Guidelines for the Inpatient Treatment of Severely Malnourished Children (UNICEF - WHO - OMS, 1998, 21 p.): Appendix 1: Recipe for ReSoMal oral rehydration solution & electrolyte/mineral solution

Guidelines for the Inpatient Treatment of Severely Malnourished Children (UNICEF - WHO - OMS, 1998, 21 p.)

		(introduction...)
		A. General principles for routine care
		B. Treatment of associated conditions
		C. Failure to respond to treatment
		D. Discharge before recovery is complete
		E. Emergency treatment
		Appendix 1: Recipe for ReSoMal oral rehydration solution & electrolyte/mineral solution
		Appendix 2: Recipes for F-75, F-100 and F-135
		Appendix 3: F-75 feed volumes by feeding frequency and body weight
		Appendix 4: Structured play activities

Appendix 1: Recipe for ReSoMal oral rehydration solution & electrolyte/mineral solution

RECIPE FOR RESOMAL ORAL REHYDRATION SOLUTION

Ingredient	Amount
Water	2 litres
WHO-ORS	one 1 litre-packet*
Sucrose	50g
Electrolyte/ mineral solution	40ml

*3.5g sodium chloride, 2.9g trisodium citrate dihydrate, 1.5g potassium chloride, 20g glucose. ReSoMal contains approximately 45mmol Na, 40mmol K and 3mmol Mg/litre.

RECIPE FOR ELECTROLYTE/MINERAL SOLUTION USED IN THE PREPARATION OF ReSoMal AND MILK FEEDS

Weigh the following ingredients and make up to 2500ml. Add 20ml of electrolyte/mineral solution to 1000ml of milk feed.

	quantity g	molar content of 20 ml
Potassium Chloride:KCl	224	24mmol
Tripotassium Citrate: C₆H₅K₃O₇.H₂O	81	2mmol
Magnesium Chloride:MgCl₂6.H₂O	76	3mmol
Zinc Acetate:Zn(CH₃COO)₂.2H₂0	8.2	300umol
Copper Sulphate:CuSO₄.5H₂O	1.4	45umol
Water: make up to	2500ml

If available, also add selenium (sodium selenate 0.028g NaSeO₄ 10H₂0) and iodine (potassium iodide 0.012g KI per 2500ml)

Note: Dissolve the ingredients in cooled boiled water. Store the solution in sterilised bottles in the fridge to retard deterioration. Discard if turns cloudy. Make fresh each month.

If the preparation of this electrolyte/mineral solution is not possible and if pre-mixed sachets are not available, give K, Mg and Zn separately:-

Make a 10% stock solution of potassium chloride (100g KCl in 1 litre of water) and a 1.5% solution of zinc acetate (15g zinc acetate in 1 litre of water).

For the oral rehydration solution, use 45ml of the stock KCl solution instead of 40ml electrolyte/mineral solution.

For milk feeds, add 22.5ml of the stock KCl solution instead of 20ml of the electrolyte/mineral solution to 1000ml of feed.

Give the 1.5% zinc acetate solution by mouth 1ml/kg/day

Give 50% magnesium sulphate intramuscularly once (0.3ml/kg to a maximium of 2ml)