Malnutrition: nutritional rehabilitation and monitoring — formative SAQs

SAQ 1 — The wasted toddler with appetite loss (10 marks, 15 minutes)

A 16-month-old boy is brought in with marked weight loss over six weeks. His weight-for-height z-score is minus 3.4, his MUAC is 108 mm, and he has no oedema. He is afebrile but lethargic, and when offered ready-to-use therapeutic food he takes only a few mouthfuls and then refuses. A bedside glucose is normal. ^[1]

a) What severity of acute malnutrition does this child have, and what single clinical finding changes his disposition? Justify your answer. (3 marks) ^{[1] [11]}

b) Outline your inpatient nutritional rehabilitation, naming the stabilisation formula, its energy content and the aim of the stabilisation phase, and how and when you move to catch-up feeding. (4 marks) ^{[1] [8]}

c) Describe how you would prevent, detect and treat refeeding syndrome in this child, including the specific biochemistry you monitor, how often, and one micronutrient you give before feeding. (3 marks) ^{[3] [6]}