Guided by Asso Prof DR Sunil K Agarawalla Presented by DR Minakhi Kumari Sahu (JR-1)
Guided by Asso Prof DR Sunil K Agarawalla Presented by DR Minakhi Kumari Sahu (JR-1)
Guided by Asso Prof DR Sunil K Agarawalla Presented by DR Minakhi Kumari Sahu (JR-1)
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Mild(+)-edema in both feet or ankles
Moderate(++)- edema in both feet +lower legs,hands
or lower arms
Severe (+++)-generalised edema
Age-group 6 to 59 M.
Steps ??
Around the LEFT Arm.
Record LMUAC to the nearest 0.1 Cm.
Colour-coded Tape.
Important:-
Repeat Measurement TWICE to ensure
Accuracy.
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More common in Oedema than in Wasted.
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1) Complications
2) Poor appetite
3) Severe edema
Presence of any emergency sign
Persistent vomiting
Very weak/apathetic
Fever-axillary temp> 38.5 deg celsius
Children with fast breathing /chest indrawing/cyanosis
Diarrhea with dehydration
Severe anemia
Jaundice
Bleeding tendecy
Hypothermia
Any other general sign which the clinician feels for
admission
In addition to above criteria if the care giver is unable to
take care of the child at home , the child also should be
admitted.
HOW TO TEST-:
For children 7-12 month- Offer 30-35ml/kg of
catch up diet.If the child takes >25ml/kg,
then appetite is good.
For children >12 month- Feed locally
prepared therapeutic food.
Amount of local therapeutic feed that a child
with SAM should take to PASS the APPETITE
TEST-:
BODY WT WT IN GRAMS
<4kg 15gm or more
4-7kg 25gm or more
7-10kg 33gm or more
Not breathing at all or gasping
Obstructed breathing
Central cyanosis
Severe respiratory distress
Shock
Coma
Convulsion
Diarrhea with severe dehydration
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In all admitted children first measure blood
glucose
Hypoglycemia- If RBS<54mg/dl
If child is conscious, alert- Give 50ml 10% glucose
bolus orally
If child is conscious but not drinking-give 50ml 10%
glucose or sucrose by NG tube
If child is unconscious, lethargic or convulsing- Give
5ml/kg sterile 10% glucose iv f/b 50ml 10% glucose
bolus by NG tube.
Start feeding as soon as possible with F-75 diet.
(give it every ½ hr for 1st 2hr)
HYPOTHERMIA??
If axillary temp<35deg cel(95 deg F)
Or not recordable by thermometer
Or rectal temp<35.5deg cel(95.9 deg f)
TREATMENT
Treat for hypoglycemia and infection
Feed immediately then 2hrly.
Kangaroo technique.
Rewarm by overhead warmer.
Prevent from draughts of air.
Monitoring .
Signs of dehydration
Diagnosis-a definite history of significant recent
sudden onset of frequent diarrhea/ history of a
recent change in the child’s appearance
Treatment- they should be rehydrated slowly
either orally or by nasogastric tube using oral
rehydration solution for malnourished children
Solution- resomal, half strength WHO low
osmolarity ORS + pottasium and glucose
Amount
Every 30 min for 1st 2 hr-5 ml/kg BW
Alternate hour for upto 10 hr – 5 -10 ml/kg
Signs of overhydration- PR>15,RR>5,
puffiness of eyes, jugular veins engorged
Sugar (gm) 9 5
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play full activities (language and motor activities ,
activities with toys)
Teach the child local songs and games using the fingers
and toes.
Encouage the child to laugh ,vocalise and describe wat
he or she is doing
Encourage the child to perform next appropriate motor
activities
Immobile children- passive limb movement
Mobile children - rolling or tumbling on a mattress,
kicking and tossing a ball, and climbing stairs.
Mothers and care givers should be involbed in all aspects
of management of her child.
After 10 to 15 days of hospital stay,the child
requires follow up for another 4 to 6 month for full
recovery.
The parent understand the cause of malnutrition
and prevent it’s recurrence by correct feeding
practices.
T/t for helminthic infection should be given to all
children before discharge.
Inform the ANM at the nearest PHC or subcentre to
ensure follow up.
All SAM children should be followed up by health
providers in the programme till s/he reaches Wt/Ht
of -1 SD
Child:
Achieved weight gain of >/= 15% and 5gm/kg/day for 3
consecutive days .
Edema has resolved
Child eating freely that the mother can prepare at home
No medical complication and infection
Child is provided with micronutrients
Immunisation
Mother /caregiver
Knows how to prepare appropriate food and to feed the child
Knows how to make appropriate toys and play with the child
Knows how to give home treatment for diarrhea,fever and
acute respiratory infections and how to recognise the signs
that he must seek medical assistance
Follow up plan is completed
Indication for BT
1)Hb<4 gm/dl
2)Hb 4-6 gm/dl and signs of resp disstress
How to give transfusion??
- No CHF-10ml/kg packed cell
-Presence of CHF- 5-7ml/kg packed cell
-Give inj lasix (1mg/kg)
-Look for signs of CHF
Initial steps are same.
Feed the infant with EBM or noncereal starter or
artificial milk feed.
Give good diet and micronutrient to mother.
In rehabillitation phase give support to the mother
and establish EBF. In artificially fed babies give
diluted catch up diet.
Discharge- Wt gain for 5 days and no medical
complications.
Relactation through supplementary sucking
technique- Used in lactation failure.
In SAM children who are infected with HIV/TB basic
principles and steps of management are same.
Start T/t of malnutrition 2 wks before the
introduction of ART/ATT.
Children with hiv- cotrimoxazole pplx against
pneumocystis pneumonia as per NACO
guidelines.Amoxicillin should also be given
For severe pneumonia in HIV infected children give
adequate anti staphylococcal and gram negative
antibiotic coverage ( ampicillin and gentamycin).
Criteria after Admission Time
Primary Failure:-
Failure to regain appetite Day-04.
Failure to start to loose O Day-04.
Oedema still Present Day-10.
Failure to gain at least 5g/kg/D Day-10.