Case Management Of Diarrhoea

:BY SANDHYA JEGANATHAN

3 or more loose or watery stools in a day. Recent Change in consistency and character of stool

Passage of frequent formed stools Passage of pasty stools in breast fed infants Transitional stools on 3rd to 7th day of life

Two or more signs Increased thirst unable to drink Irritability floppy lethargic Decreased skin turgor(may be masked in hypernatremic diarrhoea) Dry mouth and tongue Sunken eyes, Sunken AF Tears absent Decreased urine output

(classified by clinical syndromes): Acute watery diarrhoea(some dehydration or severe dehydration Dysentery Persistent diarrhoea (acute watery diarrhoea and dysentery lasting for more than 14 days)

80% ROTAVIRUS,REO VIRUS 20% Bacteria and parasitic cause

Amoebiasis and giardiasis are unlikely in childhood

Vomiting Fever , ARI Abdominal cramps Rapid weight loss anorexia

electrolytes--Na ,K , Cl Dehydration (loss of water and electrolytes HCO3--) HCO3 Malnutrition Acute renal failure Renal v thrombosis , HUS

FLUID REPLACEMENT CONTINUING FEEDING RATIONAL USE OF DRUGS

CONTD; ORS HOME AVAILABLE FLUIDS rice water,dal water with salt,lassi with salt, coconut water--preferably given along with food(starch and water protein are provided) that promote luminal absorption of Na.

A (patients without physical signs of dehydration) Use adequate amounts of home available fluids . Advice mother to continue feeding despite diarrhoea or vomiting. Take to health worker if condition does not improve or develops any of the danger signs DANGER SIGNS: Many watery stools Repeated vomiting/eating or drinking poorly Fever/blood in the stool

of dehydration

)

(patients with physical signs

Rehydration therapy Maintenance therapy Provision of normal daily fluid requirements

REPLACEMENT FLUID: In the first 4 hrs 100ml/kg of ORS MAINTENANCE FLUID After 4solution(10--20ml/kgBW) 4-6 hrs of treatment with ORS solution(10 no improvement reassess improvement continue the replacement start on maintenance maintenance fluids fluid

! 9START IV FLUIDS IMMEDIATELY 30 ML/KG IN THE 1ST HR 70 ML/KG IN NEXT 5 HRS

If unable to start ivf give feeds through nasogastric tube 15--30mins(:radial pulse) Reassess every 15 In children aged >1 yr give this in ½ the time duration

High stool purge Persistent vomiting Incorrect preparation Abdominal distension and ileus Glucose malabsorption

ORS does NOT stop Diarrhoea

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