MANAGEMENT

OF

PEM

SYAFINAZ ALI ZAINI 08425

Management of PEM
Mild

Severe up Follow

Treatment of infection / parasitic infestation

Nutritional advice

Mild PEM
Supplementation of diet

micronutrients
Vitamin A, D, Folic acid, Iron etc.

Calories : 100-150kcal/kg/day Proteins : 2-3g/kg/day

Investigation Health Education

Follow up

Severe PEM

Stabilization & Emergency treatment

Rehabilization and Restoring

Blood picture

Urine examination and culture

Stool analysis

Chest X ray

Blood glucose and electrolytes

For life threatening complications Hypothermia

Rectal Teperature less than 35.5 degree celcius. Treat by : 1) Frequent feeding 2 hourly. Day and night 2) Room temperature kept 30-33 especially night. 3) Child should be wrapped.

Hypoglycemia

Blood glucose less than 55mg/dl Moderate : maybe asymptomatic Profound : Lethargy, unresponsiveness, limpness or rigidity, twitching, convulsion, coma Treat by : 1) Frequent feeding 2) 50ml glucose 10% in water/milk 3) 1ml/kg of sterile 50% Dextrose solution IV/nasogastric

Heart Failure PEM children SHOuld NOT be digitalized Treat by Oxygen and other supportive measures ( Correction of K,Mg,Ca) Restriction of fluid

Electrolyte disturbances
Dehydration Rehydration : Oral or nasogastric IV : overhydration and heart failure IV : only in shock or failure of oral rehydration

Treatment of infections

ALL SEVERE PEM SHOULD BE ROUTINELY GIVEN ANTIBIOTICS

Severe ill / complicated cases : Ampicillin + Gentamycin (IM/IV) Metronidazole 7.6 mg/kg 3x daily for 7days Uncomplicated cases : Cotrimoxazole suspension 2.5 5 ml twice daily for 5days

NUTRITIONAL STATUS

Starting cautious initial feeding Subsequent Diet

High Energy Diet for growth catching up

Supplementation for micronutrients Stimulation, play and emotional support

Start by LITTLE, FREQUENT and ISOTONIC feeds

Feed until reversal of mental changes (smiling)

75 kcal/100ml and < 1g of protein/100ml

Give 100ml/kg of body weight /day divided o 10 small feeds/day

May start with half strength formula

Low or lactose free formula for those with milk intolerant

Given after the 5-7 days when child regains his appetite

Provides 100kcal/100ml and from 2.3 3g proteins per 100ml

Give at least 120-130 ml/kg of body weight in 8 feeds (15 ml/kg/feed)

Should gradual replace the initial diet

After the first 2 weeks, with restoration of appetite

Start giving semisolid feed in addition to milk (cereal, porridge, eggs, cheese, beans, minced meat)

Child should be fed up to appetite and frequently (every 3-4hours) Amounts are unlimited, providing at least

150-220 kcal/kg & 4-6g/kg protein/day

Multivitamin preparation are given to provide at least double the Recommendation Daily Allowances (RDA)

In case of vitamin A deficiency : Give single dose of 50 000 200 000U, orally

Zinc, Copper, and other trace elements (Iodine, Selenium, etc)

Iron SHOULD NOT be given until infections are treated even if the child is anemic

PEM delays mental and behavior developement

Tender, loving, care, structured play & cheerful environment

Children that are stimulated recovers rapidly and better mental developement

Health Education

Follow up