Notes on Severe Malnutrition and Management

Introduction to Severe Malnutrition

  • Mortality exceeds 30% in severe malnutrition cases.

Learning Objectives

  • Recognize severe malnutrition and manage related issues.

  • Understand new feeding approaches as primary treatment.

Definitions of Severe Acute Malnutrition (SAM)

  • MUAC (Mid-Upper Arm Circumference):

    • At Risk: >13.5 cm

    • Moderate: 12.5 to 13.4 cm

    • Severe: <11.5 cm

  • Weight-for-Height Z-score (WHZ):

    • At Risk: -1 to -2

    • Moderate: -2 to -3

    • Severe: <-3

  • Edema of both feet indicates severe malnutrition.

Advantages of MUAC

  • More acceptable to children; requires one person.

  • No reference table necessary; single cut-off for age/sex.

  • Not influenced by conditions like edema or dehydration.

Predictive Power of MUAC

  • Better predictor of mortality than WHZ, H/A, W/A.

  • No significant improvement combining MUAC with other measurements.

Admission Indications

  • Medical complications, severe circulatory issues, inability to feed, or altered consciousness.

Types of Malnutrition

  • Protein-Energy Malnutrition (PEM) alongside electrolyte and micronutrient deficiencies.

Electrolyte Deficiencies

  • Key deficiencies include potassium, magnesium, zinc, copper, and selenium.

  • Caution against excessive sodium from salty foods.

Reductive Adaptation Mechanism

  • SAM induces metabolic changes to conserve energy: reduced activity, slower metabolism, and diminished organ function.

Treatment Protocols

  • 10 Step Approach:

    1. Address hypoglycemia and hypothermia.

    2. Treat dehydration with Ringer’s solution.

    3. Manage electrolytes and infections.

    4. Regular monitoring and micronutrient supplementation.

    5. Initiate feeding for catch-up growth.

    6. Prepare for discharge.

Infection Control

  • High incidence of infections; all malnourished children should receive antibiotics promptly.

  • Specific treatments for identified infections such as osteomyelitis.

Vitamin Supplementation

  • Vitamin A for children with eye signs; dosage varies by age and symptoms.

Summary

  • High risk of death in severe malnutrition; complex problems requiring a multi-faceted approach to treatment, best addressed through a structured 10-step method.