Module 6B - ITC Complications
Module 6B - ITC Complications
Module 6B - ITC Complications
Complications
Inpatient Therapeutic Care
Module 6b
o Hypothermia
o Hypoglycemia
(6 kg x 11 ml) = 66 ml
• Feed frequently every 3 hours including waking the child during the
night
This is KEY
Take a detailed medical history
❖determine recent fluid loss from acute diarrhea or vomiting – sudden
onset or in the past few days
❖Elicit how well / frequent the child has voided, particularly the last 6
hours, ask about urine color
Identification of dehydration and shock
Physical examination
➢Level of consciousness
➢Skin pinch test
➢Sunken eyes
▪ Marasmic children can have sunken eyes due to loss of fat behind eyeball
➢Absent: superficial veins on the head, neck, and limbs
➢Palpate liver
➢Check extremities
Vital signs check: Heart rate, temperature, blood pressure, weight
❖ The treatment of a child with nutritional edema is the same with septic shock
and different from what is done for a child with wasting.
Rehydration for Marasmic patients
Oral Rehydration solutions for SAM Dilute 42 g sachet
Rehydration Solution for Malnutrition (ReSoMal) should be in 1 liter water
used as the standard therapy for children with SAM
diagnosed with dehydration
Low Osmolarity Oral Rehydration Solution (LO-ORS) may be used for the treatment of children
with SAM but only for those who have a positive diagnosis of Acute Watery Diarrhoea (AWD) or
Cholera
• Where ReSoMal is not available, a modified, half-strength solution of LO-ORS may be used with
added potassium and glucose.
Oral Rehydration Solutions such (ORS or ReSoMal) for the treatment of dehydration must NEVER be
freely accessible to caregivers on the hospital ward.
Modified ReSoMal
Prepare from standard ORS and mineral mix solution, as follows:
• Wash hands.
• Empty one 1-litre standard ORS packet into container that holds more than 2
liters.
• Measure and add 50 grams of sugar.
• Measure 40 milliliters or one leveled scoop of CMV in a graduated medicine cup
or syringe; add to other ingredients.
• Measure and add 2 liters cooled boiled water.
• Stir until dissolved.
• Use within 24 hours.
Test yourself!!
True or False.
0.9 NaCl IV solution is recommended for use in fluid resuscitation for
shock in children with SAM.
Continue
breastfeeding!
Introduction of F75 is
usually achieved
within 2-3 hours of
starting re-hydration.
ReSoMal and F75 can
be given in alternate
hours if there is still
some dehydration and
continuing diarrhoea.
Treatment of the child with nutritional edema
If (+) watery diarrhea
(+) clinical deterioration
→ Replace fluid loss with 30ml ReSoMal per episode of watery stool.
❖The fluid management of hypovolemia for a child with edema is the
same as the treatment for septic shock.
Treatment protocol for septic shock
• Give oxygen
• Give broad spectrum antibiotics
• Treat / prevent hypoglycemia in unconscious patients
• Treat / prevent hypothermia
• Conscious patients should be started on F75 (or sugar water) orally / NGT (Phase 1
protocols)
• Keep physical disturbance of the child to the minimum required to deliver emergency
care
• Avoid diuretics in a SAM child with heart failure. Just avoid over
hydration.