Management of Severe Malnutrition / MedUrgent

-

   Management of Severe Malnutrition







Admission criteria:


1) Children 6-59 months:

- Bilateral pitting oedema +++

- Severe wasting with any grade of oedema

- Severe malnutrition with any of the following medical complications:

 

• Anorexia / No appetite

• Intractable vomiting 

• Convulsions

• Lethargy/ Not alert

• Unconsciousness

• Hypoglycemia

• High fever

• Hypothermia

• Severe dehydration

• Lower respiratory tract infection 

• Severe anemia 

• Skin lesions 


2) Infants <6 months: 

- Bilateral pitting oedema

- Visible wasting

- Inadequate feeding

- Weight <4 kg 


*Initial Phase: 

1- Document: 

- The presence of Wasting, Oedema and Dermatosis 

- Weight-for-Height/Weight -for-Length - Z-sore (SD/%)

2- Temperature: (check every 30 min) 

- Axillary temp. <35 C, start active worming (Kangaroo position)

3- Hypoglycemia: 

- Blood glucose <3 mmol/l -Alert patient: Give 50 ml as a bolus of 10% dextrose oral 

- Unconscious or convulsing patient: Give 5ml/kg of 10% dextrose i.v., then add 50ml oral

4- Anaemia: (Hb <4gm/L) 

- Give whole fresh blood : 10ml/kg (5-7ml/kg if packed cells) over 3 hours

5- Vitamin A Deficiency:

- Eye signs present: Give vitamin A according to age (<6months:50000 I.U., 6months to one year: 100000 I.U., more than one year:200000 1.U.) on day 1,7,14. 

- Eye signs not present: Give ONE prophylactic dose of vitamin A according to age

- Eye infection: Give chloramphenicol or Tetracycline drops

6- Dermatosis:

- Start bathing with Potassium Permanganate 1% solution (or Gentian Violet solution)

7- Diarrhoea/Vomiting:

- Start with ResoMal: 5ml/kg every 30 minutes for 2 hours

- Then, add F75, according to the body weight after rehydration, alternating with ResoMal every 2 hours for 10 hours -Monitor vital signs 

- Stop ResoMal if there is evidence of fluid overload (puffy eyes, increase in pulse and respiratory rate, engorged jugulars and increase in the oedema)

8- Shock:

-Documents evidences of shock (lethargy, loss of consciousness, cold extremities, weak/fast pulse and slow capillary refill time >3 seconds)

-Start with glucose 10% as for treatment of hypoglycemia 

- Then add Normal Saline/Ringer lactate 15 ml/kg during a period of ONE hour

- Repeat the same amount for another

ONE hour if there is no improvement

- No improvement: transfuse whole fresh blood (as above)

- Improved: Start F75alternating with ResoMal for 10 hours

9- No Diarrhea/Vomiting/Recovered from Dehydration:

- Start F75 as soon as possible every 2 hours according to body weight

- Try to prolong the period between feeds to 3 hours according to the patient's response

 
*Transition phase:

- After 3-5 days from recovery, start F100 according to body weight after recovery

- Try to prolong the period between feeds to 4 hours according to the patient's response

- Add iron after 2-3 days

- Continue this phase for 5-7 days

 

*Consolidation/ Rehabilitation phase:

- Continue on F100 every 4 hours according to change in body weight 

- Add folic acid: 5mg in day one, then 1 mg/day

- Add drugs for worms

* Always: Document dose and frequency of antibiotics given 

*Document vital signs and change in weight daily

 



* Discharge Criteria:

(After control of the medical complications and return of appetite)

- Reaching WFH above -2SD

- Weight gain of 15-20%/kg/day

- MUAC >115 mm 

- Two weeks after disappearance of oedema 

  *Check the vaccination status of the patient and cover the missing dose 

  * Give a Referral Card to the Nutrition Rehabilitation Center for follow up                                                                                       


 

Comments

Post a Comment

Popular posts from this blog

VIRAL HAEMORRHAGIC FEVERS / MedUrgent

-
Image
VIRAL HAEMORRHAGIC FEVERS Viral Hemorrhagic Fever defines a syndrome caused by 4 different families of RNA viruses. Though they have constant features in common, yet there are particular clinical features associated with different viruses. They can cause disastrous epidemics with case fatality rate up to 50%. Classification 1. Arenaviruses e.g. Guanarito, Junin, Machupo and Lassa. They have rodent reservoir. Humans are infected by aerosols of rodent excreta or other close contacts with rodents. 2. Bunyaviruses e.g. Rift Valley, Criean-Congo and Hantaan. Transmission through mosquito bites, aerosols or contact with blood of domestic animals, tick bite and rodent excreta. 3. Filovirus e.g. Ebola and Marburg. Mode of transmission is by person to person through body fluids 4. Flaviviruses e.g. yellow fever, Dengue and Kyanasur forest disease. Mode of transmission is through mosquito and tick bites.  Clinical features After contracting the disease, the incubation period ...
Read more

TETANUS / MedUrgent

-
Image
  TETANUS Tetanus is an acute toxemic illness caused by a  soluble exotoxin of the obligate anaerobic bacterium Clostridium Tetani. The toxin is produced by the vegetative forms of the organism at the site of injury and it enters the bloodstream and subsequently is fixed within the central nervous system.  It is a spore forming gram positive bacillus which converts into vegetative forms in the wounds and produce the exotoxin tetanospasmin that binds to gangliosides at the myoneural junction of skeletal muscles and on neural membranes in the spinal cord blocking the inhibitory pulses to motor neurons that leads to spastic paralytic illness.  It affects all age groups including adults as occupational hazards e.g. farmers. The incubation period varies from 2-14 days to months after the injury.  In Sudan, it has 2 peaks, the neonatal period or at the age of around 7 years in female children following circumcision. Eradication of neonatal tetanus is declared by WHO a...
Read more