Abstract Purpose of Review Malnutrition is a significant and global threat in pediatric emergency departments (PEDs), associated with nearly half of all deaths in children under the age of 5. While low and middle-income countries (LMICs) face life-threatening severe acute malnutrition (SAM), high- income countries (HICs) increasingly deal with obesity related complications. This review describes the epidemiology and clinical profiles of nutritional emergencies (NEs) in PEDs, summarizes evidence-based management strategies, including the WHO 10- step protocol and discusses the systemic approaches to strengthen the global PED response. Recent Findings Globally, an estimated 13.6 million children under 5 suffer from SAM, with hospital case fatality rates ranging from 10 to 30% in many LMICs. Early recognition through visible wasting and anthropometry (MUAC < 11.5 cm) is essential for survival. Immediate PED priorities include treating hypoglycemia, active warming, and providing empiric antibiotics. Regarding fluid resuscitation, evidence from the FEAST trial (which did not specifically enroll children with SAM) showed that aggressive IV boluses increased mortality in febrile children with impaired perfusion, raising concerns about extrapolation to SAM populations who have fragile cardiac function. Current conservative WHO protocols are being re-examined as emerging data suggest liberal rehydration may not consistently increase fluid overload risk. Additionally, electrolyte imbalances and the risk of refeeding syndrome (though more commonly managed in inpatient or ICU settings after initial PED stabilization) require specialized, low-sodium rehydration solutions like ReSoMal. Emerging innovations include point-of-care ultrasound, machine learning risk prediction (AUROC 0.86–0.92), task-shifting to community health workers (improving recovery from 50% to 73%), and simplified protocols reducing RUTF use by 43 sachets per child. Summary Pediatric emergency departments (PEDs) serve as a critical frontline in the effective management of nutritional emergencies. The success of our intervention hinges on the prompt identification of cases, adherence to tailored stabilization protocols, and a strategic balance between cautious rehydration and the immediate correction of critical metabolic imbalances. By embracing these practices, we can significantly improve outcomes and save lives in vulnerable populations.
Mathew et al. (Mon,) studied this question.