Management of TB Patient - Exteremely Underweight

BMI level of less than 14 kg/m2 in men and less than 12 kg/m2 in women pose a threat to life, irrespective of other co-existing conditions.
Assess

• Look for History of unintended weight loss, appetite, and oral intake, dietary assessment, vital signs, anemia, pedal edema, medical condition, socioeconomic condition, Family History

   

Advise

• For Outpatient Care: If an assessment is met with normal clinical parameters
• For Inpatient Care: If an assessment is met with high-risk clinical parameters where referral is required. Refer the patient to the nearest CHC or District Hospital for physician consultation
• Inpatient care is required for all patients with a BMI less than 14 kg/m2 for stabilization and nutritional rehabilitation

Manage
 

• Manage underlying active TB with effective treatment under close supervision and in consultation with Medical Officer DTC / DRTB Center
• Access hydration & electrolytes (including potassium, magnesium). Prevent hypoglycemia, manage appropriately if present
• Correct dehydration if present with Rehydration Solution for Malnutrition which has lower sodium and higher potassium content. It can be prepared using the standard WHO ORS*
• Correct Vitamin and Minerals deficiencies with supplements as per clinical protocol
• Initiate feeding cautiously for patients who have been eating poorly for a long time, as well as those with alcohol abuse and electrolyte imbalance.
• Caloric intake may be initiated at 10kcal/kg/day and built up gradually to avoid the development of a refeeding syndrome, which can have serious complications*. Do not expect weight gain in the first week, which is for the patient to stabilize
• Some patients with severe anorexia, dysphagia, altered sensorium may require nasogastric feeding, which should be carefully administered (Keep head end elevated at 45 degrees)
• Increase feeding as appetite returns, aiming at weight gain from around 2 weeks
• After successful discharge, follow up for 2 months.