MANAGEMENT OF ACUTE DIARRHEACHINMAY V HEGDE

R.NO-30

PRINCIPLES

• Rehydration and maintaining hydration.• Ensuring adequate feeding

Plans of management

• No dehydration- Plan A• Some dehydration- Plan B• Severe dehydration- Plan C

PLAN A

• ORS is given• No need of hospitalization• Care giver must be educated about feeding

and danger signs

How much to give ??AGE Amount of ORS

<24 months 50-100 ml

2-10 year 100-200 ml

PLAN B

• ORAL FLUID THERAPY is given.• It should be treated in hospital• Fluid requirement is calculated

Daily fluid requirements

• Up to 10 kg = 100 ml/kg• 10-20kg =50ml/kg• >20kg= 20 ml/kg

Deficit replacement

• 75ml/kg over 4 hour• If after 4 hour dehydration persists repeat the

treatment.

Maintenance fluid therapy

• This phase is started when signs of dehydration disappear.

• ORS should be administered in volumes equal to diarrheal losses(10ml/kg/stool)

Plan C

• IV fluids such as ringer lactate with 5% dextrose

Age<12 months 100ml/kg over 6hr

>12months 100ml/kg over 3 hr

• ORS is started simultaneously if child can take orally

• Child should be assessed for every 15-30 minutes for pulse and BP.

• Management following IV hydration end is done by

<12 month 70 ml/kg in 5hr

>12 month 70 ml/kg in 2 ½ hr

• Persistence of severe dehydration- Intravenous infusion is maintained

• Hydration is improved but some dehydration present- ORS is administered according to plan B

• No dehydration- Plan A is followed.

Dietary management

• Breast feeding should continue.• Staple food should be enriched with oil and

ghee to provide more calories.• High fiber content diet should be avoided• Cow or buffalo milk can be given without

diluting.

Zinc supplementation

• It is supplemented as zinc sulfate, acetate or gluconate formulation

• Dose- 20 mg of elemental zinc per day for 14 days

Role of Drugs

• Antibiotics are not recommended usually as they cause persistent diarrhea.

• If sepsis is suspected antibiotics should be given.

• Antimotility drugs like loperamide should not be used

• Antisecretory drugs like Racecadotril is used.• Probiotics

Prevention of diarrhea

• Proper nutrition• Adequate sanitation• Vaccination against rota virus

Persistent diarrhea

• It is an episode of diarrhea, of presumed infectious etiology, which starts acutely but lasts for more than 14 days.

Etiopathogenesis

• WORSENING OF NUTRITIONAL STATUS• COW MILK PROTEIN ALLERGY• USE OF ANTIBIOTICS• ASSOCIATED INFECTIONS

CLINICAL SYMPTOMS

• Passage of several loose stools daily• No dehydration• Growth faltering• Malnutrition• Passage of explosive stools.

Management principles

• Correction of dehydration if present• Treating infections• Nutritional therapyMost of the patients(nearly 2/3rd ) respond to nutritional therapy.

Nutrition.

• 6-7 feeds per day is given. • Daily intake of 100kcal/kg is maintained.• It should be increased to 150kcal/kg/day in 2-

3 weeks.

Types of diet

• Initial diet A- (reduced lactose; milk rice gruel, milk sooji gruel, rice with curds)

• Second diet B-(lactose free)• Third diet C-(monosachharide based) Only glucose is given Protein is supplied by egg-Supplements of vitamins and minerals are given.

Successful treatment

• Adequate food intake• Reduced frequency of watery stools• Weight gain.

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