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Treatment of kwashiorkor child

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 3 replies. You can also reply via email – be sure to leave the subject unchanged.

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Anonymous 1589

OCHA

Normal user

8 Aug 2013, 14:31

Below is a question received by a field colleagues. Advice will be appreciated.

QUOTE:
I currently treat in the pediatric ward an 8 year old, 12 kg girl with a miliary Tb and Kwashiorkor (Grad I oedema, mainly facial and little sacral, no oedema on the legs). Also clearly stunted. She was started on Tb treatment recentley.
Of course ideally this child would be put on F75 as phase I in the nutritional program, but the child is above 5 years and therefore does not qualify for the therapeutic feeding program and ICRC does not have F75 nor the capacity to prepare the milk.

Right now we are giving Plumpy nut 1x2 packs per day (1000kcal, 83kcal/kg/d) and normal hospital food.
Since we are short with PPN we were debating if we can change to the high protein liquid diet according to the recipe used for the surgical patient and give only a smaller quantity for her. (for example 1/3 of the
But I am fairly worried about this, since I feel we would give too much calories and risk of refeeding syndrom is quite high, and we are not taking into account the sodium intake.

Now my questions:
1.) which diet do you think would be the most appropriate for a Kwashiorkor with Grad I oedema when F75 is not available

2.) If we are running out of Plumpynut, can we change to high protein liquid diet or is this taking too much risks? "

UNQUOTE

Alexandra Rutishauser-Perera

International Medical Corps

Normal user

8 Aug 2013, 19:13

Dear Anonymous,

It would be useful to know in which country this is happening because there might be a possibility for ICRC to obtain F75 and F100 from UNICEF, the MoH or an other NGOs...

There might be also recipes in the CMAM national protocols...

However in the FANTA Generic guideline 2010 :
http://www.fantaproject.org/cmam/generic2010.shtml

You can find recipes for making F75 and F100:

For example: To prepare F75, add 50 g of dry skim milk,140g of sugar,70g of pre-boiled cereal powder and 54g of oil to one litre (L) water and mix. Boil for 5-to-7 minutes. Allow to cool, add the combined mineral and vitamin mix (CMV) (1 red scoop:6.35 g) and mix again. Make up the volume to 2,000 millilitres (ml) with cooled boiled water.

The quantity will be changed if you use instead whole skim milk or fresh goat/cow milk.

Hope this helps,

Hamid Hussien

Nutrition Specialist Concern WW

Normal user

11 Aug 2013, 19:00

TB in children with SAM is often missed and/or over-diagnosed
. F-75 is specially made to meet a child’s needs without overwhelming the body’s systems
starting by by F75 or Plump nut depending on Type Of Oedem / medical compilations/appetite
F75 used mainly to management electrolyte balance and prevent of reductive adaptation
then if that child have only oedema + or ++ with good appetite you can start directly with plump nut and if he is +++/ fail to pass appetite test you must to use F75 made by dry or skimmed milk as described above
hope this helpful

Abu Ahammad abdullah

Normal user

12 Aug 2013, 02:56

My dear,

First of all we need to confirm whether the patient has Nutritional oedema(/Kwashiorkor) or not. As you said, the child is suffering from Kwashiorkor (Grad I oedema, mainly facial and little sacral, no oedema on the legs).

In my opinion, the child is not suffering from Kwashiorkor. Because, the Grade-I or (+) Odema means bilateral pitting oedema in both leg. But you are saying there is no oedema on the feet of the leg.

Fluid can be accumulated in our body for many reasons. Please collect the history of the child before classified him as a kwashiorkor patient.

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