If rehydration is still required at 10 h, give starter F-75 (see recipes) instead of ReSoMal, at the same times.

If not available then give half strength standard WHO oral rehydration solution with added potassium and glucose as per the ReSoMal recipe below, unless the child has cholera or profuse watery diarrhoea. The exact amount depends on how much the child wants, the volume of stool loss and whether the child is vomiting. Then give 5–10 ml/kg per h for the next 4–10 h on alternate hours, with F-75 formula. Give 5 ml/kg every 30 min for the first 2 h. Give the ReSoMal rehydration fluid orally or by nasogastric tube, more slowly than you would when rehydrating a well-nourished child: – Instead, give special rehydration solution for malnutrition, ReSoMal. The standard WHO ORS solution for general use has a high sodium and low potassium content, which is not suitable for severely malnourished children. Rehydrate slowly, either orally or by nasogastric tube, using oral rehydration solution for malnourished children (5–10ml/kg per h up to a maximum of 12 hours). Do not use the IV route for rehydration, except in cases of shock.

Sam pdf basic