Complicated severe acute malnutrition is severe wasting or nutritional oedema accompanied by poor appetite, emergency signs or significant medical complications. These children require inpatient stabilization because ordinary paediatric fluid and feeding regimens can precipitate heart failure, electrolyte disturbance and death.

• Treat hypoglycaemia immediately and begin frequent feeding.

• Prevent and treat hypothermia.

• Begin F75 stabilization feeds in small frequent volumes. Nasogastric feeding is appropriate when oral intake is inadequate but the gut is functional.

• Dehydration is managed cautiously. In a child with SAM and diarrhoea who can tolerate enteral fluid, use ReSoMal approximately 10 mL/kg/hour for the first 2 hours, then approximately 7.5 mL/kg/hour, alternating subsequently with F75 according to response.

• True shock requires extreme caution. One locally used regimen is Ringer's lactate with 5% dextrose 20 mL/kg over 2 hours, with continuous reassessment. Severe anaemia requires urgent transfusion rather than crystalloid loading.

• Treat presumed bacterial infection empirically because typical inflammatory signs may be absent.

• Correct potassium and magnesium deficiency and avoid excessive sodium.

• Withhold iron during initial stabilization; start during nutritional rehabilitation once infection is controlled and weight gain has begun.

• Transition from F75 to rehabilitation feeding only after appetite returns, oedema begins resolving and acute complications stabilize.

Complicated Severe Acute Malnutrition

Overview

Clinical Features

Diagnosis

Management