Malnutrition

Question 1

A child with Severe Acute Malnutrition (SAM) comes in to the ER with signs of shock. What is the appropriate fluid regimen to give?

Answer 1

• 15 ml/kg over 1 hour

Either:
a. half-strength Darrow’s solution with 5% dextrose, or
b. Ringer’s lactate solution with 5% dextrose.
c. 1/2 Normal saline + 5% dextrose

Question 2

What is the definition of severe acute malnutrition?

Answer 2

One or more of
1. A low mid-upper arm circumference <115 mm
2. Weight for height < 3 SD from the mean
3. Presence of bilateral pitting edema

Question 3

What are the immediate treatment measures of a child with severe acute malnutrition?

Answer 3

Treat possible infection:
* Oral amoxicillin

Slow feeding reintroduction
* Slow feeds with F-75 for initial phase of feeding

Slow correction of fluids and electrolytes
* Slow correction of electrolytes through oral fluids (unless in shock)
* ORS if some dehydration
* 1/2 strength ORS (added glucose and K+) or ReSoMal if moderate-severe dehydration and no suspition of cholera

Manage hypothermia
* Covering/kangaroo care

Specific micronutrients (not before above steps and only if required)
* Vitamin A (5000 IU daily) if they are not receiving via other supplement foods (e.g. F75, F100) if measles or corneal ulceration
* Thiamine if concerns of beriberi

Question 4

How are F-75 and F-100 used in the treatment of severe acute malnutrition?

Answer 4

• F-75 and F-100 are formula diets used for the management of children with severe acute malnutrition in inpatient care.
• F-75 (75 kcal/100 mL) is used during the initial phase of treatment
• F-100 (100 kcal/100 mL) is used during the rehabilitation phase.

Question 5

What’s the composition of ORS?

Answer 5

New ORS
* Sodium - 75 mmol/litre
* Chloride - 65 mmol/litre
* Glucose - 75 mmol/litre
* Potassium - 20 mmol/litre
* Citrate - 10 mmol/litre
* Total Osmolarity - 245 mmol/litre

Question 6

What’s the composition of ReSoMal?

Answer 6

ReSoMal Composition:
* Glucose - 125 mmol/L
* Sodium - 45 mmol/L
* Potassium - 40 mmol/L
* Chloride - 70 mmol/L
* Citrate - 7 mmol/L
* Magnesium - 3 mmol/L
* Zinc - 0.3 mmol/L
* Copper - 0.045 mmol/L
* Total Osmolarity - 300 mmol/L

Question 7

What is included in the rehabilitation phases of severe acute malnutrition treatment?

Answer 7

• F-100 formula in addition to normal diet (and breast milk if appropriate)
• Sensory stimulation and emotional support
• Planning for discharge/follow-up

Question 8

What is noma and how is it treated?

Answer 8

• Opportunistic infection affecting those with immune deficiencies e.g. malnutrition, following measles infection
• Preceded by a sore
• Rapid destruction of tissue around the mouth
• Disease of extreme poverty

Treatment
* Antibiotics - metronidazole and penicillin
* Surgery
* Treating malnutrition and nutrient deficiencies

Question 9

What is Konzo and how is it treated?

Answer 9

Konzo
* Tropical spastic paresis
* symmetrical spastic paraparesis without sensory or genitourinary involvement
* abrupt onset in less than 1 week with a non-progressive course
* occurring in a cassava-growing area, usually with other
cases emerging at the same time
* Associated with diet of cassava
* Due to chronic high dietary exposure of cyanogenic glycosides from insufficiently processed cassava tubers

Treatment
* Paraperesis is permanent so treatment is therefore supportive to reduce injuries/disease
* Walking aids

Question 10

What is neurolathyrism and how is it treated?

Answer 10

Neurolathyrism
* Toxic myelopathy caused by excessive ingestion of the Lathyrus sativus grass pea
* Clinical presentation is an irreversible acute to subacute spastic paraparesis or quadriparesis
* No sensory involvement
* Bladder and bowel function are maintained

Treatment
* Supportive
* Muscle relaxants
* Walking aids