Algorithm for Treatment of profuse acute watery diarrhea/Cholera in children with Severe Acute Malnutrition

Somali Region, Ethiopia Key messages:

  • Acute watery diarrhea (AWD) results in extensive loss of fluid and electrolytes.
  • AWD can kill rapidly, so need to act quickly to refer any suspected case, as children with SAM are even more vulnerable.
  • Children with severe acute malnutrition must be treated differently because their physiology is seriously abnormal.
  • Patient with SAM must be slowly rehydrated compare to well-nourished children because they quickly get over hydrated and have heart failure.
  • The diagnosis of dehydration is difficult in children with SAM as the usual signs of dehydration (sunken eyes, lethargy, loss of skin turgor) may be present in these children all of the time, whether or not they re dehydrated.
  • The diagnosis of SAM in dehydrated children can also be difficult, as MUAC and weight for height can be affected by rehydration. Reassessment of nutritional status is recommended following rehydration, with diagnosis and management adjusted as needed.
  • FINAL-Algoritm-and-Protocol_AWD-in-SAM_31_July-_2017_do.doc (205 downloads)


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