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Assistant professor of pediatric and in today’s lecture i am going to discuss diarrhea dehydration and who protocols of rehydration first of all let us define diarrhea passage of liquid or watery stools at least three times in 24 hours it is the consistency rather than the number of tools that is important breastfed babies often pass loose plastic stools which cannot
Be called diarrhea world over 1 billion episodes per year in children under five years of age three to five episodes per year in each child in the two years of age in developing countries are in underdeveloped countries and two million children 2 million children die annually and eighty percent in the first two years of life because of diarrhea and dehydration
Foreign there are three mechanisms of diarrhea security diarrhea osmotic diarrhea and motility diaries secretary diarrheas are caused by secreto boats like cholera toxin osmotic osmotic diarrhea is caused by poorly absorbed solute magnesium phosphate a small bowel defect like lactase deficiency on brush powder which is caused by viral infections viral diarrheas as
Well as bacterial diets and motility areas are associated with increased motility like in irritable bowel syndrome or delayed motility like in intestinal pseudo-obstruction etiology of diarrhea can be viral can be protozoal and can be bacterial rotavirus is the most common cause of diarrhea followed by norovirus norwalk like virus enteric adenoviruses astroviruses
And direct viruses then protozoal and histolytica giardia lamblia and among bacteria e coli company salmonella and vibrio cholera remains the leading cause of bacterial digest who says first asks the history of diarrhea and dehydration diarrhea vomiting dehydration then look for signs of dehydration and then feel for the signs of dehydration ask for frequency
Of stools whether there’s blood in the stools because once blood in there is blood in the stool it is the century a dysentery is most is mostly caused by invasive organisms and usually by bacteria so antibacterial must be added in the therapy whenever somebody has bloody diarrhea that is dysentery ask about danger signs these four are dangerous signs of diarrhea
And dehydration who dangerous signs of diarrhea and dehydration and general danger signs are slightly different from this vomiting everything out not able to eat uttering meaning by the child is very lethargic child has convulsions or loss of consciousness after asking look for signs of dehydration blood installs and look for malnutrition naked eye examination
Of stool will be imported here let’s have a look on signs of dehydration you can see that child is restless irritable he can be lethargic can be unconscious can have sunkan eyes you have to see whether the child is thirsty or not thirsty and the child’s ability to drink look and feel for the sunken fontanelle you can see in this picture clearly the child is
Dehydrated and has sunken fontanelle feel for the skin pinch pinching the child’s abdomen to test for decreased skin target slow return of skin pinch in severe dehydration if it takes more than 2 seconds it is very slow skin pinch going back very slowly based on your assessment you will classify patients on severe dehydration some dehydration or no dehydration
Severe dehydration meaning by that 10 percent are more than 10 percent of the body weight is lost in some dehydration are in moderate the other word for some dehydration is called mortar dehydration five to ten percent of the body weight is lost and in no dehydration which is called mild dehydration in other words less than five percent body weight is lost so you
Will classify according to who patients having no dehydration some dehydration and severe dehydration why less than five percent body weight loss is called no dehydration because the child has not shown any sign of dehydration by the time he loses less than five percent body weight when he loses more than five percent five to ten percent then he shows some signs
Of dehydration this is a tabular form on the assessment and then the treatment plan decide grade of dehydration and then decide the treatment plan which will be instituted for the treatment of this child if child looks well is alert tears are present eyes are normal tongue is moist his thirst his thirst is normal and skin pinch goes back quickly then this is no
Dehydration and you will use plan a we will discuss planar later if child on examination is restless his tears in his eyes are absent eyes are sunken his tongue is dry and he is thirsty and drinking eagerly and skin pinch goes back slowly then it is some dehydration and plan b will be used but if the child on examination is lethargic his tears are absent eyes are
Sunken and dry tongue and mucus membrane are very dry and it drinks poorly and his skin pinch returns very slowly then child has severe dehydration and plan c will be instituted for the rehydration of such a child we will start with plan c plan c is used for severe rehydration it is it consists of administration of iv fluids to a severely dehydrated child lancy
States that a child with severe dehydration is to be given 100 ml per kg iv fluid if child is less than 12 months old are less than 10 kg then out of this 100 ml 30 ml per kg is given in fast r and 70 ml per kg is given in 5 hours so total rehydration time is 6r in a child more than 12 months old or more than 10 kg this 30 ml initial 30 ml per kg will be given
In 30 minutes and remaining 70 ml per kg will be given in two and a half hour if child after 30 minutes or after 1 hour depending on the age of the child after first initial 30 ml per kg still has weak radial pulse our pulse is not detectable you need to repeat this 30 ml per kg in one hour for less than 12 months and more than 12 months in 30 minutes and after
Completing this rehydration plan c in 3r6r re-evaluate after three to six hour and if still dehydrated plan c is repeated this is a very important slide and has direct relationship with the type of fluid which will be used for the for rehydration of the child ringer lactate is the ideal fluid for such children because dehydrated children will have more um will have
