1. Port Sudan Teaching Hospital Department of Pediatrics unit of Dr. Zeinab Gaily Recognizing and Managing severe malnutrition Prepared by Dr. Nadia Khalid Baasher

9. Baggy pants sign:

16. flaking skin , raw skin , fissures

18. : Inflammation of the eye

19. Bitot’s spots Bitot’s spots

20. Corneal clouding

21. Corneal ulceration

24. This 5 year old child was severly malnourished althought recoverd but has stunted growth

43. Test blood glucose If not low > Or = 54mg/dl If low < 54md/dl Start F75 immediately To prevent hypoglycemia Give glucose to treat hypoglycemia

47. Kangaroo technique:

51. If the child is in shock : Give Oxygen immediately Quickly insert an I.V line Give Dextrose 10% 5 ml/kg i.v Give i.v fluids Keep the child warm

54. Give maintenance i.v fluids 4ml/kg/hour while waiting for the blood If there are NO signs of heart failure If there are signs of heart failure give whole blood 10 ml/kg slowly over 3 hours give packed cells 10 ml/kg slowly over 3 hours diuretics should be given to make room for the blood 1 mg/kg i.v before and after transfusion no diuretic is given. how Blood transfusion is done? If there are NO signs of heart failure give whole blood 10 ml/kg slowly over 3 hours If there are NO signs of heart failure diuretics should be given to make room for the blood 1 mg/kg i.v before and after transfusion give whole blood 10 ml/kg slowly over 3 hours If there are NO signs of heart failure

61. Signs of Dehydration: 1- Lethargy 2- Restlessness and irritability 3- Absence of tears 4- Sunken eyes 5- Dry mouth and tongue 6- Thirst 7- Skin pinch goes back slowly

62. Calculating the amount of ReSoMal: F75 is given in alternate hours until the child is rehydrated then the ReSoMal is stopped alternatively and given after each loose stool For children < 2 years give 50 – 100 ml after each loose stool For children 2 years and older give 100 – 200 ml after each loose stool 5 – 10 ml/kg Alternate hours for up to 10 hours 5 ml/kg Every 30 mins for the first 2 hours Amount to give How often to give ReSoMal

64. Signs of overhydration: Rapid and marked increase in Pulse rate and RR Jugular vein engorgement Increasing edema

66. Selecting antibiotics: Chloramphenicol i.v or i.m 25mg/kg every 8 hours for 5 days. If the child fails to improve within 48 hrs add Gentamicin i.v or i.m (7.5mg/kg) once daily for 7 days + Ampicillin i.v or i.m(25mg/kg) every 6 hours for 2 days followed by Amoxicillin orally 15mg/kg every 8 hours for 5 days Complications ( shock . Hypoglycemia , dermatosis +++ , respiratory or urinary tract infection ) Cotrimoxazole orally(25 mg sulfamethoxazole + 5mg trimethoprim/ kg) Every 12 hours for 5 days orally No Complications GIVE: IF:

82. On the ward monitor pulse, RR, temperature and WATCH for danger signs: suggests Danger sign Infection or Hypothermia Any sudden increase or decrease Rectal temp 35.5 C Temperature Pneumonia Fast breathing : 50 /min or more in a 2 month child up to 12 months 40 /min or more in a child 12 months up 5 years RR only Infection or Heart failure( possibly from overhydration due to feeding or rehydrating too fast) Confirmed increase in pulse rate of 25 or more per minute + increase in RR of 5 breaths per minute. Pulse and RR

95. Before and after