Etiopathogenesis of Severe Acute Malnutrition (SAM)

Severe Acute Malnutrition (SAM) is a life-threatening condition caused by prolonged nutritional deficiencies, particularly in children under five years old. It results from a combination of inadequate dietary intake, infection, and underlying metabolic disturbances.

Etiopathogenesis of SAM

The development of SAM is multifactorial and involves physiological, biochemical, and environmental factors:

1. Nutritional Deficiencies

• Insufficient protein-energy intake leading to muscle wasting.
• Deficiency of essential vitamins such as Vitamin A, D, and B-complex.
• Impaired absorption of nutrients due to gastrointestinal infections.

2. Infection & Immune Dysfunction

Repeated infections weaken the body’s ability to maintain adequate nutrition:

• Diarrheal diseases leading to dehydration and loss of essential electrolytes.
• Respiratory infections increasing energy demands and worsening malnutrition.
• Malabsorption syndromes preventing nutrient uptake.

3. Metabolic & Biochemical Imbalance

Severe malnutrition disrupts metabolic pathways:

• Hypoglycemia due to depleted glycogen stores.
• Electrolyte imbalances leading to organ dysfunction.
• Protein catabolism resulting in severe muscle wasting.

Complications of SAM

Unmanaged SAM can result in severe complications:

• Immune suppression increasing susceptibility to infections.
• Cardiovascular collapse due to electrolyte imbalances.
• Developmental delays and cognitive impairment in children.

Management of SAM

Effective management strategies include:

• Therapeutic feeding with ready-to-use therapeutic foods (RUTF).
• Rehydration therapy to restore electrolyte balance.
• Antibiotic therapy for managing secondary infections.
• Micronutrient supplementation to correct deficiencies.