How should I treat a severely malnourished child in shock?

If a severely malnourished child is in shock, do the following:

  • Give oxygen.
  • Give sterile 10% glucose (5ml/kg) by IV.
  • Give IV fluid at 15ml/kg over 1 hour. Use Ringer’s lactate with 5% dextrose; or half-normal saline with 5% dextrose; or half-strength Darrow’s with 5% dextrose; or if these are unavailable, Ringers lactate
  • Measure and record pulse and respiration rates before starting and then every 10 minutes
  • Give antibiotics IV.

If there are signs of improvement (pulse and respiration rates fall):

  • Repeat IV 15ml/kg over 1 hour, then
  • Switch to oral or nasogastric rehydration with ReSoMal, 10ml/kg/h for up to 10 hours. Give ReSoMal in alternate hours with F75, then
  • Continue feeding with F75.
  • If the child fails to improve after the first 15ml/kg IV, assume the child has septic shock. In this case:Give maintenance IV fluids (4ml/kg/h) while waiting for blood
  • When blood is available transfuse fresh whole blood at 10ml/kg slowly over 3 hours, then
  • Begin feeding with F75.

How do I tell the difference between dehydration and sepsis?

Shock from dehydration and sepsis are likely to co-exist in severely malnourished children. They are difficult to differentiate on clinical signs alone. Children with dehydration will respond to IV fluids. Those with septic shock and no dehydration will not respond.

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