Control of Diarrhoeal Diseases, Acute Diarrhoeal Diseases
Control of Diarrhoeal Diseases, Acute Diarrhoeal Diseases
Control of Diarrhoeal Diseases, Acute Diarrhoeal Diseases
DIARRHOEAL
DISEASES
DR. SAMARJEET KAUR
A S S O C I AT E P R O F E S S O R
D E PA RT M E N T O F C O M M U N I T Y M E D I C I N E
GSVM MEDICAL COLLEGE, KANPUR
INTRODUCTION
Diarrhoea is the leading cause of death during disasters and other emergencies
LONG TERM
Better MCH care practices
Preventive strategies
Preventing outbreaks
Management of Diarrhoea
The 3 essential elements
The 3 essential elements in management of all
children with diarrhoea are :
• Oral Rehydration therapy
• Zinc supplementation
• Continued feeding
Rehydration therapy
During diarrhoea there is an increased loss of water and electrolytes (sodium,
potassium, and bicarbonate) in the liquid stool.
Dehydration occurs when
These losses are not adequately replaced and
A deficit of water and electrolytes develops.
This vicious circle can be broken by giving nutrient-rich foods during the diarrhoea and when the child is well.
Antibiotics and other drugs
Antibiotics should not be used routinely.
◦ They are reliably helpful only for
◦ Children with bloody diarrhoea (probable shigellosis),
◦ Suspected cholera with severe dehydration, and
◦ Other serious non-intestinal infections such as pneumonia.
https://youtu.be/q-fPnkWtMjY
Skin Pinch
sunken eyes
Severe dehydration
Children with severe dehydration require rapid IV rehydration with close
monitoring.
Followed by oral rehydration once the child starts to improve sufficiently.
In areas where there is a cholera outbreak, give an antibiotic effective against
cholera.
Treat Severe Dehydration Quickly: Diarrhoea Treatment Plan C
Start IV fluids immediately. While the drip is being set up, give ORS solution if the child can drink.
If Ringer’s lactate is not available, normal saline (0.9% NaCl) can be used.
5% glucose (dextrose) solution on its own is not effective and should not be used.
Give 100 ml/kg of the chosen solution divided as shown in the table below:
Use the child’s age only when you do not know the weight.
The approximate amount of ORS required(in ml) can also be calculated by multiplying the
child’s weight (in kg) by 75.
If the child wants more ORS than shown, give more.
Demonstrate to the mother, how to give the child ORS solution, a teaspoonful
every 1-2 minutes if the child is under 2 years; frequent sips from a cup for an
older child.
Check regularly to see if there are problems.
◦ If the child vomits, wait 10 minutes; then, resume giving ORS solution more slowly (e.g. a
spoonful every 2-3 minutes)
◦ If the child’s eyelids become puffy, stop ORS solution and give plain water or breast milk.
If there is no dehydration, teach the mother the four rules of home treatment:
◦ Give extra fluid
◦ Give zinc supplements
◦ Continue feeding
◦ When to return
No dehydration
Children with diarrhoea but no dehydration should receive extra fluids at home
to prevent dehydration.
They should continue to receive an appropriate diet for their age, including
continued breastfeeding
Treat the child as an outpatient
Counsel the mother on the 4 rules of home treatment.
Give extra fluid, as follows :
◦ If the child is being breastfed, advise the mother to breastfeed frequently and for longer at each feed.
◦ If the child is exclusively breastfed, give ORS solution or clean water in addition to breast milk.
◦ After the diarrhoea stops, exclusive breastfeeding should be resumed, if appropriate to the child’s age.
To prevent dehydration from developing, advise the mother to give extra fluids-as much as the child
will take:
◦ For children < 2 years, about 50-100 ml after each loose stool
◦ For children 2 years and above, about 100-200 ml after each loose stool.
Tell the mother to give small sips from a cup. If the child vomits, wait 10 minutes and then give more slowly.
She should continue giving extra fluid until the diarrhoea stops.
Teach the mother how to mix and give ORS solution and give her two packets of ORS to take home.
If the child shows none of these signs but is still not improving, advise the mother to return for the follow-up
at 5 days.
Zinc supplementation
Tell the mother how much zinc to give:
◦ Up to 6 months ½ tablet (10 mg) per day for 14 days
◦ 6 months and more 1 tablet (20 mg) per day for 14 days
Remind the mother to give the zinc supplements for the full 10-14 days.
Continued feeding
Continuation of nutritious feeding is an important element in diarrhoea management
In the initial 4-hour rehydration period, do not give any food except breast milk.
Breastfed children should continue to breastfeed frequently throughout the episode of diarrhoea.
After 4 hrs, if the child still has some dehydration and ORS continues to be given, give food every 3-4
hrs.
All children over 4-6 months old should be given some food before being sent home.
If the child is not normally breastfed, explore the feasibility of relactation (i.e restarting breastfeeding
after it was stopped or give the usual breastmilk substitute)
If the child is 6 months or older or already taking solid food, give freshly prepared food – cooked,
mashed or ground.
Encourage the child to eat by offering food at least 6 times a day. Give the same food after the
diarrhoea stops and give an extra meal a day for 2 weeks.
The 4 rules of Home Treatment
Give extra fluid
Continue feeding
When to return
◦ Advise the mother to return immediately to the clinic if
◦ The child becomes more sick, or
◦ Is unable to drink or breastfeed, or drinks poorly, or
◦ Develops a fever, or shows blood in the stool.
◦ If the child shows none of these signs but is still not improving, advise the mother to return follow up at 5 days.
•Follow up after 2 days in dysentery, after 5 days in acute diarrhoea
Repeated vomiting,
Fever,
Blood in stool
ORAL REHYDRATION SALT(ORS)
MECHANISM OF ACTION
Sodium promotes absorption of water from the intestine
Glucose promotes the absorption of sodium and water from the
intestine
Composition of WHO -ORS
SGPT:2.6,13.5,1.5,2.9
Hypo-osmolar ORS
Glucose 75
Potassium 20
Citrate 10
Chloride 65
245 mOsm/l
SGPTC:7575,201065
Benefits of citrate ORS over bicarbonate ORS
SUPER ORS
Powder of boiled rice (50 mg/L) can be used in place of amino acids
-ORT
-Appropriate feeding
-Chemotherapy
2. Long term
-Maternal nutrition
-Child nutrition: breastfeeding, proper weaning, supplementary feeding
b. Preventive strategies
-Sanitation
-Health education
-Immunization
-Fly control
-Food Hygiene: Boil it, cook it, peel it, or forget it
3 dose schedule
2 dose schedule
A child with diarrhoea needs more food and frequent breast feeding.