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Abdominal enlargement for SAM patients treated in ITC

This question was posted the Management of wasting/acute malnutrition forum area and has 1 replies.

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Anonymous 2408

Head of Program for Nutrition

Normal user

17 Nov 2015, 08:47

Hi! we recently gathered In patient Therapeutic Care Centers in our Region who had been established for a year or more. They had case presentations and sharing of experiences. It was brought up during the open forum that the attending physicians noted enlargement of the abdomen which is very prominent during the transition and rehabilitation phase. Most centers noted 1-2 same case as this. May I ask if any of you have the same experience and what do you think contribute to this?
Your replies will be very much appreciated.


Technical expert

17 Nov 2015, 13:28

Hi Anonymous,
You mention only abdominal enlargement and not any other symptoms. If bowel sounds are normal and there is no diarrhoea then there are other possible causes;
- Lactose Intolerance: This is generally over diagnosed in cases of SAM. If you are using commercial formulas (F75, F100, RUTF) then the lactose levels are lower than breastmilk. In any case there is an increase of lactase levels in the gut during the early days of recovery and symptoms will resolve as recovery progresses. If lactose intolerance is suspected then you could either switch to a commercial formula (if not done already) or reduce the feed amount but increase the feed frequency (so that the total amount given remains the same). Symptoms will normally resolve within a few days.

If there is diarrhoea then:
- Osmotic diarrhoea: Generally this occurs following a change in diet between phases. If diarrhoea occurs after a change in diet the diagnosis can be presumptive, however there may be an increase in the frequency of stools which is normal during recovery but this should resolve and doesn't require treatment unless there is weight loss. Osmotic diarrhoea is more common when non-commercial preparations are used. If not already done try switching to Low Osmolarity F75 , F100. As with lactose intolerance, in phase 1 increase the frequency of the feed but decrease the volume of each feed to give the same total amount. In transition or Phase 2, try moving the child back one step (i.e. Phase 2 to transition or transition to phase 1). If symptoms do not resolve within 3 days assume a pathogenic cause. If symptoms do resolve, try increasing the transition phase milk volumes by an extra 10-20 kcal / kg / day until the target 200 kcal / kg / day is reached. Only increase the diet as long as the child remains free of symptoms.

In either case, the prescription, preparation(proper dilution) and administration of the therapeutic feeds should be reviewed to ensure good practice. Review hygiene practices in the preparation and administration of the milk feeds.

I hope this helps

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