Oresol: a management for diarrhea to prevent dehydration 2 Concepts of Diarrhea: a. Frequency of passing out stool=3x/day b.

Consistency of the stool=watery Contents of One Pack Oresol Dissolved in One Liter drinking Water 20 grams 1 Significance: For re-absorption of Na Facilitates assimilation of Na 2 Significance: Provides heat & energy Sodium Chloride/NaCl 3.5 grams For retention of water/fluid Sodium 2.5 grams Buffer content of solution Bicarbonate/NaHCO3 Neutralizer content of solution Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle contractility especially the heart & GIT Never advice mother to buy brand names like pedialyte or gatorade Glucose Preparation of Proper Homemade Oresol A volume or one liter homemade oresol Smaller volume or a glass homemade oresol Water 1000 ml. or 1 liter 250 ml. Sugar 8 teaspoon 2 teaspoon Salt 1 teaspoon teaspoon or a pinch of salt=10-12 granules of rock salt: iodized salt=tips of thumb & index finger are penetrated with salt For making solution=use 250 ml of water For drinking medicines=a glass is 240 ml of water a. b. c. a. b. c. 3 Categories of Dehydration: No dehydration-uses oresol Some dehydration-uses oresol Severe dehydration-uses IVF Objectives/Plan/Policies of the Use of the following Program: Plan A: for prevention of dehydration Plan B: for treatment of dehydration-mild & moderate Plan C: for treatment of dehydration-severe Assessment 1. Condition a. Normal b. Well c. Alert 2. Fontanel-normal 3. Eyeballs-normal Tears-present 4. Mouth, Tongue & Lips: moist or wet Thirst: drinks normally 5. Skin Turgor-returns back quickly which is done at forearm CDD Management Chart Category Treatment No dehydration Plan A-prevention of DHN 3 Principles/3 Fs: 1. Increase fluid: Tea-lipton tea bag left standing in a cup of water for 15 minutes & there is brownish discoloration =pectin, a diuretic & has an absorbent effect Fruit Juices-not from highly fibrous fruits like pineapple, mango, guyabano

Oresol-am or buko where 3 electrolytes are present: Na, K & Ca which are lost in diarrhea Oresol is given/LBM or every time stool is passed out: < 2 years old: 50-100 ml. always give the maximum amount 2-10 years old: 100-200 ml. 10 years old & above: as much as tolerated & desired 2. Increase feeding: 3. Fast referral Plan B-Treatment of mild & Moderate DHN using oresol If less than 2 years old: use age in months If < 4 months: 200-400 ml. 5-11 months: 400-600 ml. 12-23 months: 600-800 ml. 2-4 y/o: 800-1200 ml. 5-14 y/o: 1200-2200 ml. 15 & above: 2200-4000 ml. Treatment Plan: 1st 4 hours always give the maximum Plan C-treatment of severe DHN using IVF Priority-choice of IVF: 1. D5LRS-best or 1st choice if available for severe DHN since dextrose gives additional source of energy & improves appetite D5-is glucose LRS-has 3 chlorides 2. LRS-Lactated Ringers or Hartman solution is the most appropriate choice if no D5LRS 3. Plain NSS or 0.9 NaCl 4. D5W 5. D10W

1. Condition Some dehydration a. Restless b. Irritable 2. Sunken fontanel 3. Sunken eyeballs & absent tears 4. Dry mouth, tongue & lips Eagerness to drink 5. Skin returns back slowly

1. Condition a. Unconsciousness b. Lethargic c. Floppy-apathetic or passive 2. Very sunken fontanel 3. Very sunken eyeballs & absent tears 4. Very dry mouth, tongue & lips Refuses to drink orally 5. Skin returns back very, very slowly best done at the abdomen

Severe dehydration

2 Victims of Severe Dehydration: Child: give 100 mg/kg body weight in the 1st 4 hours Example: 8 kg=800 ml. IVF to be infused on the 1 st 4 hours for patient with severe dehydration (8am-12noon) b. Adult: give 3-4 liters of IVF in 1st 4 hours Example: 9am-1pm=4 liters=1 liter/hour a.

