Diarrhoea and dehydration

STEP TO PG-MD/MS -DR.AKIF A.B

DIARRHOEAAND

DEHYDRATION- DR.AKIF A.B

DIARRHOEA-Diarrhoea is defined as change in consistency and frequency of stools i.e liquid or watery stools that occurs > 3times a day.

DYSENTERYDiarrhoea + associated blood in stools

MC Cause of Acute Diarrhoe in childrens : Rotavirus

PERSISTENT DIARRHOEAIf acute diarrhoea continues for > 14days



NO DEHYDRATION SOME DEHYDRATION

SEVERE DEHYDRATION

Condition Well alert Restless, irritable Lethargic or unconscious

Eyes Normal Sunken Very sunken and dry

Tears Present Absent AbsentMouth and tongue

Moist Dry Very dry

Thirst Drinks normally, not thirsty

Thirsty and drinks eagerly

Drinks poorly or is not able to drink

Skin pinch Goes back quickly Slowly Very slowly

2 0r more signs = Some Dehydration

2 0r more signs = Severe Dehydration

Treatment PLAN A PLAN B PLAN C


Degree of Dehydration Assessment of Fluid Loss

No Dehydration < 50 ml/kg

Some dehydration 50-100ml/kg

Severe Dehydration >100 ml/kg


PLAN-A-Home based Treatment

-ORS to be given

- Look for DANGER SIGNS

DANGER SIGNS

1) Diarrhoea beyond 3 days2) Increase volume and frequency of

stools3) Blood in stools4) Refusal to feeds5) Repeated vomitings6) Increase thirst7) fever


ORS


HOME MADE ORS


PLAN-B-ORS should be given.

-Fluid requirement is calculated under 3 headings:

1) Daily Fluid Reuirements is as follows:

Upto 10kg = 100ml/kg10-20kg = 50ml/kg>20 kg = 20ml/kg

2) Deficit Replacements

75ml/kg of ORS over 4hrs

Assess after 4 hrs

Dehydration present

Repeat another session

3) Maintenance Fluid Therapy

- Should be begin once signs of dehydration disappears

- ORS should be administered in equal to volume of fluid loss, usually to a maximum of 10ml/kg per stool


PLAN-C-I.V Fluids : Mostly Ringer Lactate along with 5% Dextrose

-100ml/kg of fluid should be given over 6hrs in <12months age

over 3hrs in > 12 months age

Age 30ml/kg 70ml/kg< 12 months

Over 1 hr Over 5 hrs

> 12 months

Over ½ hr Over 2 ½ hrs

If child can take orally

Give ORS as much as child can take

If dehydration still present

Repeat another session


NUTRITIONAL MANAGEMENTOF DIARRHOEA

Breast feeding should be continued

Energy dense foods should be given every 2-

3 hrly

Foods to be taken

1) Khichri with oil

2) Rice with milk or curd and sugar

3) Mashed banana with milk or curd

4) Mashed potatoes with oil and lentil

5) Upma or Daliya

Food with high fibre content should be

avoidedLike fruits and

vegetablesIn Non breast fed

infants, undiluted cow or buffalo milk should be

given

- Milk mixed with water should not be given


KHICHDI WITH OILMASHED BANANAS WITH MILK OR CURD

CURD RICE WITH SUGARMASHED POTATOES WITH OIL

FOODS TO BE GIVEN

TO A CHILD WITH DIARRHOEA


FOODS TO BE AVOIDEDIN DIARRHOEA

Brown Rice Bread

Chapatis

BiscuitsOats

Noodles



BEANS



COARSE VEGETABLES



FRUITS


ZINC SUPPLEMENTATION

- 20 mg of Elemental Zinc

- for child > 6months

-for 14 days

-Being given as routine along with ORS


CONVULSIONS IN ACUTE DIARRHOEA CAUSES1) Hyponatremia

2) Hypernatremia

3) Hypoglycemia

4) Febrile Seizures

5) Hypokalemia

6) Encephalitis

7) Meningitis

8) Cerebral venous Thrombosis


DRUG THERAPYANTIBIOTICS

- Is not recommended in Acute diarrhoea in childrens

- Is given only in amoebiasis, giardiasis, bacillary dysentery, cholera SIGNS OF SEPSIS WHERE

ANTIBIOTICS SHOULD BE GIVEN IN ACUTE

DIARRHOEA

1) Poor sucking

2) Abdominal distension

3) Fever or Hypothermia

4) Fast breathing

Anti Motility agents like Loperamide and opioids should

not be given in children with acute diarrhoea

- Reduction of gut motility allows more time for bacteria to grow in

gut



Health & Medicine

Diarrhoea and dehydration