Report Diarrhea

1. Assess the nutritional status, electrolyte status and the state of hydration of the patient.(include growth chart, hydration table and how to compute for ideal body weight of age of patient) The patient is considered dehydrated, hypokalemic and malnourished. signs and symptoms that would prove this are Dehydration and malnourishment

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Sunken eyeballs Mouth and tongue were dry Poor skin turgor Decreased urine output Weighing 11kg at 3 yrs old

Hypokalemic

•

Serum electrolytes potassium levels

showed

normal

sodium

and

decreased

2. Discuss the sequence of events in diarrhea that will lead to alterations in volume, electrolyte, osmolality and acid- base balance as shown in this case. •

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Diarrhea occurs when insufficient fluid is absorbed by the colon. As part of the digestion process, or due to fluid intake, food is mixed with large amounts of water. Thus, digested food is essentially liquid prior to reaching the colon. The colon absorbs water, leaving the remaining material as a semisolid stool. Diarrhea can lead to dehydration and a loss of electrically charged particles (electrolytes), such as sodium, potassium, magnesium, and chloride, from the blood. To expel the contents of the lower digestive tract, the fluidity of the contents of the small and large intestines is increased. Active transport of Na+ back into the lumen initiates a reverse sodium transport. This causes both Cl– and HCO3– to follow passively, as well as water. Now in the intestines, the water dilutes toxins as well as triggering contractions of the intestine due to increase in intestinal distension. These contractions push the contents of the lower GI tract towards and out of the anal canal.

Electrolyte

Normal Values

Sodium

135 - 145 milliEquivalents/liter (mEq/L) 135 - 145 millimoles/liter (mmol/L)

Potassium

3.5 - 5.0 milliEquivalents/liter (mEq/L) 3.5 - 5.0 millimoles/liter (mmol/L

Chloride

97-107 mEq/L 98 - 108 mmol/L

Bicarbonate

20–29 mEq/L 22-30 mmol/L

3. What instructions will u give regarding fluid replacement? In the interview/ history taking, the patient stated that the child is positive for vomiting. The actions that would be suited are: Give Oral Rehydrating Solution To prevent too much liquid being lost from the child's body, an effective oral rehydration solution can be made using ingredients found in almost every household. Home made ORS recipe Preparing a 1 (one) litre oral rehydration solution [ORS] using Salt, Sugar and Water at Home Mix an oral rehydration solution using one of the following recipes; depending on ingredients and container availability:

Ingredients: • • •

one level teaspoon of salt eight level teaspoons of sugar one liter of clean drinking or boiled water and then cooled 5 cupfuls (each cup about 200 ml.)

Preparation Method: Stir the mixture until the salt and sugar dissolve. Feed every time a watery stool is passed. Each Feeding: •

For a child under the age of two Between a quarter and a half of a large cup

•

For older children Between a half and a whole large cup (about 200ml)

Oresol contains the following electrolytes Electrolyte Sodium Potassium Chloride Bicarbonate

Amount 90 mEq/L 20 mEq/L 80 mEq/L 30 mEq/L

4. Explain the role of glucose in oral rehydrating solutions. Glucose is a cotransporter of electrolytes in the body. Sugar is important to improve absorption of electrolytes and water, but if too much is present in ORS solutions, diarrhea and dehydration can worsen because of having an osmotic diuretic component. 5. What recommendations will you give regarding the nutritional management of this child? • Older children accustomed to eating a variety of table foods should continue receiving a regular diet; cereal-milk and cereallegume diets have been used successfully for the dietary management of these children. Other recommended foods include starches (e.g., rice, potatoes, noodles, crackers, and

bananas), cereals (e.g., rice, wheat, and oat cereals), soup, yogurt, vegetables, and fresh fruits. •

Foods to be avoided are those that are high in simple sugars, which can exacerbate diarrhea by osmotic effects. These foods include soft drinks, Jell-O, and presweetened cereals. In addition, foods high in fat may not be tolerated because of their tendency to delay gastric emptying.

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“BRAT” diet (bananas, rice, applesauce, and toast) has long been used as a dietary-management tool among pediatric practices. To the extent that it includes starches and fruits, it is a reasonable dietary recommendation. However, prolonged use of the BRAT diet, or a protracted course of diluted formulas, can result in inadequate energy and protein content in the recovering child's diet.

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An alternative diet that is being researched is the “CRAM” diet (Cereal, Rice, and Milk,) since it may add more complete protein and needed fat into the diet.