A 2-year-old child with severe acute malnutrition (SAM) presenting with edema, severe wasting, and miserable demeanor is admitted. On admission, blood glucose is 42 mg/dL. Which of the following is the most important initial intervention to prevent mortality?

• A Immediately start F-100 therapeutic milk for rapid catch-up growth
• B Start IV fluids with normal saline boluses at 20 mL/kg
• C Treat and prevent hypoglycemia with oral 10% glucose/sucrose solution and frequent feeds ✓
• D Begin iron supplementation immediately as iron deficiency is universal in SAM

Explanation

In SAM, hypoglycemia (blood glucose below 54 mg/dL) is a key cause of early mortality. The first priority per WHO protocols is treating and preventing hypoglycemia, using oral/NG 10% glucose or sugar water if the child is conscious. IV fluids are avoided in SAM unless there are signs of circulatory shock, because SAM children have impaired cardiac function and are at risk of fluid overload. F-100 is used in the rehabilitation phase (Phase 2), not Phase 1 (acute/stabilization). Iron is specifically delayed until Phase 2 because early iron supplementation in the acute phase can worsen infections by providing substrate for bacterial growth.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.