A 2-year-old child from a food-insecure household presents with marked oedema of the face and lower limbs, hepatomegaly with fatty change, apathy, sparse depigmented hair (flag sign), and flaky paint dermatosis. Weight for age is 65% of expected. Serum albumin is 1.8 g/dL. What is the immediate therapeutic priority after resuscitation?
- A Gradual dietary rehabilitation starting at 80–100 kcal/kg/day and 1–1.5 g protein/kg/day to avoid refeeding syndrome ✓
- B High-protein diet starting at 4 g/kg/day immediately
- C IV albumin infusion to correct hypoalbuminemia rapidly
- D Furosemide to treat oedema immediately
Explanation
This child has kwashiorkor (oedematous SAM). The WHO 10-step protocol for severe acute malnutrition mandates gradual dietary rehabilitation to avoid refeeding syndrome (hypophosphataemia, hypokalaemia, hypomagnesaemia triggering cardiac failure). Initial energy intake is 80–100 kcal/kg/day with 1–1.5 g protein/kg/day (F-75 therapeutic formula) in the stabilisation phase, gradually transitioning to F-100 in the rehabilitation phase. High-protein feeding from the start risks refeeding syndrome. IV albumin is not indicated as it does not address the underlying malnutrition and may worsen capillary leak. Diuretics would worsen electrolyte imbalance and intravascular volume.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.