I do not think there are recommendations against using ORS in MAM. I would use ORS when dehydration is suspected, Fortified blended flours, which are the most commonly used supplementary foods, do not contain much salt at all, so sodium may be needed for intestinal water absorption, and rehydration. In SAM electrolyte balance is perturbed, RUTF has lots of solute in it, and free water and breast milk will probably be adequate to rehydrate.

Resomal was introduced at a time when standard WHO ORS had a high Na content (90 mEq/L). As SAM children poorly tolerate Na, at that time it was recommended for SAM children to give one glass of ORS and then one glass of water. Resomal was a simplification avoiding this complex rehydration schema and also had the advantage of providing extra sugar and some Zn. Now, the standard WHO solution has a lower osmolarity and a lower Na content (70mEq/L). And it is a standard WHO recommendation to give Zn (or Zn feeds for SAM children) in case of diarrhoea. The rationale for using Resomal instead of standard ORS is not so clear. In any case, I don’t see any advantage of using it in MAM. FYI, WHO considered adding Zn to ORS, but eventually recommended to give it separately, as the dose of ORS given in case of diarrhoea is highly variable. Giving a Zn tablet is a more effective way to give a standard Zn dose.