Treatment of hypoglycaemia in severely malnourished children
In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.
All severely malnourished children are at risk of developing hypoglycaemia - or low blood sugar - which can rapidly lead to death if not treated. Hypoglycaemia may be caused by a serious systemic infection or can occur when a malnourished child has not been fed for 4–6 hours.
The treatment or prevention of hypoglycaemia and hypothermia should be included in the initial treatment a severely malnourished child receives when first admitted to hospital.
All severely malnourished children are at risk of hypoglycaemia and, immediately on admission, should be given a feed, or glucose or sucrose solution.
If the child is conscious and able to drink, glucose or sucrose should be given orally or by nasogastric tube followed by small and frequent feedings with F75 therapeutic milk.
If the child is unconscious, glucose should be given intravenously, or glucose or sucrose by nasogastric tube. When the child regains consciousness, small and frequent feedings with F75 therapeutic milk should be started.
All malnourished children with suspected hypoglycaemia should also be treated with broad-spectrum antimicrobials for serious systemic infection.
This is a summary of WHO recommendations on the treatment of hypoglycaemia in severely malnourished children. The full set of recommendations including a suggested scheme for treatment can be found in the documents, Pocket book of hospital care for children (second edition): guidelines for the management of common childhood illnesses and Management of severe malnutrition: a manual for physicians and other senior health workers under ‘WHO documents’ below.
Updates on the management of severe acute malnutrition in infants and children
Pocket book of hospital care for children: second edition. Guidelines for the management of common illnesses with limited resources