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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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