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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

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Dehydration and Severe Malnutrition

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  1. Dehydration and Severe Malnutrition

  2. 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

  3. 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 2nd 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

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

  5. Oral Rehydration in Severe Malnutrition

  6. 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

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