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    Diarrhea

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    Achyut Kanungo
    The document provides information on diarrhea including definitions, types, mechanisms, and treatment plans. It describes diarrhea as the passage of loose stools and defines different types such as acute watery diarrhea. The treatment plans include Plan A for home treatment with oral rehydration, Plan B for some dehydration with ORS, and Plan C for severe dehydration involving intravenous fluids.

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    Download as PPTX, PDF, TXT or read online from Scribd

    Diarrhea

    Uploaded by

    Achyut Kanungo
    25 views17 pages
    The document provides information on diarrhea including definitions, types, mechanisms, and treatment plans. It describes diarrhea as the passage of loose stools and defines different types such as acute watery diarrhea. The treatment plans include Plan A for home treatment with oral rehydration, Plan B for some dehydration with ORS, and Plan C for severe dehydration involving intravenous fluids.

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    The document provides information on diarrhea including definitions, types, mechanisms, and treatment plans. It describes diarrhea as the passage of loose stools and defines different types such as acute watery diarrhea. The treatment plans include Plan A for home treatment with oral rehydration, Plan B for some dehydration with ORS, and Plan C for severe dehydration involving intravenous fluids.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    25 views17 pages

    Diarrhea

    Uploaded by

    Achyut Kanungo
    The document provides information on diarrhea including definitions, types, mechanisms, and treatment plans. It describes diarrhea as the passage of loose stools and defines different types such as acute watery diarrhea. The treatment plans include Plan A for home treatment with oral rehydration, Plan B for some dehydration with ORS, and Plan C for severe dehydration involving intravenous fluids.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 17

    Diarrhea

    A brief update
    What is diarrhea?
    • Diarrhea is defined as the passage of loose,
    liquid or watery stools, usually more than 3
    times/day.
    • However it is the recent change in consistency
    and character of stools that is more important.
    • The term ‘diarrheal diseases’ should be
    considered as a convenient expression only, and
    not as a nosological or epidemiological entity.
    What is diarrhea?
    • Diarrhea is best defined as excessive loss of fluid
    and electrolyte in the stool.
    • Acute diarrhea is defined as sudden onset of
    excessively loose stools of >10 mL/kg/day in
    infants and >200 g/24 hr in older children,
    which lasts <14 days.
    • When the episode lasts longer than 14 days, it
    is called chronic or persistent diarrhea.
    • Dysentery is small-volume, frequent bloody
    stools with mucus, tenesmus, and urgency.
    Types of diarrheal diseases
    • Acute watery diarrhea
    – Main danger dehydration and weight loss if prolonged
    • Acute bloody diarrhea (dysentery)
    – Main dangers are damage of intestinal mucosa, sepsis,
    malnutrition, dehydration
    • Persistent diarrhea
    – Main danger is malnutrition
    • Diarrhea with severe malnutrition (marasmus and
    kwashiorkor)
    – Main dangers are severe systemic infection, dehydration,
    heart failure, vitamin and mineral deficiencies
    Mechanisms of diarrhea
    • Secretory
    – Decreased absorption, increased secretion,
    electrolyte transport
    – Watery, normal osmolality with ion gap <100
    mOsm/kg
    – Cholera, toxigenic Escherichia coli ; carcinoid, VIP,
    neuroblastoma, congenital chloride diarrhea,
    Clostridium difficile , cryptosporidiosis (AIDS)
    – Persists during fasting
    Mechanisms of diarrhea
    • Osmotic
    – Maldigestion, transport defects, ingestion of
    unabsorbable substances
    – Watery, acidic, and reducing substances; increased
    osmolality with ion gap >100 mOsm/kg
    – Lactase deficiency, glucose galactose
    malabsorption, lactulose, laxative abuse
    – Stops with fasting
    Mechanisms of diarrhea
    • Increased motility
    – Decreased transit time
    – Loose to normal appearing stool, stimulated by
    gastrocolic reflex
    – Irritable bowel syndrome, thyrotoxicosis,
    postvagotomy dumping syndrome
    – Infection can also contribute to increased motility
    Mechanisms of diarrhea
    • Decreased motility
    – Pseudoobstruction, blind loop
    – Possible bacterial overgrowth
    – Loose to normal appearing stool
    • Decreased surface area (osmotic,motility)
    – Decreased functional capacity
    – Short bowel syndrome
    • Mucosal invasion
    – Inflammation, decreased colonic reabsorption, increased
    motility
    – Blood, increased WBC in stool
    – Shigella, Salmonella, Yersinia, Campylobacter
    Plan A: Treat diarrhoea at home