More salts in in his body and will need a fluid which has slightly lesser ionic composition ringa lactate is ideal for this purpose it contains sodium 130 potassium 4 which is more physiological chloride 109 and lactate 28 and this lactate in corey cycle will go to be converted into glucose and lactate itself can be utilized in the tissue so this ringer lactate
In addition to giving fluid in addition to providing hydration to the body cells and in addition to providing salts it will provide a little bit of nutrition as well normal saline contains only sodium and chloride 154 mil equivalent millimole and 154 milli mole of chloride so total total 308 whereas ringer lactate has 255 when a child is dehydrated his plasma
Osmolality is already little high so we want to give a fluid which balances the plasma osmolality and ringer lactate is best for the purpose but in case of shock in case of when you are unsure of the potassium status of the child and acid-base balance of the child then normal saline is the preferred solution half normal cell line can be given in in younger babies
Less than less than one year less than six months but half the line hack and can given if given rapidly can lead to hyponatremia can lead to cerebral edema it is not the ideal resuscitation fluid for the purpose and glucose solutions because they don’t contain any ketones or any annoyance so glucose solutions are not resuscitation fluid these are only maintenance
Fluid and should be avoided in all resuscitation settings except hypoglycemia plan b some dehydration administration of oral rehydration solution to a some dehydrated child plan b states that 75 ml per kg ors is given in 4r amount of orns to give during first or are first 4 hour is as follow if child is less than 5 kg then 200 to 400 ml if 4 to 11 months or five
To eight kg 400 to 600 if a to 11 kg 600 to 800 if 11 to 11 to 15.9 kg 800 to 1200 and so on so forth and child used to be reassessed after four hour if still moderate or some dehydrated then again the same 75 ml per kg or as roughly r according to the table ors is given according to the weight of the shaft different types of ors are available in the market some
Are low or smaller some are normal or smaller but low or smaller w h o o r s is the new ors new standard os which should be used in all settings this is the composition of low or smaller ors it contains sodium chloride 2.6 gram trisodium citrate dihydrate 2.9 gram potassium chloride 1.5 gram and anhydrous glucose 13.5 gram this one packet is added into one liter of
Water and it gives sodium 75 ml equivalent glucose 75 ml equivalents chloride 65 ml equivalent potassium 20 ml equivalent and citrate 10 ml equivalent and this is the ideal ors which is seen to decrease the episodes of diarrhea and vomiting as well and is better tolerated as compared to a normal osmolar osmolality virus oras can be prepared at home to prepare ors
At home add four glasses of boiled drinking water and add three teaspoon full of sugar approximately 15 gram of sugar one pinch of salt and few drops of lemon juice will give you one liter of homemade forests which can be used in next 24 hour child has no dehydration then plan a is instituted which consists of administration of ors and continued feeding at home
Plan a states give extra fluid and feeding give 10 ml power kg ors for each loose tool and 5 ml per kg of ors for each vomiting gives zinc supplements for 10 to 14 days up to 6 months of age 10 mm 10 milligram per day and uh more than if child is more than 6 months then 20 milligram per day is given continue feeding and tell the family one to return tell about
All the dangers signed tell about the signs of dehydration so that family can return home get returned back hospital in time different anti-microbial agents are recommended by who for cholera trimethopraim sulfamethoxazole for e coli shigella compello vector sulfur trimethopraim sulfamethoxazole which is septron analytics acid and ciprofloxacin are recommended
For mbbs’s metronidazole is recommended and for grds as well as metronidazole is recommended in different doses doses are shown in the table patience monitoring is done on regular basis by checking the body weight further body weight loss is not going on vital signs are monitored pulse rate will tell you about the state of hydration uh capillary refill time will
Tell you blood pressure will tell you about the state of hydration food taken where the child is able to now take milk or other foods semi solids or not fluid electrolyte balance will also be monitored there are many complications of dehydration like hyper hypokalemia high uh hyponatremia hypernatremia hypocalcemia hypoglycemia and the most common metabolic
Rearrangement is hypokalemic hyponatremic metabolic acidosis and further damage to the kidney can lead to uremia as well but in uremia there will be hyperkalemia further if it leads to kidney damage then there will be hyperkalemia but initially most common metabolic arrangement is hypokalemic hyponatremic metabolic acidosis if organism is invasive then child can
Have dysentery child can have persistent diarrhea a child can have malnutrition conversions vitamin a deficiency which will further predispose the child to development of measles and malnutrition hemolytic uremic syndrome is a complication of diarrhea caused by sugar toxin producing e coli post ideal paralytic ileus pneumonia septicemia meningitis can be caused by
A distillery dysentries distillery diarrheas do not use anti-diarial drugs and anti-imetics in cases of diary and vomiting because the focus attention away from rehydration they prolong the excretion of bacteria in the stool can be associated with side effect they are ineffective and costly promotion of breastfeeding prevents diarrhea complementary feeding and
Weaning personal and domestic hygiene including hand washing use of safe drinking water vaccination and health education of mother can prevent diarrheal illnesses diarrhea is a common preventable condition with high morbidity and mortality in children it can be easily treated with simple cheap and effective therapy available in the form of ors that needs to be
Communicated to the community through health education virus can be prepared at home there
Transcribed from video
Diarrhoea, Dehydration and WHO guidelines. Rehydration Plans A, B and C. Dehydration Classification. By Dr Muhammad Ansari Child Specialist
