Severe Malnutrition in Adolescents and Adults with Medical Complication

Clinical Description

Most adolescents and adults with severe undernutrition will present with other health problems.

Signs and Symptoms

• Severe bilateral pitting oedema (Grade +++)
• Failed appetite test
• Infection that requires intravenous antibiotics
• Inability to care for oneself and absence of caretakers at home

Treatment

MEDICAL MANAGEMENT

• All adolescents and adults with severe malnutrition with complications require admission to the hospital.
• Review the client’s medical records and condition and treat severe infections and other medical conditions, such as severe anaemia, chronic diarrhoea, severe dehydration, HIV, TB, malignancy as per the national guidelines and refer where appropriate.

Non-pharmacological

• If admitted to inpatient care, give the client F-75 as an initial feed for the first 1–2 days based on weight (130 ml/kg/day).
• If the client has severe (+++) oedema, give only 100 ml/kg/day of F-75

See the table below for daily amounts of F-75 therapeutic milk feeds for adolescents and adults who are wasted or have bilateral pitting oedema + or ++.

Weight of patient (kg) 8 feeds per day, amount of each feed (ml) 15.0–19.9 260 20.0-24.9 290 25.0–29.9 300 30.0–39.9 320 40.0–60.0 350

See the table below for daily amounts of F-75 therapeutic milk feeds for adolescents and adults with severe bilateral pitting oedema (+++).

Weight of patient (kg) 8 feeds per day, amount of each feed (ml) 15.0–19.9 210 20.0-24.9 230 25.0–29.9 240 30.0–39.9 255 40.0–60.0 280

• When the condition is improving and the client is ready to transition, gradually introduce RUTF.
• When the client is able to consume 75% to 100% (2–3 sachets) of RUTF, stop giving the F-75 milk feeds.
• If the client is having difficulty eating RUTF due to mouth sores or severe oral thrush, use F-100 instead of RUTF during the transition period.