HAFIZ USMAN WARRAICH Roll#17-C

Diarrhea and Dehydration

Dr Shreedhar Paudel25/03/2009

Diarrhea

• Passage of loose stools in increased frequency• If mother says her baby is having diarrhea

then the baby is having diarrhea• Diarrhea may be – Acute– Chronic– Persistent

Diarrhea..

• Diarrhea might be – Secretory – Osmotic

• It might be:--Infective--Non-infective

Diarrhea …• Secretory diarrhea

--there is an increase in the active secretion, or there is an inhibition of absorption

--little or no structural damage

--most common cause is a cholera toxin that stimulates the secretion of anions, especially chloride ions.

Osmotic diarrhea

“Osmotic diarrhea occurs when too much water is drawn into the bowels”

(Lactose intolerance, malabsorption)

Diarrhea…• Acute diarrhea

--a common cause of death in developing countries

--second most common cause of infant deaths worldwide

--loss of fluids through diarrhea can cause severe dehydration which is one cause of death in diarrhea sufferers

--Along with water, dangerous amounts of important salts, electrolytes, and other nutrients are lost

Acute Diarrhea

• Important causes of infective diarrhea in developing countries– Rotavirus– E. coli– Campylobacter jejuni– Shigella– Protozoal parasites—5-15% of cases– No pathogen found—20-30% of cases

Acute diarrhea..• Non-infective causes– Malabsorption– Specific food intolerance– Indigestion– Lactose intolerance– Antibiotics– Inflammatory bowel disease– Milk protein allergy

Assessing the patient with diarrhea

Brief history and examination of the child---

Objectives:-To detect dehydration- To diagnose dysentery- To diagnose persistent diarrhea- To evaluate nutritional status - To diagnose concurrent illnesses- To find immunization status of measles

Clinical assessment should lead to- A plan for treating or preventing dehydration

- A plan for treating dysentery, if present

- A plan for treating persistent diarrhea, if present

- Recommendations for feeding during and after diarrhea

- A plan for follow-up

Treatment of Diarrhea

• Home treatment is essential part– Mothers should begin it before they seek medical

care

– Mothers should be taught how to continue the treatment of her child at home

At the time of discharge of the baby

• Mothers should be able to

– Prepare and give appropriate fluids for ORT

– Feed a child with diarrhea correctly

– Recognize when a child should be taken to a health worker

Assessing the patient for dehydrationA B C

1. Look at: Condition Eyes

Thirst

Well alert

Normal

Drinks normally

Restless, irritableSunken

Thirsty, drinks eagerly

Lethargic or unconsciousVery sunken

Drinks poorly/not able to drink

2.Feel: Skin pinch

Goes back quickly

Goes back slowly

Goes back very slowly(>2 secs)

Assessing the patient for dehydrationA B C

3. Decide The patient has no signs of dehydration

If 2 or more signs present—some dehydration

If 2 or more signs present- severe dehydration

4. Treat Use treatment plan A

Weigh the baby and use treatment plan B

Weigh the baby and use treatment plan C urgently

TREATMENT PLAN A ( to treat diarrhea at home)

• Three rules of treatment plan A1. Give the child more fluids than usual to prevent

dehydration

2. Give the child plenty of food to prevent malnutrition

3. Take the child to the health worker if the child does not get better in 3 days or becomes worse

Treatment plan A

• First rule– Use recommended home fluids• Oral rehydration solution• Food based fluids( soup, rice water…)• Plain water

– Give as much fluid as the child takes

– Continue giving fluids until the diarrhea stops

Treatment plan A…• Second rule– Continue breast feeding frequently

– Give usual milk if no breast feeding

– If the baby has already started weaning• Encourage the child to eat

• Offer food at least 6 times a day

• Give freshly prepared foods

• Provide mixture of foods—balanced diet

Treatment plan A….

• Third rule– Watch for the following features

• Many watery stools• Repeated vomiting• Marked thirst• Eating or drinking poorly• Fever• Blood in stool

Treatment plan [A]How much ORS to give after each loose stool

Age Amount of ORS to give after each loose stool

Amount of ORS to provide for use at home

Less than 2 yrs 50-100 ml 500 ml/ day

2-10 yrs 100-200 ml 1000 ml/ day

More than 10 yrs As much as wanted 2000 ml/ day

Treatment plan B ( treatment of patients with some dehydration)

• Usually do not need to be admitted• Treated in ORT corner of the oral rehydration

area• Mothers should stay with their children

– To help with treatment

– To learn how to continue it at home

Treatment plan [B]..Approximate amount of ORS to give ,in the first 4 hrs

Age Weight in KG Fluids in ml

Less than 4 months Less than 5 200- 400

4-11 months 5- 8 400- 600

12-23 months 8- 10 600- 800

2-4 yrs 11- 16 800- 1200

5-14 yrs 16- 30 1200- 2200

15 yrs or older 30 or more 2200- 4000

Treatment plan B…

• The approximate amount of ORS required can be calculated by multiplying pt. wt in kg with 75 ml

• After 4 hours– Reassess the child using the assessment chart– Then select plan A, for no signs of dehydration– Plan B, for some signs of dehydration– Plan C, for severe signs of dehydration

TREATMENT PLAN C…Treatment of patients with severe dehydration

• Admit the patient• Start IV fluids immediately• If you can’t open IV line– rehydrate the patient

by using naso-gastric tube• If patient can take orally start ORS• If you can’t open IV line and also unable to

insert NG tube—refer the patient for IV or NG treatment

Treatment plan C….

Start IV fluids immediately

While the drip is set up give ORS if the child can take orally

Give 100 ml/kg RL or NS divided as follows:

Age First give 30 ml/kg in Then give 70 ml/kg inInfants 1 hour * 5 hours

More than 1 year

30 minutes * 2.30 hours

Treatment plan C….

• * Repeat once if radial pulse is still very weak or not detectable

• Reassess the patient every 1-2 hrs

• If not improving, give the IV drip more rapidly

• Also give ORS as soon as the patient can drink– 5 ml/kg/hr

Treatment plan C….

• Reassess the patient using the chart– After 6 hours in infants– After 3 hours in older children

• Then choose the appropriate treatment plan to continue the treatment