How is marasmus treated?
People in treatment for marasmus are at risk of refeeding syndrome, a life-threatening complication that can result when the undernourished body tries to reboot too fast. For this reason, rehabilitation happens in stages. Ideally, people with marasmus should be treated in a hospital setting, under close medical supervision. Healthcare providers who are trained to anticipate and recognize refeeding syndrome can help prevent or correct it by supplementing missing electrolytes and micronutrients.
Stage 1: Rehydration and stabilization
The first stage of treatment is focused on treating dehydration, electrolyte imbalances and micronutrient deficiencies to prepare the body for refeeding. In many cases, these can all be treated with one formula, REhydration SOlution for MALnutrition (ReSoMal), given orally or through a nasogastric tube. It’s also important to keep the person warm to prevent hypothermia and to treat infections, which compromise their meager energy resources. Depending on the individual, it may take several hours to days before they are considered stable enough to begin refeeding.
Stage 2: Nutritional rehabilitation
Refeeding begins slowly with liquid formulas that carefully balance carbohydrates, proteins and fats. For inpatients, healthcare providers prefer tube feeding because it allows for gradual but continuous nutrition. Calories are introduced at about 70% of normal recommended values for the person’s age. Eventually, they may increase to 140% of recommended values to meet the growth requirements of stunted children. This phase may last two to six weeks. During this time, patients gradually progress to more ordinary oral feeding with solid foods.
Stage 3: Follow-up and prevention
Since marasmus can recur, a complete treatment protocol includes education and outgoing support for the patient and/or their caregiver before they are discharged. In the developing world, this may mean breastfeeding support, safe drinking water and food preparation guidelines, immunizations and education to prevent widespread diseases. In the developed world, caregivers may need guidance on how to recognize signs of malnutrition in those they care for. The Malnutrition Universal Screening Tool (MUST) can help identify people at risk.
