Severe Acute Malnutrition (SAM)
Severe Acute Malnutrition (SAM) is defined by a very low weight-for-height (below -3 SD of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional edema.
Clinical Presentations
| Type | Key Characteristics |
|---|---|
| Marasmus | Severe wasting of muscle and fat (“skin and bones”), calorie deficiency. No edema. |
| Kwashiorkor | Protein deficiency out of proportion to calories. Peripheral edema, fatty liver, skin lesions, and hair changes. |
Management: The “10 Steps” (WHO Protocol)
Management is divided into three phases: Stabilization, Transition, and Rehabilitation.
- 1. Treat/prevent hypoglycemia: Feed immediately.
- 2. Treat/prevent hypothermia: Keep warm.
- 3. Treat/prevent dehydration: Use cautious rehydration (ReSoMal).
- 4. Correct electrolyte imbalance: High potassium/low sodium.
- 5. Treat/prevent infection: Broad-spectrum antibiotics.
- 6. Correct micronutrient deficiencies: Vit A, Zinc, and folic acid.
- 7. Start cautious feeding: Frequent small feeds (F-75 diet).
- 8. Achieve catch-up growth: Transition to F-100/RUTF.
- 9. Provide sensory stimulation/emotional support.
- 10. Prepare for follow-up.
CRITICAL WARNING (Refeeding Syndrome):
Do not aggressively feed a starving child. Rapid infusion of calories/glucose triggers a massive insulin surge, leading to intracellular shifts of Phosphate, Potassium, and Magnesium. This can result in fatal arrhythmias and heart failure. Start slow (F-75) and monitor electrolytes closely.
Do not aggressively feed a starving child. Rapid infusion of calories/glucose triggers a massive insulin surge, leading to intracellular shifts of Phosphate, Potassium, and Magnesium. This can result in fatal arrhythmias and heart failure. Start slow (F-75) and monitor electrolytes closely.
For high-yield clinical resources and free medical questions, visit mymedschool.org. Enroll in our NEET PG High-Yield Review Course: Master Core Subjects and Clinical Recalls.