Dept.

of Food Technology and Nutrition Science

Noakhali Science and Technology University

Recipes for ReSoMal and electrolyte mineral Solution

Instructions to Prepare ReSoMal and Electrolyte Mineral Solution at Home (If Needed in Emergency Situations)

1. ReSoMal Preparation (for 1 Liter). ReSoMal is specifically for malnourished children.

Ingredients:
• Glucose (anhydrous): 45 g (or 9 teaspoons)
• Sodium chloride (table salt): 3 g (approximately ½ teaspoon)
• Potassium chloride: 4 g (available as pharmacy supplement)
• Magnesium chloride (hexahydrate): 0.5 g (optional)
• Trisodium citrate (optional): 2.9 g (or substitute with ½ teaspoon of baking soda)
• Clean water: 1 liter

Instructions:
i. Start with 500 ml of boiled and cooled water in a clean container.
ii. Gradually dissolve the glucose, salt, potassium chloride, and magnesium chloride, one ingredient at a time.
iii. Stir continuously to ensure complete dissolution before adding the next ingredient.
iv. Add enough water to make exactly 1 liter of solution.
v. Keep the solution refrigerated if possible and use within 24 hours.
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

Recipes for ReSoMal and electrolyte mineral Solution

2. Electrolyte Mineral Solution Preparation (for 1 Liter)
Ingredients:
• Table salt (sodium chloride): 3.5 g (about ½ teaspoon)
• Potassium chloride: 1.5 g (available at pharmacies; roughly ¼ teaspoon)
• Magnesium sulfate (Epsom salt): 0.3 g (a pinch)
• Calcium gluconate (optional): 0.5 g
• Glucose (sugar): 20 g (about 4 teaspoons)
• Clean water: 1 liter
Instructions:
i. Begin by dissolving the salt and potassium chloride in half of the water.
ii. Gradually stir in magnesium sulfate and calcium gluconate.
iii. Add the sugar slowly and continue stirring until all ingredients are completely dissolved.
iv. Top up the mixture to exactly 1 liter.
v. Store in a sterilized container and use within 24 hours.
vi. Important Tips:
vii. Always ensure accurate measurement for safety and effectiveness.
viii. Clean hands, utensils, and containers thoroughly to avoid contamination.
ix. Consult a healthcare provider if unsure about correct dosing.
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

Why We Use These Solutions in Emergency Situations?

ReSoMal:
For Severe Acute Malnutrition (SAM)
In emergencies (e.g., humanitarian crises, famine) where malnourished children suffer from dehydration and electrolyte
imbalances, ReSoMal is lifesaving.
SAM patients have compromised organ function, particularly the kidneys, which cannot handle high sodium. They also
have severe potassium, magnesium, and zinc deficiencies.
ReSoMal rehydrates gently, prevents fluid overload, and corrects essential mineral deficits crucial for recovery.

Electrolyte Mineral Solution (EMS):

For General Dehydration and Electrolyte Imbalance
Used in emergencies involving diarrhea, vomiting, heat exhaustion, or fluid loss (common in floods, disease outbreaks,
or extreme heat).
EMS provides a quick way to restore hydration and correct electrolyte imbalances by replacing lost sodium, potassium,
and glucose to maintain cellular functions and nerve activity.
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

Functional Difference
Parameter ReSoMal Electrolyte Mineral Solution (EMS)
Sodium (Na⁺) Lower (~45 mmol/L) Higher (~75 mmol/L)
Potassium (K⁺) Higher (~40 mmol/L) Moderate (~20 mmol/L)
High for energy and better nutrient Lower but sufficient to aid
Glucose
absorption hydration
Zinc & Magnesium Included for malnutrition recovery Optional or lower amounts
Gentle rehydration while correcting Rapid rehydration and electrolyte
Primary Function
severe deficiencies restoration
Any individual suffering from
Target Group Malnourished children (SAM)
dehydration
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

Functional Benefits in the Body?

ReSoMal:

• Prevents fluid overload by limiting sodium intake (malnourished kidneys can't handle excess sodium).
• Provides essential potassium, zinc, and magnesium to restore electrolyte balance and support recovery from
malnutrition.
• Ensures safe rehydration without risking complications like edema (fluid retention).

Electrolyte Mineral Solution:

• Rapidly restores fluid balance in general dehydration cases.

• Sodium and potassium maintain cellular electrical functions (nerve signaling, muscle contractions).
• Glucose helps improve absorption of electrolytes in the small intestine and provides an energy boost.

***Why Using the Right Solution Matters in Emergencies

• Giving ReSoMal to non-malnourished individuals: May not effectively treat dehydration due to low sodium.
• Giving EMS (or ORS) to malnourished children: Can cause hypernatremia (high sodium levels), fluid
overload, and life-threatening conditions like heart failure.
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

F-75 Therapeutic Milk Recipe for Severe Acute Malnutrition (SAM)

The F-75 diet is a low-energy, low-protein, and low-fat therapeutic food used in the stabilization phase for treating
children with Severe Acute Malnutrition (SAM). It is carefully designed to provide essential nutrients while being
gentle on the digestive system.

