Fluid management in severely malnourished children under 5 years of age with shock
In children who are under 5 years of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length or clinical signs of bilateral pitting oedema. A very low mid-upper arm circumference also indicates severe acute malnutrition in children who are 6–59 months of age. 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.
Children with severe acute malnutrition may have difficulty keeping themselves properly hydrated and may be unable to tolerate the rapid changes in blood volume associated with changes in hydration status. This can lead to shock, a medical emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. Adequately managing fluids is critical for treating shock in children with severe acute malnutrition.
Children under 5 years of age with severe acute malnutrition and signs of shock or severe dehydration and who cannot be rehydrated orally or by nasogastric tube should be treated with intravenous fluids, either
- half-strength Darrow’s solution with 5% dextrose, or
- Ringer’s lactate solution with 5% dextrose
If neither is available, 0.45% saline + 5% dextrose should be used.
This is a summary of one of several WHO recommendations on the management of SAM in infants and children. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines and guidance documents 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
Other guidance documents
Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers
The treatment of diarrhoea: a manual for physicians and other senior health workers
WHO Training course on the management of severe malnutrition, 2002
Management of severe malnutrition: a manual for physicians and other senior health workers
Systematic reviews used to develop the guidelines
Systematic review of the role of fluid infusions and blood transfusions in the care of hospitalized children with severe acute malnutrition
The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review
Related Cochrane reviews
- Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children