Paediatric emergencies: shock in severe acute malnutrition: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: shock in severe acute malnutrition

Sample item

A severely malnourished 2-year-old is lethargic with cold hands, weak pulse and delayed capillary refill, but has no diarrhoea. What is the recommended fluid for shock?

APacked red cells onlyB30 mL/kg normal saline in 15 minutesC15 mL/kg over 1 hour of Ringer lactate with 5 percent dextrose or half-strength saline with 5 percent dextroseDOral ORS only

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. 15 mL/kg over 1 hour of Ringer lactate with 5 percent dextrose or half-strength saline with 5 percent dextrose

Shock in severe acute malnutrition is treated with 15 mL/kg over 1 hour of a fluid such as half normal saline with 5 percent dextrose or Ringer lactate with 5 percent dextrose, and the child is reassessed. Rapid large boluses cause heart failure in these children.

Option by option

A. Packed red cells only
Blood is reserved for severe anaemia with shock after initial treatment.
B. 30 mL/kg normal saline in 15 minutes
Rapid large boluses risk fluid overload.
C. 15 mL/kg over 1 hour of Ringer lactate with 5 percent dextrose or half-strength saline with 5 percent dextrose (correct)
Correct. This is the WHO regimen.
D. Oral ORS only
ORS alone is inadequate for shock.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, 15 mL/kg over 1 hour of Ringer lactate with 5 percent dextrose or half-strength saline with 5 percent dextrose. Shock in severe acute malnutrition is treated with 15 mL/kg over 1 hour of a fluid such as half normal saline with 5 percent dextrose or Ringer lactate with 5 percent dextrose, and the child is reassessed.

Why is "Packed red cells only" not the answer?

Blood is reserved for severe anaemia with shock after initial treatment.

Why is "30 mL/kg normal saline in 15 minutes" not the answer?

Rapid large boluses risk fluid overload.

Why is "Oral ORS only" not the answer?

ORS alone is inadequate for shock.

What concept does this question test?

It tests Paediatric emergencies: shock in severe acute malnutrition in Pediatrics. Rapid large boluses cause heart failure in these children.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: shock in severe acute malnutrition?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.