The following information is from the PASA
Veterinary Healthcare Manual Second Edition - Full text included
- Severely malnourished primates usually have infections, impaired
function of the intestines and liver, and electrolyte imbalances when
they arrive at a Sanctuary. They are unable to tolerate the amounts of
protein, fat and sodium found in a normal diet and must initially be
given a diet low in these nutrients and higher in carbohydrates. (D425.3.7.w3g)
- Diets are available for severely malnourished human children,
and can be obtained as powders to be added to water. Alternatively, they
can be mixed from basic components. (D425.3.7.w3g)
- The F-75 diet provides 315 kJ per 100 mL and is used initially, with
the F-100 diet (420kJ per 100 mL) used after the infant's appetite has
- F-75: dried skimmed milk 25g, sugar 70 g, cereal flour
35g, vegetable oil 27 g, mineral mix 20 mL, vitamin mix 140 mg: add
water to make one litre.
- F-100: dried skimmed milk 80g, sugar 50 g, vegetable oil
60 g, mineral mix 20 mL, vitamin mix 140 mg: add water to make one
- To prepare, add all the ingredients except the minerals and
vitamins to some of the water, mix, boil for 5 - 7 minutes, allow to
cool, then add the minerals and vitamins and mix again, then add the
rest of the water to reach one litre.
- Standard proprietary multivitamin supplements can be given if
the preparation of small quantities means that using the vitamin mix
is not practical.
- The F-75 diet provides, per 100 mL: Energy 75 kcal (315 kJ),
protein 0.9 g, lactose 1.3 g, potassium 3.6 mmol, sodium 0.6 mmol,
magnesium 0.43 mmol, zinc 2.0 mg, copper 0.25 mg with 53% of the
energy coming from fat and 12% from protein. Osmolarity is 333
- The F-100 diet provides, per 100 mL: Energy 100 kcal (420 kJ),
protein 2.9 g, lactose 4.2 g, potassium 5.9 mmol, sodium 1.9 mmol,
magnesium 0.73 mmol, zinc 2.3 mg, copper 0.25 mg with 32% of the
energy coming from fat and 5% from protein. Osmolarity is 419 mOsmol/L.
- The diet is given little and often, to avoid overloading the
gastrointestinal tract, liver and kidneys: every 2-4 hours day and
- If the infant vomits, the amount given per feed is reduced, with
the time between feeds also reduced. (D425.3.7.w3g)
- If the infant will not take the diet voluntarily then it is
given via nasogastric tube. (D425.3.7.w3g)
- Initially give at least 80 kcak (315 kJ) per kg bodyweight per day
but no more than 100 kcal (420 kJ) per kg bodyweight per day, to prevent
further tissue breakdown while avoiding metabolic imbalance.
- Feed using a cup and spoon or for very weak individuals a
dropper or syringe, but not a feeding bottle, as these carry a greater
risk of transmitting infection.
- Initially give 130 mL of F-75 per kg bodyweight per day, divided
between the feeds, so an infant weighing 7 kg and fed every two hours
(12 feeds per day) would be given 75 mL per feed; if fed every three
hours (eight feeds per day) this would be 115 mL per feed, and if fed
every four hours (six feeds per day), 155 mL per feed. (D425.3.7.w3g)
- Use coaxing and be patient to encourage the infant to take its full
allotment of food at each feed. (D425.3.7.w3g)
- If the infant will not take enough food orally (e.g. due to
weakness, poor appetite or severe stomatitis), then a nasogastric tube
must be passed to give the diet.
- The tube should be properly fixed so that it cannot move from
the oesophagus into the trachea.
- NOTE: ALWAYS aspirate the nasogastric tube before
administering anything through the tube.
- At each feed, offer food by mouth. Once the infant stops taking
the diet, give the rest of the ration via the nasogastric tube.
- Once the infant takes the whole of two consecutive feeds by
mouth, or is regularly taking more than 75% orally, the tube can be
removed, but it must be replaced if the infant does not take at
least the minimum 80 kcal/kg (336 kJ/kg) daily.
- If abdominal distension develops, give 2 mL of 50% magnesium
sulphate solution by intramuscular injection; this enhances
- Improvement of the infant's appetite, which usually occurs after two
to seven days, indicates improvement in its general condition: the liver
able to metabolise the nutrients, infections under control and metabolic
abnormalities reducing. At this stage a gradual transition to the
F-100 diet can be carried out: first replace the -75 diet with a similar
amount of the F-100 diet for two days, then gradually increase the
volume given per feed. (D425.3.7.w3g)
- The quantities of food offered and taken, type of food, and the
date and time of each feed should be recorded accurately.
- If vomiting occurs, the amount of feed lost should be estimated.
- Once daily, the amount of energy the individual has taken in
should be calculated and the quantities to be offered the next day
should be confirmed or recalculated to ensure the appropriate intake
(80-100 kcal/ 336-420 kJ) per day. (D425.3.7.w3g)
- Additional treatment
- An anthelmintic should be given e.g.
- Broad-spectrum antibiotic treatment should be given initially,
because severely malnourished individuals oftern have infections and
may show few signs of such infection (e.g. only drowsiness or
lethargy rather than evident fever and inflammation). The standard
first-line antibiotic to be given should be standard at a given
facility, based on local patterns of important bacteria; pathogens,
and cost/availability. Suggestions include: (D425.3.7.w3g)
- Cotrimoxazole (25 mg sulfamethoxazole (Sulphonamides)
plus 5 mg
Trimethoprim) orally twice daily for five days. (D425.3.7.w3g)
- For individuals with evidence of infection: (D425.3.7.w3g)
Ampicillin 50 mg/kg intramuscularly or intravenously
every six hours for two days, then
Amoxycillin 15 m/kg orally every eight hours for
five days (or ampicillin 25 mg/kg orally every six hours). (D425.3.7.w3g)
Gentamicin 7.5 mg/kg intramuscularly or
intravenously once daily for seven days. (D425.3.7.w3g)
- If the infant fails to respond to the first-line antibiotic,
then in addition,
Chloramphenicol 25 mg/kg intramuscularly or intravenously
every eight hours (every six hours for suspected meningitis) for
five days. (D425.3.7.w3g)
- If the infant has a fever (>39.5 °C or
>103 °F) give an antipyretic. (D425.3.7.w3g)