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MANAGEMENT

OF

PEM

SYAFINAZ ALI ZAINI

08425

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Follow up

Managementof PEM

Mild

Severe

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MildPEM

Treatment ofinfection /

parasiticinfestation

micronutrients

Supplementationof diet

Nutritionaladvice

Vitamin A, D, Folic acid,

Iron etc.

Calories : 100-150kcal/kg/day

Proteins : 2-3g/kg/day

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SeverePEM

Investigation

HealthEducation

Rehabilization

and Restoring

Stabilization &

Emergencytreatment

Followup

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Urine examination and cultureBlood picture

Stool analysis Blood glucose and electrolytesChest X ray

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Hypothermia

Hypoglycemia

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.

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 solutionIV/nasogastric

For life threatening complications

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Heart Failure

Dehydration

PEM children SHOuld NOT be digitalized

Treat by Oxygen and other supportive

measures ( Correction of K,Mg,Ca)

Restriction of fluid

Electrolyte disturbancesRehydration : Oral or nasogastric

IV : overhydration and heart failure

IV : only in shock or failure of oral

rehydration

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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

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Starting cautious initial feeding

Subsequent Diet

High Energy Diet for

growth catching up

Supplementation for

micronutrients

Stimulation, play and emotional support

NUTRITIONAL STATUS

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Low or lactose free formula for those with milk intolerant

May start with half strength formula

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

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

Feed until reversal of mental changes (smiling)

Start by LITTLE, FREQUENT and ISOTONIC feeds

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Should gradual replace the initial diet

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

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

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

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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

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Multivitaminpreparation are given toprovide at least double

the RecommendationDaily Allowances (RDA)

In case of vitamin Adeficiency : Give single

dose of 50 000

200000U, orally

Zinc, Copper, and othertrace elements (Iodine,Selenium, etc)

Iron SHOULD NOT be

given until infectionsare treated even if the

child is anemic

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PEM delaysmental andbehaviordevelopement

Tender, loving,care,structured play& cheerfulenvironment

Children that

are stimulatedrecoversrapidly andbetter mentaldevelopement

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Health Education

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Follow up

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