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treatment of heart failure in SAM;treatment of dehydration/shock in oedematous malnutrition;target weight;sympathetic activity in hypoglycemia & shock

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 2 replies. You can also reply via email – be sure to leave the subject unchanged.

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Dr. satish raghuwanshi

P.G. student,deptof pediatrics,REWA,m.p.,India

Normal user

15 Jul 2009, 18:58

Sir,It is given in guidelines that no fluid or no feeding should be given in heart failure,even upto 48 hours,why?it is also given that you can give little sugar water both things are contradictory,kindly explain .
2.It is given in guidelines that if patient is oedematous,dont treat for dehydration;if a child having oedematous malnutrition comes with history of fluid loss OR with this history brought unconscious having all signs of shock,how we are going to treat such patient in such situation?,kindly explain.
3.what is target weight & estimated weight in treatment of dehydration,for e.g. if a child weighing 5kg at admissin came with history of fluid loss & recent change in appearence of eyes,then explain what is target weight,estimated weight,measured weight.
4.sympathetic activity will be present in both hypoglycemia & septic shock both can cause lid retraction,then explain how it differs.
waiting for your explaination.
thankyou very much in anticipation.

Tarig Abdulgadir

CMAM Specialist / UNICEF

Normal user

20 Jul 2009, 11:06

Dear friend,

Yes it is a good points that you have mentioned for the target weight usually two ways can be followed either you rehydrate with close monitoring for disappearance of dehydration signs which means close follow up by well trained person and with chance for overhydrating the child , some care givers assumes that in moderate dehydration the child lose from 5-10 % of his body weight so if you calculate these lost weight and add it to the weight at admission ( assuming that he/she present with dehydration)these will gives you rough clue for the weight before dehydration, however it is difficult as well i should turn your attention my dear that signs of dehydration in well nuroshed child is a feature of malnutrition so we mainly depend on loss of fluid ( vomiting or diarrhoea) , loss of weight and recent appearance of dehydration signs ( eye sinking), again moderate dehydration and severe dehydration are defrentiated by level of consciousness and vital signs which are very important in monitoring rehydration , in some instances dehydration can occur as inpatient incidance and gto know the weight you need to stop rehydration at , you look to the weight before starting losses , but generally for better information i would recommend for me and you to go back what professor . Mike Golden said and i wish if he could answer us here
thank you for your question

Dr Reginald Annan

Normal user

21 Jul 2009, 10:50

Dear Dr Satish Raghuwanshi
I would like to refer you to an on-line training course titled Inpatient Management of Severe Malnutrition available via the International Malnutrition Task Force website for free.

I believe most of the questions you have raised have been answered and I am sure you and any one interested in Severe Malnutrition management would find this course useful.

You can access the course at http://imtf.org/page/training/

Thank you.

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