Diarrhea resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Synonyms and keywords:

Diarrhea resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Diarrhea remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. Diarrhea is defined as an increase in the number of stools or the presence of looser stools than is normal, like more than three bowel movements each day. Acute diarrhea is when diarrhea occurs for less than 3 weeks total. When diarrhea lasts longer than three weeks, it is considered to be chronic.

Causes

Life Threatening Causes	Common Causes	Misc
Cholera Entamoeba histolytica Enterohemorrhagic Escherichia coli (EHEC) Enteroinvasive Escherichia coli (EIEC) Campylobacter spp. Nontyphoidal Salmonella enterica	Rotavirus. Enterotoxigenic Escherichia coli (ETEC) Cryptosporidium Shigella spp.	Parenteral causes including infections elsewhere in the body : UTI,Acute otitis media, Sepsis. Inflammatory including IBD,Allergy to cow's milk , whipples disease. Malabsorption including celiac disease ,lactase deficiency Feed related Endocrine :Hypothyroidism,Addison's disease ,Hyperparathyroidism' Neoplastic causes psychosocial

FIRE: Focused Initial Rapid Evaluation

• A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the patients in need of immediate intervention].

Patient presents with acute diarrhea in Emergency

Mild Dehydration

Moderate Dehydration

Severe Dehydration

Home with DGKJ information sheet, patient prescription, and dietary recommendations

Evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old

Dehydration > 9 % Shock, Impaired consciousness

ORS by spoon or syringe: Infants 5—9 kg: 2.0 mL every minute (120 mL/hr) Infants 9—12 kg: 2.5 mL every minute (150 mL/hr) Toddlers 12-15 kg: 3.0 mL every minute (180 mL/hr) If no vomiting, then larger volumes at longer intervals: 10-15 mL every 5 or 20-30 mL every 10 minutes Racecadotril in 5 mL of water) < 9 kg: 10 mg, 10-15 kg: 20 mg, 16-29 kg: 30 mg

Intensive care

Complete Diagnostic Approach

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Patient with history of diarrhea

Assessment A child with diarrhea should be assessed for dehydration bloody diarrhea, persistent diarrhea Malnutrition and serious non-intestinal infections so that an appropriate treatment plan can be implemented.

History Duration and severity of diarrhea; Presence of blood in the stool; Number of watery stools per day; Number of episodes of vomiting; swollen; diaper rash Presence of fever, cough, or other important problems (eq. convulsions, recent measles); Pre-illness feeding practices; type and amount of fluids (including breast milk) and food taken during the illness; History of Medications History of immunization.

Physical Examination Look for the signs and symptoms of dehydration Is the child alert, restless or irritable ? Look for the eyes, are they normal or sunken? Look for skin turgor? Does the stool contain red blood? Is the child malnourished? Look for growth char, weight for length or measure the mid-arm circumference Measure the temperature of child

Mild Dehydration There are no specific signs and symptoms.

Moderate Dehydration Initially, the signs and symptoms that develop include: - Thirst - restless or irritable behavior - decreased skin turgor - sunken eyes - and a sunken fontanelle (in infants)

Severe Dehydration these effects become more pronounced and the patient may develop evidence of hypovolaemic shock including: - Diminished consciousness - lack of urine output - cool moist extremities - a rapid and feeble pulse (the radial pulse maybe undetectable) - low or undetectable blood pressure - peripheral cyanosis. Death follows soon if rehydration is not started quickly

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Patient presents with acute diarrhea in Emergency

Mild Dehydration

Moderate Dehydration

Severe Dehydration

Children with no signs of dehydration need extra fluid and salt to replace their losses of water and electolytes due to diarrhea. Fluids to be given • ORS • Salted drinks eg. salted rice water or salted yogurt drink • Vegetable or chicken soup with salt • Home-based ORS: 3 gm of table salt and 18 gm of common sugar in one liter of water. Plain water should also be given. Commercial carbonated beverages, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.

Oral rehydration therapy for children with some dehydration: ORS + Zinc supplementation After 4 hours, reassess the child and decide what treatment to be given next as per the Grade of dehydration. Children who continue to have some dehydration even after 4 hours should receive ORS by nasogastric tube or RL intravenously (75 ml/kg in 4 hours). If abdominal distension then oral rehydration should be withheld and only IV rehydration should be given

Start IV fluids immediately. If the patient can drink, give ORS by mouth until the drip is set up. Give 100 ml/kg Ringer's Lactate Solutions divided as follows: First, give 30 ml/kg in: Then give 70 ml/kg in Infants (under 12 months) in 1 hour Reassess the patient every 1-2 hours. If hydration is not improving, give the IV drip more rapidly. After six hours (infants) or three hours (older patients), evaluate the patient using the assessment chart. Then choose the appropriate Treatment Plan (A, B or C) to continue treatment.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.