Severe Acute Malnutrition in Adolescents and Adults

CLINICAL DESCRIPTION

Severe acute malnutrition in adolescents and adults is defined as bilateral pitting oedema or MUAC <18.5cm or Body-Mass-Index (BMI) <16.0.

In pregnant/lactating women severe acute malnutrition is defined as a MUAC <19.0cm.

SEVERE MALNUTRITION IN ADOLESCENTS AND ADULTS WITH MEDICAL COMPLICATION

CLINICAL FEATURES

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.

NUTRITIONAL CARE

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 the Patient	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 the Patient	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.

ADOLESCENTS AND ADULTS WITH SEVERE MALNUTRITION WITHOUT COMPLICATIONS

MEDICAL TREATMENT

Assess for associated or underlying medical conditions such as HIV, TB, malignancy or anaemia and provide treatment or refer for treatment according to the national guidelines.

NUTRITIONAL CARE

All patients who fail the appetite test i.e., does not eat at least half a sachet of RUTF, should be referred to in-patient care.
Patients who pass the appetite test should be given 3 sachets of RUTF and 300 grams of likuni phala per day or 3 sachets of RUTF and 300 grams of CSB++ (Corn Soya Blend) to consume at home provided they have someone to support him or her.
RUTF and likuni phala or CSB++ should not be shared with family members; they should not be discontinued if the patient has diarrhea and they should be given in addition to the family food.

Note: Severely undernourished pregnant and lactating women up to 6-month post-partum should not be treated with RUTF. Provide the client with only likuni phala or CSB ++ or other supplementary food that meets recommended standards. RUTF contains high doses of vitamin A, above the recommended 10,000 IU per day. High doses of vitamin A can cause teratogenic effects in early pregnancy.

Encourage pregnant and lactating women to meet their additional energy requirements by eating other home-prepared nutritious foods.
Adolescents and adults should be transitioned from severe undernutrition without medical complications to moderate undernutrition if the criteria indicated in the table below are met.

Group	BMI	BMI for Age	MUAC	Weight
12–14 years		≥ –3	≥ 160 mm	Gains 10% or more of his/her body weight
15–18 years		≥ –3	≥ 185 mm
≥ 19 years	≥ 16.0		≥ 190 mm
Pregnant women and lactating women up to 6 months postpartum			≥ 190 mm	Gains at least 2.0 kg per month