A 3-year-old boy from a remote area presents with bilateral pitting edema up to the thighs, skin peeling (flaky-paint dermatosis), depigmented hair (flag sign), hepatomegaly, and irritability/apathy. Weight-for-height z-score is −3. His serum albumin is 1.6 g/dL. According to the WHO F-75/F-100 rehabilitation protocol, what is the CORRECT first 48-hour management priority?
- A High-protein diet immediately to correct hypoalbuminemia
- B Treat/prevent hypoglycemia, hypothermia, and infections; start F-75 formula cautiously ✓
- C IV albumin infusion to correct edema and hypoalbuminemia
- D High-calorie F-100 formula immediately to accelerate recovery
Explanation
This is Kwashiorkor (severe acute malnutrition with edematous SAM). The WHO 10-step management protocol prioritizes immediate treatment of life-threatening complications before nutritional rehabilitation: hypoglycemia (2 mg/kg glucose bolus), hypothermia (keep warm), dehydration (ReSoMal — not standard ORS which has too much sodium), electrolytes (K+ and Mg²+ supplementation), infections (broad-spectrum antibiotics), and micronutrients. F-75 (75 kcal/100 mL, low protein) is used in the stabilization phase (first 1–7 days) to allow slow recovery without overwhelming the damaged metabolic pathways. Starting with high-protein diet or F-100 immediately risks refeeding syndrome and worsening edema. IV albumin infusion does not address the cause and is contraindicated (overloads failing cardiac function).
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.