A 2-year-old child with severe acute malnutrition (SAM) presents with bipedal pitting edema, skin changes (flaky paint dermatosis), and irritability. On admission, blood glucose is 1.8 mmol/L. After 10% glucose (5 mL/kg IV over 15 minutes), the next step in management per WHO/UNICEF guidelines is:
- A F-75 therapeutic feed (starter formula) given 2-hourly for the first 1–2 weeks ✓
- B Immediate high-protein, high-calorie diet to rapidly correct nutritional deficit
- C Therapeutic feeding with F-100 immediately to achieve catch-up growth
- D IV albumin infusion to correct hypoalbuminemia before feeding
Explanation
The WHO phased management of SAM begins with F-75 (low-protein, low-energy: 75 kcal/100 mL, 0.9 g protein/100 mL) given in small, frequent feeds (every 2–3 hours, day and night) during the initial stabilization phase (1–2 weeks). F-75 prevents refeeding syndrome by avoiding excessive protein and energy loads on a compromised metabolism. Aggressive high-protein/high-calorie feeding risks refeeding syndrome (hypophosphatemia, hypokalemia, sudden death). F-100 is used only after metabolic stabilization (transition phase). IV albumin is not recommended; it worsens pulmonary edema in kwashiorkor.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.