Etiopathogenesis, Classification, Clinical Features, Complications, and Management of Severe Acute Malnutrition (SAM)

Introduction

Severe Acute Malnutrition (SAM) is a life-threatening condition that occurs due to extreme deficiency of essential nutrients. It primarily affects children under five years of age, leading to increased morbidity and mortality.

Etiopathogenesis

SAM arises from inadequate nutritional intake, infections, or underlying medical conditions. Factors such as poverty, food insecurity, and lack of breastfeeding exacerbate its prevalence.

Classification

• Marasmus: Severe wasting due to chronic energy deficiency.
• Kwashiorkor: Characterized by edema and protein deficiency.
• Mixed Malnutrition: Features of both Marasmus and Kwashiorkor.

Clinical Features and Diagnostic Criteria

The diagnosis of SAM is based on specific anthropometric and clinical criteria:

• Weight-for-height Z-score less than -3 SD
• Mid-upper arm circumference (MUAC) below 11.5 cm
• Presence of bilateral pitting edema

Complications

Complications of SAM include hypoglycemia, hypothermia, electrolyte imbalance, severe infections, and micronutrient deficiencies. If left untreated, these complications may lead to fatal outcomes.

Management

The treatment of SAM follows a stepwise approach:

1. Stabilization: Correction of hypoglycemia and hypothermia.
2. Dietary Therapy: Use of therapeutic foods such as F-75 and F-100 formulas.
3. Medical Treatment: Management of infections and electrolyte imbalances.
4. Follow-up: Regular monitoring and long-term nutritional rehabilitation.