If still severe dehydration, 2-6pm=infuse 4 liters IVF Fruits for Diarrhea: Apple: has pectin & tarum which has an absorbent property, eat the skin Banana: has K+ Caimito: eat the flesh in cases of constipation but in diarrheal cases, eat the extracts, milky substances (dagta) found on the inside of the skin Duhat: wash first the fruit then sprinkle with rock salt & shake, notice extracts to come out of the fruit, eat both skin & flesh Fruits to avoid during diarrhea: Papaya flesh, pineapple flesh, mango, guyabano & kaimito flesh BRAT Diet: Banana, Rice, Apple, Tea, toasted bread or toasted rice beads which has activated charcoal that acts as absorbent Direction: In a cup of warm water, add 1 tablespoon of toasted rice or bread & allow to stand for 20-30 minutes produces a blackish discoloration which is pectin UFC (Under Five Children) Program-basic health service for children under 5 Policies to implement UFC: GOBIC G rowth Monitoring: age, weight & height O resol: CDD policies B reast feeding I mmunization C ARI Program (Care & Control of Acute Respiratory Infection (Pneumonia, Ear & Throat Infection) DIARRHEA -occurs when stool contains more water than normal -consistensy of stool: watery loose stool. -frequency of bowel movement: 3 or more within a day -Clinical Manifestation: 3 or more of loose/watery stool within a day according to WHO and DOH. Program:CDD (Control of diarrheal disease) Main objective:to reduce mortality rate d/t diarrhea among children 5years of age through extensive care management. Extensive care management: Oresol rehydration Therapy ORS:1.oresol pocket/hydrite 2.home made ORS 3. AM- Rice water DIARRHEA Assess: 1.For how long? Acute <14 days Persistent >14 days 2.Blood on stool? 3.Assess signs of Dehydration/DHN ***1st sign of DHN Thirs,irritable and drinks eagerly TREATMENT: PLAN C 1.IVF=D5LR Exemption to the rule if no other severe disease and availability of resources. 2. REFER!!! PINK SEVERE DHN S/S C-T-E-S-T 2 signs of DHN or above YELLOW SOME DHN S/S C-T-E-S-T 1pink and other signs of yellow or above. TREATMENT: PLAN B 1.Give ORS every 4 hours (wt by kg) x 75 = #cc <4mos = <400 4mos-1y/o= 400-700 1y/o-2y/o = 700-900 2y/o-5y/o = >900 4-1-2-5-4-7-9 ***after 4 hrs re-assess the child: Severe=plan C and refer!!! Same=repeat plan B GREEN NO DHN S/S C-T-E-S-T TREATMENT: PLAN A 1.ORS given 1wk old-2y/o=50cc100cc 2y/o-5y/o=100cc200cc 2. 4home rule mgt 3.follow up 5 days REMINDERS IN ORS!!! a.severe vomits- stop ORS then start IVF b.Mild Vomits Stop

SEVERE PERSISTENT (YC&YI) 2 or more signs of DHN 1.PLAN C (Same exemption) 2. Vitamin A is given

DYSENTERY (YI) No exemption referral is needed!!!

No DHN=shift to plan A 2. 4 home rule management a. continue feeding/BF b. give extra fluid(juices,soup) c.give zinc supplemet(10-14 days) d.Instruct the mother to s/s to know when to return the child 3.Follow up 5 days PERSISTENT (YC) No signs of DHN 1.Give Vit.A 2.Proper feeding recommendation If still BF: a.frequent BF day and night If milk supplement: a.replace milk supplement to breast milk. b.replace half of the milk with nutrient rich semi solid food. c.do not use condense or evaporated milk. 3.Follow up 5 days DYSENTERY (YC) 1.5 days antibiotic 1st line:Cotrimoxazole 2nd line:nalidixic 2.follow up 2 days YELLOW RESTLESS/IRRITABL E DRY SUNKEN EYES SLOWLY <2seconds DRINKS EAGERLY

ORS in 10 mins then continue slowly c.Puffiness of eyelids means overhydration give 1 milk or 1 glass of water.

C-T-E-S-T C-ONDITION T-ONGUE

PINK ABNORMALLY SLEEP VERY DRY

GREEN WELL AND ALERT MOIST NORMAL EYES QUICKLY 1seconds or less than DRINKS NORMALLY

E-YES SUNKEN EYES S-KIN T-HIRST VERY SLOWLY > 2seconds DRINKS POORLY

Preventive measure: a. Breast feeding -effective and practical way. -Breastmilk include Lactalbumin (for easily digestion) b.Handwashing c.Measles vaccine that can reduce incidence of diarrhea to children. How To Pinch in Abdomen: 1.Lying on his back/supine 2.use thumb and 1st finger 3.do not use fingertips 4.Location:halfway between umbilicus & side of abdomen.

Home made Oresol: 1L of water 1 tsp salt 8 tsp sugar -1 glass of water 1pinch salt 2 tsp of sugar