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Treatment of diarrhea in SAM and MAM

This question was posted the Management of wasting/acute malnutrition forum area and has 2 replies.

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Anonymous 758

Normal user

28 Jan 2013, 01:17

What is the most up-to-date recommendations on treating diarrhea with ORS/zinc in children with moderate acute malnutrition who are entering a supplementary feeding program providing RUSF? The Nutrition cluster's HTP suggests that ORT not be given to children suffering from SAM who are being treated in outpatient care with RUTF; same concerns/recommendation with MAM? "Diarrhoea is often a precipitating cause leading to SAM. Whereas the use of oral rehydration therapy (ORT) (and zinc supplementation) is effective to prevent dehydration, it is not recommended to use ORT in children with SAM. The effect of diarrhoea on the nutrition status of children can be minimised by continued feeding, breastfeeding and administration of RUTF (note that RUTF provides a daily supplementation of Zinc) during the diarrhoea episode."

Mark Manary

Washington University School of Medicine

Technical expert

5 Mar 2013, 03:01

I do not think there are recommendations against using ORS in MAM. I would use ORS when dehydration is suspected, Fortified blended flours, which are the most commonly used supplementary foods, do not contain much salt at all, so sodium may be needed for intestinal water absorption, and rehydration. In SAM electrolyte balance is perturbed, RUTF has lots of solute in it, and free water and breast milk will probably be adequate to rehydrate.

André Briend

Frequent user

5 Mar 2013, 07:45

Resomal was introduced at a time when standard WHO ORS had a high Na content (90 mEq/L). As SAM children poorly tolerate Na, at that time it was recommended for SAM children to give one glass of ORS and then one glass of water. Resomal was a simplification avoiding this complex rehydration schema and also had the advantage of providing extra sugar and some Zn. Now, the standard WHO solution has a lower osmolarity and a lower Na content (70mEq/L). And it is a standard WHO recommendation to give Zn (or Zn feeds for SAM children) in case of diarrhoea. The rationale for using Resomal instead of standard ORS is not so clear. In any case, I don’t see any advantage of using it in MAM. FYI, WHO considered adding Zn to ORS, but eventually recommended to give it separately, as the dose of ORS given in case of diarrhoea is highly variable. Giving a Zn tablet is a more effective way to give a standard Zn dose.

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