Severe Acute Malnutrition (SAM) : Definition, Etiology, Pathophysiology, Types, Criteria, Signs, Symptoms, Complications, Management, & Prevention
Definition
Severe Acute Malnutrition (SAM) is said to be there if any one out of three are present
- Severe wasting (Weight for height <70% or < -3 standard deviation)
- Mid upper arm circumference (MUAC) < 11.5 cm
- Decrease in weight for age with symmetrical edema
Types
Criteria | Kwashiorkor | Marasmus |
Edema | Edematous SAM | Non-edematous SAM |
Cause | Moderate to severe deficiency of calories + Severe deficiency of protein + Free radical damage | Severe deficiency of calories & protein But no free radical damage |
Features | Hallmark features (PEM-G) P: Psychomotor changes (irritability, apathy) E: Edema (e.g. ascites, effusion) M: Muscle wasting G: Growth retardation (stunting) Other features Hepatomegaly Hypoalbuminemia Poor appetite Hair changes (FLAG sign) Skin changes (Flaky paint dermatosis OR Crazy pavement dermatosis) Increased infections | No edema No CNS changes No hair changes No skin changes Alopecia Wrinkles on face (Old man look OR Monkey child look) Baggy pants appearance due to fat loss from thigh & buttocks Voracious appetite |
Prognosis | Poor | Better outcome |
Hormones in SAM
Increase | Decrease |
Serum cortisol | Serum growth hormone |
Serum insulin | Serum IGF-1 (Somatomedins) |
Complications
Mnemonic: SHIELDED
- S: Sugar deficiency i.e. hypoglycemia
- H: Hypothermia
- I: Infections
- EL: Electrolyte disturbances
- DE: Dehydration
- D: Diarrhea → Death
Management
Hospitalize
↓
2 phases
⇓
Stabilization (0-7 days)
Rehabilitation (2nd to 6th week)
Following guideline is followed:
A. Stabilization phase (0-7 days)
Treat & prevent
- Hypoglycemia (First 2 days)
- Hypothermia (First 2 days)
- Dehydration (First 2 days)
- Infections (All days)
Initiation of feeds
- Day 1
75-80 Kcal/kg/day
0.8-1 g/kg/day of proteins
↓Slowly increase
- Day 7
100-110 Kcal/kg/day (Never by ≥ 130 Kcal/kg/day)
2-3 g/kg/day of proteins
- Type of food: F-75 feed
- Timing: Feed every 2-3 hourly
Micronutrients
- All micronutrients are needed (except: Oral iron in stabilization phase)
1. Vitamin A (orally)
- < 6 months: 50000/IU
- 6-12 months: 1 lakh/IU
- > 12 months: 2 lakh/IU
2. Folic acid
- Day 1: 5 mg
- Later on: 1 mg/day
3. Zinc
- 2 mg/kg/day
4. Copper
- 0.2 mg/kg/day
B. Rehabilitation phase (2-6 weeks)
Give micronutrients as before
+
Oral iron 3 mg/kg/day
- Calorie: 175-200 Kcal/kg/day
- Protein: 4-6 g/kg/day
- F-75 → F-100
Failure of therapy
A. Primary failure to respond
- Failure to regain appetite by day 4 OR
- Failure to start losing edema by day 4 OR
- Presence of edema on day 10 OR
- Failure to gain at least 5 gm/kg/day by day 10
B. Secondary failure to respond
- Failure to gain at least 5 gm/kg/day by day for 3 consecutive day during rehabilitation phase.
Disclaimer: DoctorAlerts is an educational platform. It does not provide medical advice, diagnosis, or treatment. We neither promote nor sell any type of prescription drug or supplement.