A 2-year-old severely malnourished child with bilateral pitting edema, skin changes, and hair depigmentation is being treated for Kwashiorkor. On day 3 of treatment, he develops persistent hypoglycemia, hypothermia, and bradycardia despite glucose supplementation. What is the MOST likely complication responsible for this clinical deterioration?
- A Refeeding syndrome causing hypophosphatemia
- B Cardiac failure from rapid fluid resuscitation
- C Unrecognized concurrent infection (sepsis) with metabolic derangement ✓
- D Vitamin A deficiency causing ophthalmic complications
Explanation
In severe acute malnutrition (SAM), the leading cause of treatment failure and early death (especially in the first 72 hours) is unrecognized or under-treated concurrent infection/sepsis. Children with SAM have profoundly impaired immunity, reduced inflammatory response, and often lack fever even with severe infection (hypothermia may indicate sepsis). Persistent hypoglycemia (despite glucose), hypothermia, and bradycardia in SAM despite standard management should prompt urgent evaluation for sepsis and broad-spectrum antibiotic escalation. WHO SAM management protocol recommends empirical antibiotics for ALL admitted SAM children even without overt signs of infection. Refeeding syndrome occurs later (>3 days) with electrolyte shifts.
Reference: Ghai Essential Pediatrics, 10th ed.
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