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“It is still just unbelievable to us that diarrhea is one of the leading causes of child deaths in the world.

” Melinda Gates.

INVESTIGATIONS:
1. Blood Counts.
2. Stool examination for :
_PH and reducing substances
_Giardia cysts and entamoeba .
- Bioassay for E.coli
- Leukocytes and RBCs
- Culture and sensitivity
-Elisa test for (Rota virus)
3. Serum electrolytes (Na+ and K+) and bicarbonate (HCO3)
4.Urine examination and culture for parenteral diarrhea.
5.Blood culture for salmonellosis or shigellosis
6. X_ray chest (for pneumonia)
MANAGEMENT

• Before starting therapy, we assess degree and type of dehydration


according to the following plan:
• DOES THE CHILD HAVE DIARRHEA?
• If yes , ASK:
• For how long?
• Is there blood in the stool ?
• LOOK and FEEL :
• Look at the child’s general condition .
• Is the child lethargic or unconscious ?
• Restless and irritable ?
• Look for sunken eyes
• Offer the child fluid .
• Is the child :
• Not able to drink or drinking poorly?
• Drinking eagerly ,or thirsty?
• Pinch the skin of abdomen .
• Does it go back :
• very slowly (longer than 2 sec)?
• slowly?
ASSESSMENT OF DIARRHEA FOR DEHYDRATION

No dehydration Some dehydration Severe dehydration

Not enough signs to classify Two of the following signs : Two of the following signs :
as some or severe
dehydration
Restless and irritable Lethargic or unconscious
Sunken eyes Sunken eyes

Drinks eagerly ,thirsty Not able to drink or


drinking poorly

Skin pinch goes back slowly Skin pinch goes back very
slowly

TREATMENT PLAN A TREATMENT PLAN B TREATMENT PLAN C


Treatment plan A (For no dehydration):
Treat diarrhea at home
Counsel the mother on the 3 rules of home treatment:
Give extra fluid, continue feeding, when to return.
• 1.Give extra fluid (as much as the child will take ):
• (a) tell the mother :
• Breastfeed frequently and for longer at each feed .
• If the child is excessively breast feed ,give ORS or clean water in addition
to breast milk .
• If the child is not excessively breast feed , give one or more of the
following :
• ORS solution
food based fluids
clean water
(b) Teach the mother how to prepare ORS at home:
Give mother 2 packets of ORS to use at home
and also teach the mother how to prepare ORS at home : 8 glasses of
water :
8 spoons of sugar
1 spoons of salt
1 liter of water
and a half lemon
© show the mother how much fluid to give in addition to usual fluid intake
Upto 2 years 50 to 100ml after each
loose stool
2 years or more 100 to 200 ml after each
loose stool
(d) Tell the mother to :
give frequent small sips from a cup.
If the child vomits, wait for 10 mins .
Then continue , but more slowly .
Continue giving extra fluid until the diarrhea stops.
• 2. Continue feeding
• 3.when to return for follow up visit:
• Advise the mother to come after 5 days for follow up.
• 4. When to return immediately :
• Not able to drink or breast feed
• Becomes sicker
• Develops fever
Blood in the stool
• Treatment plan B (for some dehydration )
• Tell the recommended amount of ORS over the 4 hour period
• Determine the amount of ORS to give during first 4 hours
• Use the child age only when u don’t know the weight
• The approximate amount of ORS required can be calculated by multiplying
the Childs weight times 75
• Show the mother how to give ORS solution
• After 4 hours :
• Reassess the child and classify the child for dehydration
• Select the appropriate plan to continue treatment
• Begin feeding the child in clinic
Treatment plan C ( treat severe dehydration quickly )

1.Give IV fluids immediately if you can :


Give 100ml/kg
Ringer lactate solution .
(if not available =N/S)
AGE FIRST GIVE THEN GIVE
30ml/kg IN : 70ml/kg:

Infant under 12 month 1 hour 5 hours

Children under 12 30 mins 2 and half hours


months upto 5 years
• If IV Rx is available then :
• Refer urgently to the hospital for IV Rx
• If the child can drink provide the mother ORS solution and show her how
to give frequent sips during the trip
Hospital management of severe dehydration

1.DIRECT THERAPY :
To correct existing water and electrolyte and deficit
FLUIDS FOR DEFICIT THERAPY
Give ringer solution or N/S
If the child is in shock _ 20ml/kg in 10-15 mins
(repeat the fluid 20ml/kg in 10 -15 mins if the radial pulse is still very week )
2. Concurrent losses:

• Replacement of ongoing losses due to diarrhea and vomiting


• 5%dextrose 1/5 saline is given 100ml/kg/day
• 3. Maintenance therapy
• IV therapy is indicated in following cases :
• Severe dehydration ,shock, severe vomiting , abdominal distantion
4.Electrolyte replacement

• K+ normal requirement is 2mEq/kg/day


• Given in drip not less than 6 hours
• (rapid injections of K+ can cause ventricular fibrillation and death )
• Bicarbonate is given in sever metabolic acidosis
• Sodium bicarbonate is given 2mEq/kg stat slow IV diluted and repeat after
2 hours
5.Antibiotics
CAUSE ANTIBIOTIC OF CHOICE

CHOLERA Tetracycline 50mg/kg/day 4 divided


doses for 2 days
Furazolidine 5mg/kg/day 4 divided
doses for 3 days
SHIGELLA Ampicillin 100mg/kg/day 4 divided
doses for 5 days
Nalidixic acid 55mg/kg/day

AMEBIASIS Metronidazole 30mg/kg/day 3 times a


day for 5 days

GIARDIASIS Metronidazole 15mg/kg/day for 5 days


Quinacrine 7mg/kg/day for 5 days