in front of a case that does not tolerate anything orally it is necessary to:
1. place the nasogastric tube,
2. verify if there is still intestinal perstaltism
3. divide the milk from 8 meals to 12 meals or an interval of 2 hours per meal.
4. treat them with F75 milk
5. put the child on amoxicillin as the first choice antibiotic
6. evaluate the evolution of the patient

my experience working in the hospital in uganda, where SAM with complication with and without oedema are being managed is that we follow some steps in general pinciples for routine care:
- we treat/prevent hypoglycemia and hypothermia which usually work hand in hand
- we treat/prevent dehydration which is common even on SAM with oedema (kwashiokor). A customized version of ORS (Resomal) is provided where there are signs of dehydration
-we correct electolyte imbalance with ORS improved formula (Resomal), and our therapeutic feeds which are packed with macro and micronutrients. in the case of oedima the starting formula would be F75, then plumpynut/F100 to catch up with all the nutrients that they've lost
- we treat and prevent infections with a combination of antibiotics: Gentamicin, ampicillin then amoxicillin
- we correct micronutrients deficiency
- we start cautious feeding , then achieve catch up growth , provide sensory stimulation and emotional support; finally prepare for follow up after recovery...

we have great success in the recovery rate of our SAM children with and without oedema, following this protocol.

feel free to let me know if you would like any aditionnal information

Marlyse

Buenas noches. La infusión de albúmina no se recomienda en estos casos, ya que se relaciona con aumento de la mortalidad. En la fisiopatología del edema del desnutrido intervienen los radicales libres, alteración de potasio y magnesio, menos importante el papel de la hipoproteinemia. El edema cede progresivamente cuando se hace el tratamiento prudente y de acuerdo a las directrices de la OMS, ya citadas en una de las respuestas anteriores.

Good evening. Albumin infusion is not recommended in these cases, since it is related to increased mortality. In the pathophysiology of nutritional edema, free radicals intervene, potassium and magnesium alteration, the role of hypoproteinemia is less important. The edema progressively subsides when the prudent treatment is made and according to the WHO guidelines, already mentioned in one of the previous answers.