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Converting F100 to F75 or making F75 from commercial milk powder

This question was posted the Infant and young child feeding interventions forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Erin

Nutrition Specialist

Normal user

28 Mar 2009, 14:12

We have a problem of access to one area in Darfur and are asking for feedback on how to either convert F100 to be equivalent to F75 OR how to prepare F75 from locally available dried full cream milk powder.

If anyone has recent experience with this, please let us know.

Thank you,

Michael Golden

Normal user

12 Apr 2009, 16:42

First, F100 cannot be converted to F75, the proportions of the ingredients are quite different.

Second, for both F100 and F75 the home-made recipies are MADE UP TO one litre of multiples thereoff. The comercial preparations not the same they are ADDED TO 2 Litres of water. This difference is often not appreciated. When I designed F100 and F75 and then wrote the WHO 1999 manual I stiputated the final volume to be 1000ml. However, in the field it was found to be quite difficult to see the final volume because of the froth (foam) on top that formed during mixing - so there was a change so that the powder was added to a fixed amount of water.

Third, the commercial preparation of F75 is very difficult to emulate with home made recipies. The correct formula uses 35g of cereal powder and 70g of sugar. The problem with this formulation is that it becomes quite viscous and is difficult to put down an NG tube. For this reason one of the subesquent advisors to WHO suggested using 100g of sugar instead of the cereal powder. The problem now is that the formulation is hyperosmolar and frequently provokes an osmotic diarrhoea (we had about 12 deaths in Somalia due to this problem when the local staff started to use sugar instead of the cereal powder). If this osmotic diarrhoea is misdiagnosed as infective diarrhoea and treated with resomal then the children get an overload of sodium and go into heart failure. For this reason the formulation using sugar alone is dangerous unless all the staff clearly understand the reason and can correctly differentiate osmotic diarrhoea (no or trivial weight loss) from infective diarrhoea (weight loss if to be treated with rehydration fluids).

For these reasons we strongly advocate for the use of the commercial preparation of F75 - relatively small amounts are needed.

F75 was designed for the severe cases with liver dysfunction, sepsis, intestinal problems - and particularly for those with kwash. If there are limited supplies of the commercial formulation then, whilst more are being secured, they can be reserved for this type of child who will require NG tube feeding. The children who are not so severely ill can indeed be managed with diluted F100. The problem being that such changes in the protocol to suit pipeline breaks can cause confusion amongst the staff.



Carla Hugen

Master in International Health, MD

Normal user

30 Mar 2009, 15:25

I have a home recipe for F100 for you, but not for F75. I think SDTM (diluted F100) can be used as a replacement for F75 in case of shortages.

For F100/HEM:
Mix 1,7 liter water, 160 gram DSM (= dry skimmed milk, not full cream), 100 gram sugar, 120 gram oil and 1 red scoop of CMV, to make 2 liter of F100.

To dilute to SDTM add 700 ml of water extra, to make 2,7 liter.

If anyone knows a home recipe for F75, I would also be very interested.

Rogers Wanyama

Emergency Nutrition Specialist

Normal user

30 Mar 2009, 15:56

Check "Guidelines for the inpatient treatment of severely malnourished children SEARO Technical Publication No. 24" It has the recipes for starter formulas indicated below:
F-75 starter formulas
.Full-cream dried milk 35 g, 100 g sugar, 20 g (or ml) oil, 20 ml electrolyte/ mineral solution, and make up to 1000 ml
.Full-cream cow's milk (fresh or long life) 300 ml, 100 g sugar, 20 g (or ml) oil, 20 ml electrolyte/mineral solution and make up to 1000 ml
You can download the publication from www.who.int

Kamar

Normal user

11 Apr 2009, 09:16

To reduce osmolarity of F75 prepared by adding 100g of Sugar ( High osmolarity formula may not be well tolerated by all children) use 70g of sugar and 35g of cereal flour

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