Dehydration and Severe Malnutrition

Assessment difficult: Loss of skin elasticity (skin pinch over breast bone) Sunken eyes due to loss of subcutaneous tissue Dry mouth – salivary gland function suboptimal Choice of oral rehydration fluid fluid should have low sodium, high potassium, high glucose Choice of intravenous fluid Volume and flow rate Case fatality rate is high especially if not well managed Tahmeed et al. Ind J Paeds 1998

Rehydrating Severely Malnourished Children Avoid IVF unless patient in shock/severely dehydrated and cannot take ORS – Dextrose saline or HSD (+ 5% dextrose) – 15 ml/kg over 1 hr, then 10 ml/kg next 1 hr – Start ORS in the 2 nd hr at 10 ml/kg/hr for 2 hrs, then 5 ml/kg/hr for hrs For children who can drink: – ORS (modified) at rate as specified above

ReSoMal – modified ORS ReSoMal: Rehydration Solution for Malnutrition Preparation of ReSoMal from ORS 1.Add two pkts of ORS in 2 litres of water (instead of 1 litre) 2.Add 50gm ( 10 rounded 5mls teaspoon of sugar) 3.Add 3 vials of the 10 ml vial of 15% KCL (20mmol/10ml) in the 2 liters

Oral Rehydration in Severe Malnutrition All concentrations are in mmol/l Na + K+K+K+K+Lactate* (HCO 3 -) Glucose WHO / UNICEF ORS Rehydration Solution for Malnutrition – ReSoMal* ~ 200

Replace on-going losses Should be done once the rehydration therapy is over ReSoMal 10ml/kg for every watery stool Continue feeding Vitamin A, multivitamins, zinc supplementation Antibiotics etc

Summary Prevention of diarrhoea Prevention of dehydration Early recognition and adequate treatment of dehydration with ORS and/or IVF Continued feeding Zinc supplementation