    • Treat a child who has diarrhoea and NO DEHYDRATION


    with Plan A. The 3 Rules of Home Treatment are:
    • 1. GIVE EXTRA FLUID (as much as the child will take)
    2. CONTINUE FEEDING
    3. WHEN TO RETURN
    • Children with diarrhea who come to a health facility
    with NO DEHYDRATION will be put on Plan A. Children
    with SOME or SEVERE dehydration need to be
    rehydrated on Plan B or C, and then put on Plan A.
    Eventually, all children with diarrhea will be on Plan A.
    Plan A: Treat diarrhoea at home
    • RULE 1: GIVE EXTRA FLUID
    • Tell the mother or caretaker:
    • Give as much fluid as the child will take. The purpose of giving extra fluid is to
    replace the fluid lost in diarrhoea and thus to prevent dehydration. The critical
    action is to give more fluid than usual, as soon as the diarrhoea starts.
    • Tell the mother to breastfeed frequently and for longer at each feed. Also
    explain that she should give other fluids. ORS solution is one of several fluids
    recommended for home use to prevent dehydration.
    • If the child is exclusively breastfed, it is important for this child to be breastfed
    more frequently than usual. Also give ORS solution or clean water. Breastfed
    children under 4 months should first be offered a breastfeed then given ORS.
    • If a child is not exclusively breastfed, give one or more of the following:
    • - ORS solution
    - Food-based fluids
    - Clean waterIn most cases a child who is not dehydrated does not really need
    ORS solution. Give him extra food-based fluids such as soups, rice water and
    yoghurt drinks, and clean water (preferably given along with food).
    Plan A: Treat diarrhoea at home
    • Show the mother or caretaker how much fluid to give in addition to the usual
    fluid intake
    • Explain to the mother that her child should drink the usual fluids that the child
    drinks each day and extra fluid. Show the mother how much extra fluid to give
    after each loose stool:
    •  Up to 2 years 50 to 100 ml after each loose stool
    •  2 years or more 100 to 200 ml after each loose stool
    • Explain to the mother that the diarrhoea should stop soon. ORS solution will not
    stop diarrhoea. The benefit of ORS solution is that it replaces the fluid and salts
    that the child loses in the diarrhoea and prevents the child from getting sicker.
    • Tell the mother to:
    • Give frequent small sips from a cup or spoon. Use a spoon to give fluid to a young
    child.
    • If the child vomits, wait 10 minutes before giving more fluid. Then resume giving
    the fluid, but more slowly.
    • Continue giving extra fluid until the diarrhoea stops.
    Plan A: Treat diarrhoea at home
    • RULE 2: CONTINUE FEEDING
    • If a child is classified with PERSISTENT DIARRHOEA, we will teach
    the mother some special feeding recommendations.
    • RULE 3: WHEN TO RETURN
    • Tell the mother of any sick child that the signs to return are:
    • • Not able to drink or breastfeed
    • Becomes sicker
    • Develops a fever
    • If the child has diarrhoea, also tell the mother to return if the
    child has:
    • Blood in stool
    • Drinking poorly “Drinking poorly” includes “not able to drink or
    breastfeed.”
    Plan B: Treat some dehydration with ORS
    • Determine the amount of ORS to give during the first 4 hours
    • The age or weight of the child, the degree of dehydration and the number of
    stools passed during rehydration will all affect the amount of ORS solution
    needed. The child will usually want to drink as much as he needs. If the child
    wants more or less than the estimated amount, give him what he wants.
    • Multiply the child’s weight (in kilograms) by 75. For example, a child weighing
    8 kg would need: 8 kg × 75 ml = 600 ml of ORS solution in 4 hours
    • Giving ORS solution should not interfere with a breastfed baby’s normal
    feeding. The mother should pause to let the baby breastfeed whenever the
    baby wants to, then resume the ORS solution.
    • For infants under 6 months who are not breastfed, the mother should give
    100-200 ml clean water during the first 4 hours in addition to the ORS
    solution. The breastmilk and water will help prevent hypernatraemia in
    infants.
    Plan B: Treat some dehydration with ORS
    •After 4 hours
    –After 4 hours of treatment on Plan B, reassess the child using the ASSESS
    AND CLASSIFY chart.
    •Note: Reassess the child before 4 hours if the child is not taking the ORS
    solution or seems to be getting worse.
    •If the child has improved and has NO DEHYDRATION, choose Plan A.
    •Note: If the child’s eyes are puffy, it is a sign of overhydration. It is not a
    danger sign or a sign of hypernatraemia. It is simply a sign that the child
    has been rehydrated and does not need any more ORS solution at this
    time. The child should be given clean water or breastmilk. The mother
    should give ORS solution according to Plan A when the puffiness is gone.
    •If the child still has SOME DEHYDRATION, choose Plan B again.
    •If the child is worse and now has SEVERE DEHYDRATION, you will need
    to begin Plan C.
    Plan C - Treat severe dehydration quickly

     Start IV fluid immediately. If the child can drink, give ORS by mouth while the drip is set up.
    Give 100ml/kg Ringer’s Lactate Solution (or, if not available, normal saline), divided as
    follows:

    AGE First give 30 ml/kg in: Then give 70 ml/kg in:


    Infants 1 hour* 5 hours
    (under 12 months)
    Children 30 minutes* 2 ½ hours
    (12 months up to 5 years)
    * Repeat once if radial pulse is still very weak or not detectable.• Reassess the child every 1-
    2 hours. If hydration status is not improving, give the IV drip more rapidly.
    • Also give ORS (about 5 ml/kg/hour) as soon as the child can drink: usually after 3-4 hours
    (infants) or 1-2 hours (children).
    • Reassess an infant after 6 hours and a child after 3 hours. Classify dehydration. Then
    choose the appropriate plan (A,B, or C) to continue treatment.

    Note:
    • If possible, observe the child at least 6 hours after rehydration to be sure the mother can
    maintain hydration giving the child ORS solution by mouth.

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