

Question 8

Discharge question 2…

Answer 8

Are they eating?

Question 9

Discharge question 3…

Answer 9

Have all IV/IM treatments stopped?

Question 10

Discharge question 4…

Answer 10

Are vaccines up to date?

Question 11

Discharge question 5…

Answer 11

Are the family ready/Is there a follow up plan?

Question 12

What are the medical complications of SAM that trigger admission… Describe a journey

Answer 12

I was shocked (Shock)

That he looked so pale (Anaemia <4g/dl or <6g/dl with symptoms)

Then he started to convulse (Seizures)

We checked the RBS which was low (Hypoglycaemia)

I noticed he was also breathing fast (any Pneumonia)

And was covered in mosquito bites (Malaria)

In fact I think he had several severe infections…

Resulting in severe dysentery and dehydration

He remained lethargic after the seizure

And then began intractable vomiting

Other conditions for further investigation… HIV/TB/PUO

Severe skin lésions

Vitamin A deficiency

Congenital malformations

Social problems

Question 13

SAM +failed appetite test

Answer 13

Admit

Question 14

1+ oedema

Answer 14

Feet only

Question 15

2+ oedema

Answer 15

Feet and lower legs

Question 16

3+ oedema

Answer 16

Feet, legs and anywhere else including the face

Question 17

Indications for Ceftriaxone in SAM patients…

Answer 17

Hypothermia (Cold)
Hypoglycaemia (Low sugar)
Looks sick or lethargic

Question 18

Minimum duration of Ceftriaxone…

Answer 18

48 hours

Question 19

Aim of phase 1

Answer 19

Restore metabolic function

Treat or prevent medical complications

Question 20

Starting volume F75 =

Answer 20

135ml/kg/day - usually 3 hourly

Question 21

Duration of phase 1…

Answer 21

Up to 7 days

Question 22

When can you move from phase 1 to transition…?

Answer 22

Medical complications stabilised

No danger signs

Stable vitals

No feed intolerance

Patient has appetite

Oedema has reduced <3+

Question 23

Transition phase… How many feeds per day?

Answer 23

6-8 times per day

Question 24

1 sachet of RUFT = how many Kcal?

Answer 24

500

Question 25

Not tolerating RUFT…

Answer 25

Try F100 instead..

Question 26

Duration of transition phase

Answer 26

1-3 days…

Question 27

We are not using weight gain as a discharge criteria… This is the aim of phase 2 (AFTC) - T/F?

Answer 27

True