DIARRHOEA AND DEHYDRATION IN CHILDREN

Dr.Soma Sekhara Reddy

OBJECTIVESINTRODUCTIONCAUSESETIOPATHOGENESISCLINICAL FEATURES AND

COMPLICATIONSDIAGNOSISEVALUATION OF DEHYDRATIONTREATMENTPREVENTION

Introduction common cause of death in developing

countries second most common cause of infant deaths

worldwide.

DIARRHOEA

DEFINITION – Passage of watery stools atleast 3 times in a 24h period.

Recent change in consistency is more important.

ETIO-PATHOGENESIS

VIRAL – MC – ROTA, ADENO

CAUSES OF DIARRHOEA WITH MORBIDITY

CLINICAL FEATURESBLOODY STOOLS – BACTERIAL ETIOLOGY HUS

ABDOMINAL PAIN – GE

PERITONEAL SIGNS - APPENDICITIS

DIAGNOSISATLEAST 3 STOOLS PER 24H

ASSESSING DEHYDRATION -H/O NORMAL FLUID INTAKE AND OUT

PUT - PHYSICAL EXAMINATION

- PERCENTAGE OF BODY WT LOSS

EVALUATING DEHYDRATIONGENERAL CONDITION-MENTAL STATUS* THIRST* EXTREMITIES CAPILLARY REFILL TIME SKIN TURGORBREATHINGHEART RATEB.PPULSE QUALITYEYES*TEARS*MUCOUS MEMBRANES*ANTERIOR FONTANELLEURINARY OUTPUT

SIGNS NONE /MINIMAL DEHYDRATION(<3%LOSS OF BODY WT)

SOME/ MILD TO MODERATE(3 -9% LOSS OF B.WT)

SEVERE ( >9% LOSS OF B.WT)

CLINICAL DEHYDRATION SCORE

LAB.EVALUATION AND IMAGINGSTOOL CULTURE- salmonella shigella yersinia campylobacter pathogenic E.coli-serotyping RAPID STOOL TEST: for inflammatory markers Hematological tests: white blood cell band count >100/mm3.

C-reactive protein cut point of >12 milligrams/dl

Biochemical tests: BUN Ser.bicarbonate <17 mEq/L GRBS USG

TREATMENTORT [ ORS: CH-75mmol/l; Na-75; k-20;

Cl-65; base-10; osmolarity-245m osm/l]ZINC FORTIFIED-ORSNO SUBSTITUTESIV REHYDRATION-only for severe

dehydrationREHYDRATION PHASE -Give 50 to 100 mL

of ORS/kg plus additional 10 mL/kg per stool and 2 mL/kg per emesis

BREAST FEEDING

I.V. REHYDRATIONSTART I.V.F IMMEDIATELY IF CHILD IS

SEVERELY DEHYDRATED.CONSIDER ORS IF CHILD CAN DRINK.I.V.F : R.L + 5 % DEXTROSE*** R.L** N.S.* - can be used ONLY 5 % DEXTROSE – not effective

I.V. REHYDRATIONTARGET : 100 ml /kg< 1 yr : 30 ml/kg in 1 hour repeat 30 ml/kg in 1

hour 70 ml/kg in 5 hours >1 yr : 30 ml/kg in 30 min repeat 30 ml/kg in 30

min 70 ml/kg in 2 and ½ hrs

Start giving ORS if child starts drinking: 5 ml/kg/hr

< 1 year : within 3 to 4 hours

>1 year : within 1 to 2 hours

IF UNABLE TO GIVE I.V.FLUIDS: N.G.TUBE

20 ml/kg/hour

reassess after 1 to 2 hours repeated vomitting/ abdominal

distension no improvement after 3 hours give the fluids

more Start i.v.fluids as soon as possible slowly

TREATMENTANTIEMETIC-Ondansetron 0.5mg/kg/doseNO ANTIMOTILITY MEDICATION : Diarrhea may function as an evolved

expulsion defense mechanism Can cause HUS in EHEC infection.ADSORBANTS AND ANTISECRETORY

AGENTS: Bismuth – inc.salicylate levelsPROBIOTICS - Lactobacillus GG and

Saccharomyces boulardii ANTIBIOTICS FOR A/C GE

PREVENTIONGood Hygiene

Vaccines

Prevent global warming Global warming α food borne infections α contamination of water

ENRICH – ( December 2011 Bulletin from IAP

)

Thank you