Standard F-75 Recipe (1 Liter)

Ingredients:
• Full Cream Cow’s Milk: 300 ml (or substitute with powdered milk, see next slide)
• Sugar: 70 g (approx. 5 tablespoons)
• Vegetable Oil (sunflower or soybean preferred): 20 g (approx. 4 teaspoons)
• Electrolyte Mineral Solution (for potassium, magnesium, and other micronutrients): 20 ml (or commercial mineral
supplement equivalent)
• Clean Water: Add to make a total of 1 liter
Instructions:
1. Start Mixing: Pour 300 ml of full-cream milk into a clean container.
2. Add Sugar and Oil: Gradually dissolve 70 g of sugar and 4 teaspoons of oil into the milk, stirring continuously.
3. Add Electrolytes: Stir in the electrolyte mineral solution if available.
4. Top Up: Add clean water to make exactly 1 liter of the solution.
5. Store Properly: Use immediately or refrigerate and use within 24 hours.
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

F-75 Therapeutic Milk Recipe for Severe Acute Malnutrition (SAM)

***Alternative Recipe with Powdered Milk
If fresh cow’s milk is unavailable, use powdered milk instead:

Ingredients:
• Powdered Full Cream Milk: 35 g (approx. 3 heaping tablespoons)
• Sugar: 70 g or 100g
• Vegetable Oil: 20 g
• Electrolyte Mineral Solution: 20 ml
• Clean Water: Add to make 1 liter
• Preparation: Follow the same steps as above, ensuring complete dissolution of the powder before adding water.

Key Nutrient Content of F-75 (per 100 ml)

• Energy: 75 kcal
• Protein: 0.9 g
• Fat: 2.2 g
• Sodium: 0.6 mmol
• Potassium: 1.9 mmol
• Magnesium: 0.43 mmol
Dept. of Food Technology and Nutrition Science
Noakhali Science and Technology University

F-75 Therapeutic Milk Recipe for Severe Acute Malnutrition (SAM)

Important Notes:
 Medical Use Only: F-75 is for use in the stabilization phase of malnutrition treatment and should not be fed to
healthy children or adults.
 Strict Dosage: Administer under supervision with precise feeding schedules in therapeutic programs.
 Transition: After stabilization, patients are typically switched to F-100 diet, which provides higher energy and
protein.
Phase Main Goal Key Feeding Protocols Duration
Correct life-threatening
complications (dehydration, F-75 (low-energy milk),
Stabilization (Phase 1) 2-7 days
infections, electrolyte oral rehydration solution
imbalances)
Promote weight gain, F-100 (higher-energy milk),
Rehabilitation (Phase 2) 2-6 weeks
restore nutritional status micronutrient supplements
RUTF, regular home
Ensure sustained growth
Follow-up (Phase 3) feeding, continued 6 months+
and prevent relapse
monitoring
Treatment of associated conditions
Vitamin A deficiency

Children with vitamin A deficiency are likely to be photophobic and have closed eyes. It is important
to examine the eyes very gently to prevent damage and rupture. All children should have their eyes
examined carefully and gently. If the child shows any eye signs of deficiency, give orally:

• Vitamin A on days 1, 2 and 14:

• Children 0-6 months: 50,000IU
• Children 6-12 months: 100,000 IU
• Children >12 months: 200,000 IU
• If first dose has been given in the referring centre, treat on days 1 and 14 only
• If there is corneal clouding or ulceration, give additional eye care to prevent extrusion of the lens:
• Instil chloramphenicol eye drops (1%) 2-3 hourly as required for 7- 10 days and or tetracycline
eye ointment in the affected eye at night
• Instil atropine eye drops (1%), 1 drop three times daily for 3-5 days
• Cover with eye pads soaked in saline solution and bandage
Dermatosis
Signs:
• Hypo-or hyper pigmentation
• Desquamation
• Ulceration (spreading over limbs, thighs, genitalia, groin, and behind the ears)
• Exudative lesions (resembling severe burns) often with secondary infection, including
Candida
• Zinc deficiency is usual in affected children and the skin quickly improves with zinc
supplementation (1-2 mg/kg/day for 2 wks).
• In addition, weeping skin lesions are commonly seen in and around the buttocks of
children with kwashiorkor:
• Keep the perineum dry.
• Apply a gauze soaked in 1% potassium permanganate solution over affected areas and
keep for 10 minutes twice daily.
• Candidiasis should be treated with anti-fungal cream (eg. clotrimazole) twice daily for 2
weeks. Oral candidiasis should be treated with oral nystatin (100,000 IU four times daily).
Helminthiasis

Treatment of helminth infections should be delayed until the rehabilitation

phase of treatment. Give a single dose of any one of the following
antihelminthics:
• 200 mg albendazole for children aged 12-23 months, 400 mg albendazole for
children aged >24 months or
• 100 mg mebendazole twice daily for 3 days for children >24 months (not
recommended below 24 months) Or
• 10 mg/kg pyrantel pamoate (any age) : single dose.
Continuing diarrhoea and dysentery

Diarrhoea is a common feature of malnutrition but it should subside during the

first week of treatment with cautious feeding. In the rehabilitation phase, loose,
poorly formed stools are no cause for concern provided weight gain is satisfactory.

Mucosal damage and giardiasis are common causes of continuing diarrhoea.

Where possible examine the stools by microscopy. Treat giardiasis with
metronidazole (7.5 mg/kg 8-hourly for 7 days).

If stool contains visible blood, treat the child with an oral antimicrobial that is
effective against most local strains of Shigella (ciprofloxicillin 10 mg/kg/12 hourly
for 3 days or pivmecillinum 15 mg/kg/6 hourly for 5 days).
Lactose intolerance
• Only rarely is diarrhoea due to lactose intolerance. Treat only if continuing
diarrhoea is preventing general improvement.
• Starter F-75 is a low-lactose feed. In exceptional cases:
• Substitute animal milk with yoghurt or a lactose-free infant formula (eg rice
suji)
• Reintroduce milk feeds gradually in the rehabilitation phase

Osmotic diarrhoea may be suspected if diarrhoea worsens substantially in

young children with diarrhoea who are given F-75 prepared with milk powder,
which has slightly higher osmolality. In these cases:
• Use low osmolar cereal-based F-75 (see Annex 4), or yoghurt or
rice suji , then
• Introduce F-100 gradually.