Download - Diarrhoea and dehydration in children
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DIARRHOEA AND DEHYDRATION IN CHILDREN
Dr.Soma Sekhara Reddy
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OBJECTIVESINTRODUCTIONCAUSESETIOPATHOGENESISCLINICAL FEATURES AND
COMPLICATIONSDIAGNOSISEVALUATION OF DEHYDRATIONTREATMENTPREVENTION
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Introduction common cause of death in developing
countries second most common cause of infant deaths
worldwide.
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DIARRHOEA
DEFINITION – Passage of watery stools atleast 3 times in a 24h period.
Recent change in consistency is more important.
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ETIO-PATHOGENESIS
VIRAL – MC – ROTA, ADENO
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CAUSES OF DIARRHOEA WITH MORBIDITY
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CLINICAL FEATURESBLOODY STOOLS – BACTERIAL ETIOLOGY HUS
ABDOMINAL PAIN – GE
PERITONEAL SIGNS - APPENDICITIS
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DIAGNOSISATLEAST 3 STOOLS PER 24H
ASSESSING DEHYDRATION -H/O NORMAL FLUID INTAKE AND OUT
PUT - PHYSICAL EXAMINATION
- PERCENTAGE OF BODY WT LOSS
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EVALUATING DEHYDRATIONGENERAL CONDITION-MENTAL STATUS* THIRST* EXTREMITIES CAPILLARY REFILL TIME SKIN TURGORBREATHINGHEART RATEB.PPULSE QUALITYEYES*TEARS*MUCOUS MEMBRANES*ANTERIOR FONTANELLEURINARY OUTPUT
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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)
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CLINICAL DEHYDRATION SCORE
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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
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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
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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
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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
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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
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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
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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
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PREVENTIONGood Hygiene
Vaccines
Prevent global warming Global warming α food borne infections α contamination of water
ENRICH – ( December 2011 Bulletin from IAP
)
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Thank you