This is a summary on the causes of diarrhea diseases in children, it gives also an approach to assessment and classification.as well as appropriate management of dehydration in such patients.

1. By Abenezel
NIYOMURENGEZI
UNIVERSITY OF RWANDA COLLEGE OF MEDICINE AND HEALTH SCIENCES
DIARREAL IN CHILDREN

2. DIARRHEA
 Diarrheal: Passage of loose or watery stool three times or more in 24 hours
period.
 Acute: In period less or equal to 14days.
 Persistent or chronic: in period greater than 14 days.
 Diarrheal diseases account for 1 in 9 child deaths worldwide
 Thus it is the second leading cause of death among children under(CDC, 2016)

3. Three clinical types of diarrhea
1. Acute watery diarrhea dehydration ,electrolytes loss
2. Bloody diarrhea tissue damage, toxemia
3. Persistent diarrhea malnutrition

4. Age and diarrhea
1. Most diarrhea episodes occur during the first 2 years of life
2. Incidence is highest in the age group 6-11 month
 Declining levels of maternally acquired antibodies
 The lack of active immunity in the infant
 The introduction of food

5. Causes
 Infections(germs). Bacterial, viral, and parasites.
 Poor sanitation and hygiene
 Food intolerance/ allergy, Failing to breast.
 Medicines(Laxatives, Allergies..)
 Inflammatory bowel diseases (IBS, Gastroenteritis..)
 Malnutrition
 Immunisable dz: Measles
 Travelers' diarrhea.

6. Effects of Diarrhoea
 Dehydration, shock
 Biochemical disturbances
Sodium, Potassium
Metabolic acidosis
Blood glucose
Uraemia
• Convulsions
• Severe gut damage : ileus

7. Assessing the patient with diarrhea
 Eyes:normal? Sunken? Very sunken and dry?
 Tear: have tear?
 Mouth and tongue: wet? dry?very dry?
 Thirst: drinks normal?drinks eagerly?drinks poorly?
 Skin pinch: immediately? Slowly(>2se) ? very slowly?
 Additional sign: anterior fontanel?pulse? Breathing?
 From here the patient is classified into A, B, and C according to
the level of dehydration.

8. What dehydration category ???

9. Management:
 Category A (No dehydration): Water, Food - based fluids (soup, rice water,
Yoghurt drink, Glucose water).
 Category B(Mild dehydration): ORS per Oral,75ml/kg every 15 minutes. (see MOH
treatment guidelines)
 Category C( Severe dehydration): Children require rapid IV rehydration followed
by oral rehydration therapy
 For IV rehydration, Ringer’s lactate (also called Hartmann’s solution) is
recommended. If not available, normal saline can be used
 Give 100ml/kg of fluid:
 <12 months: 30ml/kg in first hour then 70ml/kg in 5 hours.
 =, >12months: 30ml/kg in 30 minutes then 70ml/kg in two and half hours.
 ZINC supplement: reduce severity by improving intestinal absorption
 Investigate the causes and address accordingly.

10. Case of bloody diarrheal
 Laboratory findings: – Leukocytosis(WBC=13,200, 85% neutrophils), blood
cultures, – Stool examination reveals fecal leukocytes, no ova and parasites
 Ensure adequate hydration and nutrition
 Antibiotics
 Refer to a specialist if dysentery and complications eg: persistent shock,
hemolytic uremia syndrome, toxic megacolon.

11. prevention
 Primaryreduce diseases transmission.
 Vaccination(rotavirus, measles), sanitation, safe drinking water, hand
washing…
 Secondaryreduce disease severity.
 Breastfeeding, vitamin A supplements, zinc supplements

12. Question??..............Thanks!!!!