Correction of electrolyte imbalance

Normally the body uses energy to maintain appropriate balance of potassium inside the cells and sodium outside the cells. In severely malnourished children the level of sodium in the cells rises and potassium leaks out due to reductive adaptation.

Therefore all severely malnourished children should be given potassium to make up for what is lost. Magnesium is essential for potassium to enter the cells and be retained. Malnourished children already have excess sodium in their cells, so sodium intake should be restricted.

In order to correct electrolyte imbalance:-

  • Give supplemental potassium at 3–4 meq/kg/day for at least 2 weeks. Potassium can be given as syrup potassium chloride; the most common preparation available has 20meq/15ml. It should be diluted with water.
  • On day 1, give 50% magnesium sulphate IM once (0.3 mL/kg) up to a maximum of 2 ml. Thereafter, give extra magnesium (0.4 – 0.6 mmol/kg/daily) orally. If oral commercial preparation is not available you can give injection magnesium sulphate (50%); 0.2–0.3 ml/kg orally as magnesium supplements mixed with feeds. Give magnesium supplements for 2 weeks.
  • Give food without added salt to avoid sodium overload.

Do not treat oedema with diuretics