RESOMAL

RESOMAL : Rehydration Solution For Malnutrition
In APPROACH TO STRENGTHEN GROWTH

AND DEVELOPMENT OF MALNURISHED CHILD .
Dr Aditya sinha
Chc magarlod
District dhamtar
MALNUTRITION
WHO defines Malnutrition as
"the cellular imbalance between the supply of nutrients

and energy and the body's demand for them to ensure
growth, maintenance, and specific functions.
PROTEIN ENERGY MALNUTRITION

Defination :- PEM is also referred to as protein-calorie
malnutrition
The term protein-energy malnutrition
(PEM) applies to a group of related disorders that
include
1 marasmus,
2 kwashiorkor, and
3 intermediate states of marasmus-kwashiorkor.
AETIOLOGY:
Different combinations of many aetiological factors can

lead to PEM in children. They are:
Social and Economic Factors
Biological factors
Environmental factors
Role of Free Radicals & Aflatoxin
Age of the Host
Amongst the Social, Economic, Biological and

Environmental Factors the common causes are:
Lack of breast feeding and giving diluted

formula
Improper complementary feeding
Over crowding in family
Ignorance
Illiteracy
Lack of health education
Poverty
Infection
Familial disharmony
AETIOLOGY of PEM
Leading cause of death (less than 5 years of age)
Primary PEM: Protein + energyintakes below

requirement for normal growth.
Secondary PEM:
the need for growth is greater than can be
supplied.
decreased nutrient absorption
increase nutrient losses
Linear growth ceases

Static weight
Weight loss
Wasting
Malnutrition and its signs
DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS
AND KWASHIORKOR
CLINICAL MARASMUS KWASHIORKOR

FEATURES
MUSCLE Obvious Hidden by edema
WASTING and fat
- FAT Severe loss of Fat often
WASTING subcutaneous fat retained but not
firm
- EDEMA None Present in lower

legs, and usually
in face and lower
arms
- WEIGHT FOR Very low May be masked

HEIGHT by edema
- MENTAL Sometimes quite Irritable,

CHANGES and apathetic moaning,
apathetic
ADMISSION CRITERIA
All patients that fulfil any of the criteria in the following table have severe
acute malnutrition (SAM).
They should be offered therapeutic feeding in one of the available settings.
AGE ADMISSION CRITERIA
6 months to 18 years ----------- W/H or W/L < 70%

or
MUAC < 110 mm with a Length > 65 cm

or
Presence of bilateral pitting oedema
Adults
---------------
MUAC < 170 mm

or
MUAC < 180 mm with recent weight

loss or underlying chronic illness
or
BMI< 16 with
or
Presence of bilateral pitting oedema

(unless there is another clear cut
cause)
TREATMENT
Treatment strategy can be divided into three stages.
Resolving life threatening conditions
Restoring nutritional status
Ensuring nutritional rehabilitation.
Rule 1 --- Fluids .

Rule 2 --- Zn , Vit A , Magnesium , Cu ,potassium
supplementation .
Rule 3 --- BREAST feeding.
Rule 4 --- Role of F75 and F100 Ready To Use
Therapnuetic Food (RUTF WHO Guideline 2016) .
WHO Guidelines
AGE QUANTITY IN M/L
<6 mon
50 ml(1 cup)
7 mon 2 yrs 50-100 ml
2 yrs- 5 yrs 100-200ml
Older child As much as they take
Role of Zn supplementation
Improves immune function
Improves intestinal permeability
Regulation of intestinal water & electrolyte
transport & brush border enzymatic function
Intestinal tissue repair
Role Of ReSoMal In severe Acute Malnourished Child
ReSoMal
Basis of solution
SAM children are deficient in potassium

and have very high level of sodium, normal ores
solution is dangerous for them.
They need solution which contain less sodium and
more potassium.
These pt. are also deficient in in other minerals like
magnesium, copper, zinc, and these minerals are
added
ReSoMal contains a mixture of salts and minerals to

correct deficiencies of potassium, magnesium, zinc and
copper and to address high levels of sodium in children
with SAM
New sachets must be reconstituted by adding 1

liter of boiled, cooled water, which will result in
1 liter of liquid ReSoMal.
Comparision between standard ORS vs ReSoMal
Component Standard ORS ReSoMal
Glucose 111 mmol/lit 125 mmol/lit
Na 90 45
K 20 40
Cl 80 70
Citrate 10 7
Mg - 3
Zn - 0.3
Cu - 0.045
Osmolarity 311 300

FORMULATION OF RESOMAL
Role of F75 and F100 Ready To Use Therapnuetic Food
(RUTF) WHO Guideline 2016)
F-75 :
is the "starter" formula to use during initial management,

beginning as soon as possible and continuing for 2-7 days
until the child is stabilized.
Severely malnourished children
cannot tolerate usual amounts of protein and sodium at
this stage, or high amounts of fat.
As soon as the child is stabilized on F-75,
F-100
is used as a "catch-up" formula to rebuild
wasted tissues. F-100 contains more calories and protein.
Nowdays F75 and F100 sachets come under formulation for

ready to use therapnuetic food .
Hence these sachets are used under the supervision of a
doctor for any complication occurring following lactose
freediets .
Following shows that the performance of two sachets
that is resomal and F75 and F100 sachets are ready to
use therapnuetic food INCLUDING BREAST FEEDING
which helps in growth and development of a child
suffering from severe acute malnutrition .
ReSoMal contains all the specific micronutrients
and minerals needed for the growth and development
of child suffering from severe acute malnutrion .
Contains zinc ,cupper , magnesium and potassium that
are already low and help in mental and growth
development of a child .
To fulfill the above requirement the govt needs to free
supply of resomal and F75 and F100 in every center for
better achievement of in poverty and socially
challenged child .
Thank you

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RESOMAL : Rehydration Solution For Malnutrition

In APPROACH TO STRENGTHEN GROWTH

WHO defines Malnutrition as

"the cellular imbalance between the supply of nutrients

PROTEIN ENERGY MALNUTRITION

Different combinations of many aetiological factors can

Amongst the Social, Economic, Biological and

Lack of breast feeding and giving diluted

Primary PEM: Protein + energyintakes below

Linear growth ceases

CLINICAL MARASMUS KWASHIORKOR

- EDEMA None Present in lower

- WEIGHT FOR Very low May be masked

- MENTAL Sometimes quite Irritable,

AGE ADMISSION CRITERIA

6 months to 18 years ----------- W/H or W/L < 70%

MUAC < 110 mm with a Length > 65 cm

Presence of bilateral pitting oedema

MUAC < 170 mm

MUAC < 180 mm with recent weight

Presence of bilateral pitting oedema

Rule 1 --- Fluids .

AGE QUANTITY IN M/L

SAM children are deficient in potassium

ReSoMal contains a mixture of salts and minerals to

New sachets must be reconstituted by adding 1

Component Standard ORS ReSoMal

Glucose 111 mmol/lit 125 mmol/lit

Osmolarity 311 300

is the "starter" formula to use during initial management,

Nowdays F75 and F100 sachets come under formulation for

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