Dehydration and Severe Malnutrition Dehydration and Severe Malnutrition

Dehydration and Severe Malnutrition

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 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 10 -12 hrs • For children who can drink: – ORS (modified) at rate as specified above

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

Oral Rehydration in Severe Malnutrition All concentrations are in mmol/l Lactate* Na+ K+ WHO / UNICEF ORS 90 20 10 111 Rehydration Solution for Malnutrition – Re. So. Mal*. 45 40 5 ~ 200 (HCO 3 -) Glucose

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