guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Contents 7
Medicines given under specific circumstances only.................................................................. 68
1. Vitamin A ___________________________________________________________________________ 68
2. Folic acid ___________________________________________________________________________ 69
3. Antihelminthics ______________________________________________________________________ 69
4. Other nutrients_______________________________________________________________________ 69
Surveillance ........................................................................................................................................ 69
Criteria to progress from Acute-Phase to Transition Phase ..................................................... 70
Treatment of Complications ............................................................................................................ 71
1. DEHYDRATION ................................................................................................................................ 71
• Diagnosis of dehydration ______________________________________________________________ 71
• Diagnosis of dehydration in the marasmic patient __________________________________________ 71
• Diagnosis of shock with dehydration in the marasmic patient _________________________________ 72
• Treatment of dehydration in the marasmic patient __________________________________________ 73
• Treatment of shock from dehydration in the marasmic patient ________________________________ 75
• Monitoring of rehydration ______________________________________________________________ 76
• Diarrhoea in the oedematous (kwashiorkor) patient_________________________________________ 78
• Persistent or chronic diarrhoea _________________________________________________________ 78
• Re-feeding diarrhoea after admission ____________________________________________________ 78
2. HYPERNATRAEMIC DEHYDRATION ........................................................................................... 79
• Diagnosis ___________________________________________________________________________ 80
• Treatment __________________________________________________________________________ 80
3. SEPTIC (OR TOXIC) SHOCK .......................................................................................................... 82
• Diagnosis of septic shock ______________________________________________________________ 82
• Treatment of septic shock _____________________________________________________________ 82
4. ABSENT BOWEL SOUNDS, GASTRIC DILATATION AND INTESTINAL SPLASH WITH
ABDOMINAL DISTENSION. ................................................................................................................... 84
5. HEART FAILURE.............................................................................................................................. 85
• Signs and symptoms__________________________________________________________________ 85
• Treatment __________________________________________________________________________ 87
6. HYPOTHERMIA ................................................................................................................................ 88
7. FEVER ................................................................................................................................................ 89
8. SEVERE ANAEMIA .......................................................................................................................... 90
9. HYPOGLYCAEMIA........................................................................................................................... 91
• Clinical signs ________________________________________________________________________ 91
• Treatment __________________________________________________________________________ 91
10. Other conditions .............................................................................................................................. 92
11. DRUGS............................................................................................................................................... 92
12. Re-feeding syndrome ..................................................................................................................... 93
Severe Acute Malnutrition and HIV/AIDS ...................................................................................... 95
FAILURE TO RESPOND to treatment (in-patients) ...................................................................... 98
• Action required when failure to respond is commonly seen in a programme ____________________ 100
• Chronic diseases____________________________________________________________________ 100
TRANSITION PHASE ........................................................................................................................101
1. DIET ...................................................................................................................................................101
2. ROUTINE MEDICINE ......................................................................................................................104
3. SURVEILLANCE ..............................................................................................................................104
4. CRITERIA TO MOVE BACK FROM TRANSITION PHASE TO THE ACUTE PHASE ............104
5. CRITERIA TO PROGRESS FROM TRANSITION PHASE TO OTP ..........................................104