ReSoMal

ReSoMal stands for Rehydration Solution for Malnutrition. It is a specialized oral rehydration fluid formulated specifically for the management of children with Severe Acute Malnutrition (SAM) who present with some or severe dehydration but are not in shock.

Physiological Rationale

Children with SAM have an altered physiology characterized by "reductive adaptation."

• Sodium Excess: They have an excess of total body sodium, even though plasma sodium levels may appear low. Giving standard ORS (high sodium) can lead to sodium overload and heart failure.
• Potassium/Magnesium Depletion: They have severe intracellular depletion of potassium and magnesium.
• ReSoMal Design: To address this, ReSoMal has lower sodium (37.5–45 mmol/L) and higher potassium (40 mmol/L) compared to standard WHO low-osmolarity ORS.

Composition

The approximate electrolyte concentration of ReSoMal is:

• Sodium: 45 mmol/L (approx. half of standard ORS)
• Potassium: 40 mmol/L
• Glucose: 125 mmol/L
• Magnesium: 3 mmol/L
• Zinc: 0.3 mmol/L
• Copper: 0.045 mmol/L
• Osmolarity: 300 mOsm/L

Preparation

Since ReSoMal is not always commercially available, it is prepared using standard WHO Low-Osmolarity ORS packets. The recipe is:

1. Take one packet of standard WHO Low-Osmolarity ORS (meant for 1 liter).
2. Dissolve it in 2 liters of boiled and cooled water (this dilutes the sodium).
3. Add 50 g of sucrose (sugar) to maintain energy and osmolarity.
4. Add 40 mL of Mineral-Electrolyte Solution (CMV) to provide potassium, magnesium, and trace elements.
   • Alternative: If CMV is unavailable, add 45 mL of Potassium Chloride syrup or 30 mL of Potassium Chloride injection.

Administration and Monitoring

• Route: Oral or Nasogastric tube. It should never be given intravenously.
• Dosage:
  • First 2 hours: 5 mL/kg every 30 minutes.
  • Next 4–10 hours: 5–10 mL/kg on alternate hours.
• Monitoring: Careful monitoring is required to prevent fluid overload. Rehydration must be stopped if the pulse rate increases by 25 beats/min or respiratory rate increases by 5 breaths/min.

Contraindication

If the malnourished child has profuse watery diarrhea (suspected cholera), ReSoMal should not be used. Standard low-osmolarity ORS should be used instead to adequately replace the massive sodium losses associated with cholera.