Severe Acute Malnutrition

Question 1

In what age group do you measure MUAC?

Answer 1

6-59m

Question 2

How do you measure MUAC?

Answer 2

In midpoint of relaxed left upper arm

Question 3

Usual admission criteria for SAM?

Answer 3

a) MUAC < 115 mm ( this criteria is not used in children> 59m or taller than 110 cms)
b) W/H index < -3Z ( with reference to new WHO child growth standards)
c) bilateral pedal edema

Question 4

Usual discharge criteria for SAM

Answer 4

a) W/H index >-2Z
b) Absence of b/l pedal edema ( 2 consecutive assessments 1 week apart)
c) No clinical problems

Question 5

What are therapeutic milks? When and how are they used?

Answer 5

Therapeutic milks are used in the treatment of SAM- exclusively in hospitalised patients
a}F-75 ( 75kcal/100ml, 0.9g protein)- initial phase, given in 8 daily meals
purpose- to cover basic needs while complications are being treated
b) F-100 (100kcal/100ml, 2.9g protein)- given after a few days when patient has stabilised.
purpose - to facilitate rapid weight gain

Question 6

What are RUTFs

Answer 6

Ready to Use Therapeutic Foods
- can be given in ambulatory patients
purpose- rapid weight gain (approximately 500kcal/100g)

Question 7

A child is suffering from SAM.What broad spectrum antibiotic will you put her on

Answer 7

Amoxicillin- 70-100mg/kg/day in two divided doses for 5 days

Question 8

What is ReSoMal

Answer 8

ORS for Severely Malnourished Children ONLY ( REhydration SOlution for MALnourished children)
-Contains less sodium and more potassium than standard solutions

Question 9

Principles of management with ReSoMal

Answer 9

• Should be given in an inpatient setting under clinical supervision when there is no hypovolaemic shock
  -First determine target weight- wt of child before dehydration ( 2- 5% of current weight) (Note :NOT more than 5%)
  -Give 20ml/kg/hr- first 2 hours
  Then 10ml/kg/hr- until target weight achieved ( measure weight every hour)

Question 10

Treatment of hypovolemic shock in malnourished child

Answer 10

IV line- 0.9% Saline 10ml/kg over 30min
under close medical supervision
-Start Broad spectrum antibiotic (IV Ceftriaxone 100mg/kg/day + IV Cloxacillin 200mg/kg/day)
- Oxygen ( min 2L/min)16-Glucose- ( 5ml/kg of 10% glucose by IV injection
-Evaluate clinical response every 5min
-If patient has improved ,switch to oral ReSoMal ( 5ml/kg every 30 min for 2hrs). If patient has not improved repeat IV 0.9% Saline 10ml/kg over 30 min and then switch over

Question 11

What is hypothermia

Answer 11

Axillary temprature < 95 F. Suspect severe infection

Question 12

How will you treat hypoglycemia in an unconscious child?

Answer 12

5ml/kg 10% glucose IV, repeated once if neccesary

Question 13

Admission criteria for SAM in adolescents

Answer 13

a) Adolescents- W/H according to NCHS-CDC-WHO growth standards 1982 or b/l pedal edema grade 3+ after excluding other causes of edema

Question 14

Admission criteria for SAM in adults

Answer 14

a) MUAC <160 mm or b/ pedal edema

b) MUAC <185 mm in poor general condition

Question 15

Discharge criteria for SAM in adolescents and children

Answer 15

a) Adolescents- same as in children

b) Adults- 10-15% weight gain or b/l pedal edema below grade 2 and good general condition