Severe Acute Malnutrition(SAM)

severe Acute Malnutrition (SAM):

10 Steps Management :

1⃣Treat/Prevent Hypoglycemia :

If child Conscious :

1. 10%DA(Dextropac-10)

• 50 ml through Orally or NG Tube stat.
  

2.Diet: F-75 started every 30 min for 1st 2 hours (4 times) (Giving 1/4 of total recommended volume 1st 2 hours)

Then 2 hourly 

If child Unconscious :

10% DA (Dextropac-10)

• I/V.... 5 ml/kg 
  

Then 

10%DA(Dextropac-10)

• 50 ml through Orally or NG Tube stat.
  

Then

Diet: F-75 started every 30 min for 1st 2 hours (4 times) (Giving 1/4 of total recommended volume 1st 2 hours)

 if Convulsion :

inj.Sedil (Diazepam)(10mg/2ml)

• (Wt* 0.1 ml) + 2 ml N/S.... P/R through NG tube

2⃣Treat/ Prevent Hypothermia :

If axillary temperature 

• Keep the Child warm 
  
• Rewarm the clothes and covering the child with covering head. 
  
•  kangaroo mother care(KMC)
  

3⃣ Treat/Prevent Dehydration:

if child is dehydrated due too Diarrhoea or Vomiting then give

ReSoMal (850 ml water+ 1 pack Neo-ORS + 4 tsf sugar+ 3.5 tsf Syrp.KT)

• 5-10 ml/kg Orally /NG tube
  

ReSoMal given every 30 min 1st 2 hours. Then Alternative hours of F-75 diet until child is rehydrated. 

🔕Do Not use any Othet Fluid. 

4⃣Correct Electrolyte Imbalance :

Until Stabilization give extra 

1. K+ 4 mmol/kg/day..... 7 days 

2. Magnesium sulphate... 0.1 ml/kg/day....7 days 

Prepare food with salt 

🔕Do not treat edema with diuretics

5⃣Treat/prevent Infections:

inj.Ceftriaxone (Ceftron)(250/500mg)

• wt/2 ml I/V stat & BD(100mg/kg/day)

Inj.Gentin(20mg/2 ml)

• wt/4... I/V stat & BD (check urine output)(3-6mg/kg/day)

6⃣ Correct Micronutrient Deficiencies :

1.Cap.Retinol Forte (vitamins-A)

• 0-6 month: 50000IU stat orally 
• 6-12 month : 100000 IU stat
• > 12 month : 200000 IU stat 

2. Tynisol P/D (multivitamin) 

• 6-10 drops daily 

3. Tab.Folison(5mg)

• 1tab stat then 1 mg/kg/day...OD

4. Syrp.Pep/Nid/Zinc (10mg/5ml)

• 2mg/kg/day...BD

After 7 days 

Compiron(40mg/ml) p/d(iron)

• 3mg/kg/day

7⃣Start Feeding Cautiously:

• Small amount & Frequently (2-3 hrly)
  
• F-75 
  
• Total fluid shoulf be < 130 ml

8⃣Achieve Catch-Up growth. 

weight gain monitoring 

• Poor: < 5 gm/kg/day 
  
• Moderate: 5-10 gm/kg/day 
• Good:>10 gm/kg/day

9⃣provide sensory stimulation & emotional support. 

• Give tender loving care eg.smiling, laughing, patting, touching etc.
  
•  Establish cheerful, stimulating environment. 
  
• Organize structured play therapy

🔟 Prepare for discharge & Follow up after recovery.