I found an article from a previous post addressing the issue of IV fluids and how they may affect MUAC, http://www.nutritionj.com/content/10/1/92 and based on that article it seems that treatment of SAM in a child with cholera should likely wait until the child is recovering well and finished with IV fluids before we screen with MUAC for admission. Is this the protocol that most people use in the case of a cholera and SAM? Also, would a SAM case would then be considered uncomplicated (and therefore eligible for OTP) since the cholera symptoms have cleared up and presuming the child has no other complications?
Hi Anonymous,
The danger is in misclassification and this is 'more likely' to occur with WFH than with MUAC due to dehydration. If a child is classified as SAM with MUAC then it is best to err on the side of safety and treat the child as SAM until the fluid deficit is corrected and the child can be checked again. If the child is no longer SAM by any criterion following rehydration then you may be able to adjust your diagnosis and alter your treatment accordingly. In terms of treatment of cholera you would still use the same rehydration solution for a SAM case as a non-SAM case (see WHO updates 2013). I think there is potentially more harm to the child done by withholding treatment for SAM than in proceeding with treatment and adjusting the diagnosis later.
Answered:
9 years ago