- Rickets will only develop if growth is taking place, marasmic

of mothers Curalive - [a) Treatment of any accompanying Infection or diarrhoea .[b) Adequate supply of proteins and calones - High protein (3-5 gm/kg/day), calories upto 200 cals/kg/day. palatable and digestible with small frequent feeds .Widening of diet should be gradual. Principles same as in marasmus (c) Multipurpose food (MPF),a low fatted ground nut with Bengal grams (75.25) is also useful (d}Vitamin and mineral supplements. (e) Treatment of complication such as skin sepsis, lung infection, etc. (f) Treatment of elact'rolyte imbalance Potassium supplements orally upto 4-5 irEq/kg/day .lnjection magnesium sulphale 0.1 ml/kg/day of 50%solutioh. aids Incatch-up growth [g) Zinc and multivitamln supplementation Iron should! not be used in the acute stages since it catalyses the production of free radiats Should be given after oedema subsides and recovery has begun (h) Treatment of cardiac failure -Diuretics, cautious digitallsailon if co-existing severe anaema packed cells 15 ml/kg. never If Hb>5 gm% On recovery initial weight loss due to loss ol oedema and thus gainof dry weight (Inverted tick sign of Wharton) The first smile given by the child is important sign ol recovery (i) Investigaiion for underlying TB - Mantoux teat may be negative (false negative) Chest X-ray, gastric lavage for diagnosis Aacites. if present. Is almosl always fuberculous MARASMlC KWASHIORKOR - Severe form of PEM where some cases may present with both marasmus and kwashlorkorwrth variable manifestailonsol each High mortality Treatmenl pnnciples same 13 RICKETS Biology Age - Between 4 months-2 years, also in prematures. Diet - Less common in breast fed infants, may develop if mothers diet is poor. growth - Rickets will only develop if