As a result of malnutrition, an estimated 149 million (22%) of children under the age of five-years were affected by stunting (low height for age) and 45 million by wasting (low weight for height). Wasting is associated with a high risk of mortality.^1,2

Malnutrition is not just the result of undernutrition, but also be caused by overnutrition (overconsumption of energy and micronutrients eg consuming energy above 1587 calories/day, protein above 41–57g/day, and fat above 19–32g/day increases overweight/obesity both in men and women), imbalance of essential nutrients (pharmacological and pharmaceutical properties of drugs can affect the intake, digestion, absorption, storage, metabolism, and elimination of nutrients, causing imbalance in the amount of nutrients required in the body), impaired nutrient utilisation (diseases that induce loss of appetite, malabsorption of nutrients, or loss of nutrients through diarrhoea or vomiting).² 

Apart from stunting and wasting, malnutrition can result in for example night blindness (vitamin A deficiency), anaemia (iron deficiency), Beriberi (vitamin B1 deficiency), Pellagra disease (vitamin B3 deficiency), birth defects (folic acid deficiency), while overnutrition has been associated with cardiovascular disease, cancer, type 2 diabetes.²

Antibiotics and fluid-management of paediatric patients with severe acute malnutrition

Children with uncomplicated severe acute malnutrition, not requiring to be admitted and who are managed as outpatients, should be given a course of oral antibiotic such as amoxicillin.³

Children who are undernourished but who do not have severe acute malnutrition should not routinely receive antibiotics unless they show signs of clinical infection.³

Children with severe acute malnutrition who present with some dehydration or severe dehydration but who are not shocked should be rehydrated slowly, either orally or by nasogastric tube, using oral rehydration solution for malnourished children (5 ml/kg/hour -10ml/kg/hour up to a maximum of 12 hours.³

Full-strength, standard low-osmolarity oral rehydration solution (75 mmol/l of sodium) should not be used for oral or nasogastric rehydration in children with severe acute malnutrition who present with some dehydration or severe dehydration. Give either ReSoMal or half-strength standard low-osmolarity oral rehydration solution with added potassium and glucose, unless the child has cholera or profuse watery diarrhoea or have profuse watery diarrhoea.3

Such children should be given standard low osmolarity oral rehydration solution that is normally made for example not further diluted.³

Children with severe acute malnutrition and signs of shock or severe dehydration and who cannot be rehydrated orally or by nasogastric tube should be treated with intravenous fluids, either:  half-strength Darrow’s solution with 5% dextrose, or Ringer’s lactate solution with 5% dextrose. If neither is available, 0.45% saline + 5% dextrose should be used.³

Infants who are less than six months old with severe acute malnutrition should receive the same general medical care as infants with severe acute malnutrition who are six months or older.³

Infants with severe acute malnutrition who are admitted for inpatient care should be given parenteral antibiotics to treat possible sepsis and appropriate treatment for other medical complications such as tuberculosis, HIV, surgical conditions, or disability.³

Infants with severe acute malnutrition who are not admitted should receive a course of broad-spectrum oral antibiotic, such as amoxicillin, in an appropriately weight-adjusted dose.³

REFERENCES:

1. Food and Agriculture Organization of the United Nations. 2022 State of Food Security and Nutrition in the World https://www.fao.org/publications/sofi/2022/en/
2. Ersado TL. Causes of Malnutrition. In: Saeed F, Ahmed A, Afzaal MM, editors. Malnutrition [Working Title] [Internet]. London: IntechOpen; 2022 [cited 2022 Aug 19]. Available from: https://www.intechopen.com/online-first/81782 doi: 10.5772/intechopen.104458
3. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization, 2013.