Page 50 - Learnwell EVS
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ere acute malnutrition
- I f the clinical co nd itio n has no t im p ro ved , ad m inister again 1 0 m l/ k g o f 0.9%
sodium chloride o ver 3 0 m inutes th en, w h en th e clinical co nd itio n h as
im p ro ved , switch to the o ral ro ute as abo ve.
W h en switch ing to th e o ral ro ute, sto p th e infusio n but leave th e cath eter
(cap p ed ) in p lace to k eep a veno us access, fo r IV antibio tic therap y .
– Bacterial infections
L o wer resp irato ry infectio ns, o titis, sk in and urinary infectio ns are co m m o n, but
so m etim es d ifficult to id entify (absence o f fever and sp ecific sy m p to m s).
I nfectio n sho uld be susp ected in a d ro wsy o r ap athetic child .
S evere infectio n sh o uld be susp ected in th e event o f sh o ck , h y p o th erm ia o r
h y p o gly caem ia. S ince th e infectio us fo cus m ay be d ifficult to d eterm ine, a bro ad
sp ectrum antibio tic therap y (clo xacilline + ceftriaxo ne) is reco m m end ed .
– Hypothermia and hypoglycaemia
H y p o therm ia (rectal tem p erature < 3 5 .5 °C o r axillary < 3 5 °C ) is a frequent cause o f
d eath in the first d ay s o f ho sp italisatio n.
P reventio n m easures includ e k eep ing the child clo se to the m o ther‟s bo d y (k angaro o
m etho d ) and p ro visio n o f blank ets.
I n case o f h y p o th erm ia, warm th e ch ild as abo ve, m o nito r th e tem p erature, treat
h y p o gly caem ia. S evere infectio n sho uld be susp ected in the event o f hy p o therm ia
(see abo ve).
I n hy p o gly caem ia, susp ected o r co nfirm ed (test strip ), ad m inister gluco se P O if the
child is able to d rink (5 0 m l o f sugar water [5 0 m l water + a teasp o o n o f sugar] o r
5 0 m l o f m ilk ) ; if the ch ild is unco nscio us, 5 m l/ k g o f 1 0 % gluco se slo w I V , to be
rep eated o nce if necessary . T reat p o ssible und erly ing infectio n.
– Oral candidiasis
L o o k ro utinely fo r o ral cand id iad is as it interferes w ith feed ing, see treatm ent
p age 9 2 .
I f th e ch ild fails to reco ver d esp ite ap p ro p riate nutritio nal and m ed ical treatm ent,
co nsid er ano ther p atho lo gy : tuberculo sis, H IV infectio n, etc.
Adolescents and adults
C linical exam inatio n o f the p atient (sud d en weight lo ss, lo ss o f m o bility fro m m uscle
w asting, cach exia, bilateral lo w er lim b o ed em a in th e absence o f o th er causes o f
o ed em a) is ind isp ensable fo r the d iagno sis and ad ap ted m ed ical, nutritio nal and even
so cial care o f the p atient.
44
- I f the clinical co nd itio n has no t im p ro ved , ad m inister again 1 0 m l/ k g o f 0.9%
sodium chloride o ver 3 0 m inutes th en, w h en th e clinical co nd itio n h as
im p ro ved , switch to the o ral ro ute as abo ve.
W h en switch ing to th e o ral ro ute, sto p th e infusio n but leave th e cath eter
(cap p ed ) in p lace to k eep a veno us access, fo r IV antibio tic therap y .
– Bacterial infections
L o wer resp irato ry infectio ns, o titis, sk in and urinary infectio ns are co m m o n, but
so m etim es d ifficult to id entify (absence o f fever and sp ecific sy m p to m s).
I nfectio n sho uld be susp ected in a d ro wsy o r ap athetic child .
S evere infectio n sh o uld be susp ected in th e event o f sh o ck , h y p o th erm ia o r
h y p o gly caem ia. S ince th e infectio us fo cus m ay be d ifficult to d eterm ine, a bro ad
sp ectrum antibio tic therap y (clo xacilline + ceftriaxo ne) is reco m m end ed .
– Hypothermia and hypoglycaemia
H y p o therm ia (rectal tem p erature < 3 5 .5 °C o r axillary < 3 5 °C ) is a frequent cause o f
d eath in the first d ay s o f ho sp italisatio n.
P reventio n m easures includ e k eep ing the child clo se to the m o ther‟s bo d y (k angaro o
m etho d ) and p ro visio n o f blank ets.
I n case o f h y p o th erm ia, warm th e ch ild as abo ve, m o nito r th e tem p erature, treat
h y p o gly caem ia. S evere infectio n sho uld be susp ected in the event o f hy p o therm ia
(see abo ve).
I n hy p o gly caem ia, susp ected o r co nfirm ed (test strip ), ad m inister gluco se P O if the
child is able to d rink (5 0 m l o f sugar water [5 0 m l water + a teasp o o n o f sugar] o r
5 0 m l o f m ilk ) ; if the ch ild is unco nscio us, 5 m l/ k g o f 1 0 % gluco se slo w I V , to be
rep eated o nce if necessary . T reat p o ssible und erly ing infectio n.
– Oral candidiasis
L o o k ro utinely fo r o ral cand id iad is as it interferes w ith feed ing, see treatm ent
p age 9 2 .
I f th e ch ild fails to reco ver d esp ite ap p ro p riate nutritio nal and m ed ical treatm ent,
co nsid er ano ther p atho lo gy : tuberculo sis, H IV infectio n, etc.
Adolescents and adults
C linical exam inatio n o f the p atient (sud d en weight lo ss, lo ss o f m o bility fro m m uscle
w asting, cach exia, bilateral lo w er lim b o ed em a in th e absence o f o th er causes o f
o ed em a) is ind isp ensable fo r the d iagno sis and ad ap ted m ed ical, nutritio nal and even
so cial care o f the p atient.
44
