GastroSAM: Rethinking rehydration for malnourished children

Challenging Long-Standing Guidelines

For over 25 years, treatment guidelines for children with severe acute malnutrition (SAM) and severe dehydration from gastroenteritis have differed significantly from those for well-nourished children. Because SAM affects heart and kidney function, rapid IV rehydration has been feared to overwhelm these fragile organs. As a result, the World Health Organization (WHO) recommended the use of a low-sodium oral rehydration solution (ORS), and restricted IV fluids to cases of shock under strict medical supervision.

Despite these precautions, hospital data from several African countries have continued to show high mortality from dehydration among children with SAM. The conservative approach in the rehydration guidelines has largely been based on expert opinion rather than strong clinical evidence.