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INTRODUCTION
EPIDEMIOLOGY
AETIOLOGY
CLINICAL PRESENTATION
PATHOLOGICAL FEATURES
INVESTIGATIONS
MANAGEMENT
COMPLICATIONS
FOLLOW-UP
Severe acute malnutrition is defined as the presence of
severe wasting and bilateral edema or weight for height
below -3Z score or mid-upper arm circumference
<115mm) in a child up to the age of 5 years
Disease conditions
◦ Measles
◦ Whooping cought
◦ HIV/AIDS
◦ Repeated diarrhea
◦ Intestinal parasitosis
Frequent upper respiratory tract infection
Malaria
Give Resomal 5mls/kg every 30mins for the 1st 2 hours then 5-
10mls/kg/hr over the next 4-10 hours.
Continue breastfeeding
Continue breastfeeding
TREATMENT
For inpatients hypernatremic child i.e. conscious child
◦ Breastfeed child
◦ Give 10mls/kg/hr of 10% Dextrose water in
sips over several hours until thirst of the child is
satisfied for developed Hypernatremic
dehydration
◦ The aim is to reduce serum Na+ at about
12mmol/24hrs OR correct over 48hrs
◦ Treat slowly, measure serum Na+
SHOCK
SIGNS AND SYMPTOMS
1. Semiconsciouness
2. Weak and fast pulse ≥160beat/min for children 2-
12months, ≥140beats/min for children 1-5years
3. Absent radial and femoral pulse
4. Cold clammy hands and feet
5. Poor capillary refill in the nailbed(>3sec.)
TREATMENT
Give Oxygen
Give 10% DW 5mls/kg
Give 15mls/kg IV over the 1st hour and reassess using
either 1/2strength Ringer’s lactate with 5% dextrose
OR ½ strength N/S with 5% dextrose.
If there are signs of improvement (↓PR & ↓RR)
Repeat the 15mls/kg IV over another 1hour
Then stop the drip & switch over to oral or NG-tube
rehydration with Resomal at 10mls/kg.
If no improvement i.e. PR and RR still ↑ and child has
gained weight,
Consider Toxic, septic or cardiogenic shock.
Stop rehydration.
TREATMENT
Transfuse if PCV <12%
Transfuse if PCV 12-18% + signs of Respiratory
distress
Give whole blood 10mls/kg slowly over 3hours under
iv lasix.
HYPOGLYCEMIA(RBS<3mmol/L)
All SAM Patients are at risk of hypoglycemia and
immediately on admission should be given 10% glucose
3-4 hourly feeding.
SYMPTOMS OF HYPOGLYCEMIA
Usually no signs at all
They do not sweat or have raised hair on their arms or
so pale
They become less responsive, slip into coma and often
present with hypothermia
Eyelid retraction(usually noticed at sleep)
TREATMENT
If conscious and able to drink, give 50mls of sugar
water(5-10mls/kg) or F-75 by mouth
If imminent unconsciousness, 50mls of sugar water by
NG-tube, if fully conscious F-75 frequently.
If unconscious, give IV 10% Dextrose water 5mls/kg
or pass NG-tube and give sugar water.
MONITORING
If the initial blood glucose was low, repeat
measurement after 30mins.
If blood glucose <3mmol/L repeat 10% glucose or
oral sugar solution.
HYPOTHERMIA
SAM children are highly susceptible to hypothermia and
indicates coexisting hypoglycemia or serious infection.
DIAGNOSIS
◦ Axillary temp. - <35oC
◦ Rectal temp. < 35.5oC
TREATMENT
◦ Keep child warm using kangaroo technique
◦ Cover child with warm clothing and caps
◦ Give hot drinks to mother so her skin gets warm
◦ Keep child away from drought, windows and doors
closed at night.
◦ Feed child immediately and then 3-4hourly unless they
have abdominal distension, if dehydrated rehydrate also
◦ Monitor body temp. every 30min.
◦ Change wet nappies, clothing and beddings
INFECTIONS
Signs of infection such as fever is usually absent and
infections are usually hidden.
Give broad spectrum antibiotics
If child does not have complication and is on inpatient
management
◦ Give oral Amoxil 15mg/kg/12hrly × 5/7
If child is ill(lethargic) OR has complications, give IV
antibiotics.
First line IV Amoxil 50mg/kg/day every 12hrly for 1/52
IV cefotaxime 50mg/kg 12hrly × 5/7 + IV genticin +
IV Flagyl 10mg/kg 12hrly ×1/52.
2nd Line : IV Ciprofloxacin 10mg/kg/dose every
12hrs for 72hrs, then continue for 1/52 OR IV
ceftriaxone 50-100mg/kg/day daily × 5/7
Vit. A, Zn, Folic acid, Cu, are present in F-75, F-100
and RUFT, So should not be given in solution.
Give Fe from the 2nd week.
If there are signs of Vit. A def. or child has measles,
then give Vit. A on day 1.
◦ <6months – 50,000IU
◦ 6-12months -100,000IU
◦ >12months – 200, 000I
If child is not on F-75, F-100 or RUTF, give
multivitamins syrups dly for 2/52
REHABILITATION PHASE
Provide sensory stimulation/emotional support
1. Provide tender loving care
2. Provide a cheerful, stimulating environment
3. Structured play therapy for 15-30minutes/day
4. Teach mother how to make simple toys and
emphasize the importance of regular play sessions at
home.
Transferred patients to the out-patient clinic
continue to receive nutritional care with and
medical care on weekly basis.
During visits, health and nutrition education
sessions will be given to caregivers until the child is
discharged from out-patient care.
SAM is a major global health problem, contributing to
childhood morbidity, impaired intellectual development,
poor school achievement, sub-optimal adult work capacity
and increased risk of non-communicable disease.
Prompt Diagnosis and treatment will reduce the burden
in our society
THANKS FOR
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