Inpatient Monitoring & Problem Solving for Severe Acute Malnutrition — Checklist

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Daily bedside checklist for monitoring and troubleshooting inpatient severe acute malnutrition.

• Check for danger signs (severe lethargy, convulsions, respiratory distress)

  Look for conditions that need immediate emergency action.

• Measure and record weight and oedema status

  Use the same scale daily; note pitting oedema and symmetry.

• Assess and document vital signs (temperature, pulse, respiratory rate)

  Record values on the chart and compare to prior readings.

• Test blood glucose and treat hypoglycemia if low

  Check immediately on admission and with any low-consciousness episode.

• Start or adjust therapeutic feeding plan based on weight

  Calculate feed volumes and types using current weight.

• Verify feeding volume and schedule for each meal

  Confirm prescribed ml per feed and feeding times match plan.

• Observe feeding tolerance and document vomiting or diarrhoea

  Note signs of intolerance and time since feed started.

• Monitor fluid balance and signs of dehydration

  Track intake/output, skin turgor, and urine output.

• Review and treat infections promptly

  Start antibiotics when clinical assessment indicates infection.

• Monitor for hypothermia and keep patient warm

  Provide blankets or skin-to-skin and avoid cool surfaces.

• Check electrolyte and micronutrient corrections

  Ensure potassium, zinc, vitamin A, and other supplements are given per plan.

• Order or review relevant laboratory tests (CBC, electrolytes)

  Request labs to guide treatment when indicated.

• Investigate causes of poor or no weight gain and adjust plan

  Check feeding technique, intolerance, intercurrent illness, or missed feeds.

• Escalate care to a senior clinician for persistent complications

  Request review if problems continue despite adjustments.

• Communicate care plan and feeding instructions to caregiver

  Explain schedule, warning signs, and how to help at bedside.

• Record daily progress and review discharge readiness

  Track weight trend, clinical stability, and milestone criteria.

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