Model Answer
0 min readIntroduction
Severe Acute Malnutrition (SAM) is a life-threatening condition affecting millions of children globally, particularly in developing countries. It’s characterized by wasting (low weight-for-height), stunting (low height-for-age), and/or edema. The initial phase of stabilization is critical for reducing mortality and preparing the child for rehabilitation. This phase focuses on correcting electrolyte imbalances, preventing hypoglycemia, and initiating cautious feeding. The dietary plan during this phase is carefully designed to avoid refeeding syndrome, a potentially fatal metabolic disturbance. This answer will detail the dietary plan, frequency, duration, and supplementation required during this crucial stabilization period.
Initial Stabilization Phase: Dietary Plan
The initial stabilization phase typically lasts 24-48 hours, although it can extend depending on the child’s clinical condition. The primary goal is to correct immediate life-threatening complications and prepare the gut for gradual feeding.
1. Type of Feed
Initially, feeding starts with F-75 therapeutic milk. F-75 is a specially formulated milk with a low energy density (75 kcal/100ml) and low protein content. This is crucial to avoid overwhelming the compromised metabolic system and preventing refeeding syndrome. It contains essential electrolytes and vitamins.
2. Amount and Frequency of Feed
- First 6-8 hours: 30-60 ml/kg/day of F-75, given in small, frequent feeds (5-10 ml every 30-60 minutes). This is administered via a nasogastric (NG) tube if the child is unable to feed orally.
- Next 6-8 hours: Gradually increase the amount to 80-100 ml/kg/day, maintaining frequent small feeds.
- Subsequent 24-48 hours: Continue increasing the amount gradually, monitoring for signs of refeeding syndrome (edema, electrolyte imbalances, cardiac arrhythmias).
3. Duration of Phase
The stabilization phase continues until the child is able to tolerate and absorb feeds without signs of refeeding syndrome, and their vital signs are stable. This usually takes 24-48 hours, but can be longer in severely compromised children. Once the child shows improvement, they are transitioned to the rehabilitation phase with F-100.
Vitamin and Mineral Supplementation
Alongside F-75, specific vitamin and mineral supplementation is essential during the stabilization phase:
- Vitamin A: A single dose of Vitamin A (100,000 IU for children 6-12 months, 200,000 IU for children >12 months) is administered on day 1 or 2. This is crucial as Vitamin A deficiency is common in SAM and contributes to increased morbidity and mortality.
- Zinc: Zinc supplementation (10mg daily for children 6-12 months, 20mg daily for children >12 months) is given for 14 days. Zinc deficiency impairs immune function and wound healing.
- Iron: Iron supplementation is avoided during the stabilization phase. Iron can exacerbate inflammation and increase the risk of infection. It is introduced later during the rehabilitation phase.
- Folate and B Vitamins: These are included in the F-75 formulation.
- Electrolytes: Careful monitoring and correction of electrolyte imbalances (sodium, potassium, magnesium) are crucial, guided by laboratory investigations.
4. Monitoring for Refeeding Syndrome
Close monitoring is paramount during the stabilization phase. Key parameters to monitor include:
- Electrolytes: Frequent monitoring of sodium, potassium, magnesium, and phosphate levels.
- Blood Glucose: Regular blood glucose monitoring to prevent hypoglycemia.
- Edema: Assessment for the development or worsening of edema.
- Cardiac Function: Monitoring for signs of cardiac arrhythmias or failure.
- Fluid Balance: Strict monitoring of fluid intake and output.
5. Transition to Rehabilitation Phase
Once the child is clinically stable and tolerating F-75 without complications, they are transitioned to the rehabilitation phase. This involves increasing the energy density of the feed to F-100 (100 kcal/100ml) and gradually increasing the amount to promote weight gain.
Conclusion
The initial stabilization phase in managing SAM is a delicate balance between providing adequate nutrition and avoiding the potentially fatal complications of refeeding syndrome. Careful monitoring of electrolytes, blood glucose, and clinical signs is crucial. The use of F-75 therapeutic milk, along with appropriate vitamin and mineral supplementation, forms the cornerstone of this phase. Successful stabilization sets the stage for effective rehabilitation and long-term recovery, ultimately reducing morbidity and mortality associated with severe acute malnutrition.
Answer Length
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