guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM In-patient: Complications 76 � If there is no improvement and the child has gained weight, then assume that the child has toxic, septic or cardiogenic shock or liver failure. Stop rehydration treatment. Search for other causes of loss of consciousness. � As soon as the child regains consciousness or the pulse rate drops towards a normal level then stop the drip and treat the child orally or by NG-Tube with 10ml/kg/hour of ReSoMal. Continue with the protocol (above) for re-hydration of the child orally; continue to use weight change as the main indicator of progress. � There should never be a drip present in a malnourished child who is able to drink or is absorbing fluid adequately from an NG-tube. Monitoring of rehydration All rehydration (oral or intravenous) therapy should be stopped immediately if any of the following are observed: � The target weight for rehydration has been achieved (go to F75) � The visible veins become full (go to F75) � The development of oedema (over-hydration – go to F75) � The development of prominent neck veins* � The neck veins engorge when the abdomen (liver) is pressed*. � An increase in the liver size by more than one centimetre.* � The development of tenderness over the liver.* � An increase in the respiration rate by 5 breaths per minute or more* � The development of a “grunting” respiration (this is a noise on expiration NOT inspiration).* � The development of râles or crepitations in the lungs* � The development of a triple rhythm* * If these signs develop then the child has fluid overload, an over-expanded circulation and is going into heart failure.
ACF-In Guidelines for the integrated management of SAM In-patient: Complications 77 Conscious Unconscious Resomal 10ml/kg/hour first 2hrs Treatment of dehydration Then reassess using weight change and clinical change ONLY Rehydrate until the weight deficit (measured or estimated) is corrected and then STOP – DO not give extra fluid to “prevent recurrence” Darrow’s solution IV fluid Or 1/2 saline & 5% glucose Or Ringer lactate & 5% dextrose At 15ml/kg the first hour & reassess - If improving, 15ml/kg 2nd hour; - If conscious, NGT: ReSoMal - If not improving assume other cause – toxic/septic shock, cardiogenic shock, liver failure, cerebral malaria, drug intoxication, acidosis, etc.
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Cover photography: © ACF, Anne-Dom
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guidelines for the integrated management of severe acute malnutrition

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