<prompt> All are the criteria for the diagnosis of severe acute malnutritionSAM except:Weight-for-length or height below -3SDMid Upper arm circunference 11.5cmBilateral edemaVisible severe wasting  <response>: Visible severe wasting is no longer a criteria to diagnose Severe acute Malnutrition SAM Severe acute malnutritionSAM in children of ages 6 to 59 months is defined by WHO as any of the following: Weight-for-length or height below -3SD of the WHO child growth standards Presence of bipedal edema Mid-Upper arm circumference 11.5cm The previous name Protein-Energy malnutrition is avoided, as it oversimplifies the complex multi-deficiency etiology. Clinical features: Treatment: The general treatment involves 10 steps in 2 phases Phases: Initial Stabilization Phase: Focuses on restoring homeostasis and treating medical conditions 2-7 days of inpatient treatment Rehabilitation Phase: Treat hypoglycemia Blood Glucose level 54 mgdl: If symptomatic give 10 Dextrose IV 5 mlKg. Feeding should be initiated with staer F-75 Formula with 75 Kcal100 ml of feed Treat hypothermia axillary 35oC or 95oF : Skin-to-Skin contact with care Kangaroo technique of dress in warmer clothes, cover head, wrap in a warmed blanket, and provide indirect heat. Treat dehydration: Hydrate with ReSoMal 45 mmol NaL. It is a low-sodium rehydration solution for malnutrition. Correct electrolyte imbalance: There is a deficit of potassium and magnesium and excess sodium. Give extra potassium 3 to 4 mEqKgday and magnesium 4 mEqKgday for atleast 2 weeks. Treat infection: Staing on the first day, give broad-spectrum antibiotics to all children. Correct micronutrient deficiencies: Donot give iron in the stabilizing phase, because excess iron leads to free radical injury. Give iron 3mgKgday once the child stas gaining weight after the stabilization phase. Give Vitamin A on day 1. Repeat on day 2 and day 14 Folic acid 1 mg 5 mg on day 1 Zinc 2 mgKgday Copper 0.3 mgKgday Sta caitious feeding: Give 8 to 12 small feeds of F75 to provide 130 mLKgday, 100 Kcalkgday, and 1 to 1.5 g proteinKgday Rehabilitation: The indications of entry to this phase are reducedminimal edema and the return of appetite Begining of feeding After 3 days, the transition to energy-dense feeding Stimulation of emotional and sensorial development Transfer to home-based diet Ref: Ghai Essential Pediatrics 9th edition Pgno: 97 