diarrhoea and dehydration
TRANSCRIPT
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
STEP TO PG-MD/MS -DR.AKIF A.B
STEP TO PG-MD/MS -DR.AKIF A.B
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
STEP TO PG-MD/MS -DR.AKIF A.B
Degree of Dehydration Assessment of Fluid Loss
No Dehydration < 50 ml/kg
Some dehydration 50-100ml/kg
Severe Dehydration >100 ml/kg
STEP TO PG-MD/MS -DR.AKIF A.B
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
STEP TO PG-MD/MS -DR.AKIF A.B
ORS
STEP TO PG-MD/MS -DR.AKIF A.B
HOME MADE ORS
STEP TO PG-MD/MS -DR.AKIF A.B
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
STEP TO PG-MD/MS -DR.AKIF A.B
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
STEP TO PG-MD/MS -DR.AKIF A.B
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
STEP TO PG-MD/MS -DR.AKIF A.B
KHICHDI WITH OILMASHED BANANAS WITH MILK OR CURD
CURD RICE WITH SUGARMASHED POTATOES WITH OIL
FOODS TO BE GIVEN
TO A CHILD WITH DIARRHOEA
STEP TO PG-MD/MS -DR.AKIF A.B
FOODS TO BE AVOIDEDIN DIARRHOEA
Brown Rice Bread
Chapatis
BiscuitsOats
Noodles
STEP TO PG-MD/MS -DR.AKIF A.B
FOODS TO BE AVOIDEDIN DIARRHOEA
BEANS
STEP TO PG-MD/MS -DR.AKIF A.B
FOODS TO BE AVOIDEDIN DIARRHOEA
COARSE VEGETABLES
STEP TO PG-MD/MS -DR.AKIF A.B
FOODS TO BE AVOIDEDIN DIARRHOEA
FRUITS
STEP TO PG-MD/MS -DR.AKIF A.B
ZINC SUPPLEMENTATION
- 20 mg of Elemental Zinc
- for child > 6months
-for 14 days
-Being given as routine along with ORS
STEP TO PG-MD/MS -DR.AKIF A.B
CONVULSIONS IN ACUTE DIARRHOEA CAUSES1) Hyponatremia
2) Hypernatremia
3) Hypoglycemia
4) Febrile Seizures
5) Hypokalemia
6) Encephalitis
7) Meningitis
8) Cerebral venous Thrombosis
STEP TO PG-MD/MS -DR.AKIF A.B
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
STEP TO PG-MD/MS -DR.AKIF A.B
STEP TO PG-MD/MS -DR.AKIF A.B