2. Diarrhea is a condition in which there is :
- Unusual frequency of bowel movements (more than 3 times
a day).
- Changes in the amount ( more than 200g a day).
- Change in consistency( liquid stool).
It is a common cause of death in developing countries and
the second most common cause of infant deaths
worldwide.
WHO defines :
Having 3 or more loose or liquid stools per day, or as having
3 or more loose stool.
3. TYPES OF DIARRHEA
Acute diarrhea is an attack of loose motion with
sudden onset which usually lasts 3 to 7days but
may last up to 10 – 14 days. It is caused by an
infection of the large intestine, but may be
associated with infection of gastric mucosa and
small intestine. The term “acute gastroenteritis” is
most frequently used to describe acute diarrhea.
4. Chronic diarrhea is termed when the loose motion is
occurring for 3 weeks or more. It is usually related to
underlying organic diseases with or without
malabsorption.
Diarrhea with watery stools and visible blood in the stools
is called dysentery.
Persistent diarrhea refers to the episodes of acute
diarrhea that last for 2 weeks or more and may be due to
infective origin.
5. CAUSES OF DIARRHEA
The main causes of this disease are lack of
knowledge of hygiene and sanitation, home
environment, feeding practices of the parents and
under five years of children.
It can be caused by chronic ethanol ingestion.
Chronic mild diarrhea in infants and toddlers may
occur with no obvious cause and with no other ill
effects ,this condition is called toddler’s diarrhea.
6. EPIDEMIOLOGY
About 1/3 of total hospitalized
children are due to
diarrheal diseases and 17%of all
deaths in indoor
pediatric patients are related to this
condition. The
morbidity rate in terms of diarrhea
episodes per
year per child under the age of 5
years is about 1.7.
7. AGENT FACTORS
Diarrhea is mostly infectious. A large numbers of
organism are responsible for acute diarrhea.The
infectious agent causing diarrhea with enteric
infection include the followings:
- Viruses: Rota virus, adenovirus,enterovirus,norwalk
group viruses,measles virus etc.
8. RESERVOIR OF INFECTION
Man is the main reservoir of enteric pathogens ,so
most transmission originates from human factors.
For some enteric pathogens and viral agents
animals are important reservoir.
10. MODE OF TRANSMISSION:
It is mainly feco-oral route.It is water- borne,foodborne
disease or may transmit via
fingers,fomites,flies or dirt.
11. CLINICAL MANIFESTATIONS:
Stools are usually loose watery in consistency.It
may be greenish or yellowish-green in color with
offensive smell. It may contain mucus, pus or blood
and may expelled with force,preceded by
abdominal pain.
Frequency of stools varies from 2 to 20 per day or
more.
12. The child may have low grade fever,thirst, anorexia.
Behavioral changes like
irritability,restlessness,weakness, lethargy, sleepyn
ess, delirium,stupor and flaccidity are usually
presengort.
Physical changes like loss of weight, poor skin
turgor, dry mucus membranes,dry
lips, pallor, sunken eyes,depressed fontanelles are
also found.
13. Vital signs are changed as low blood
pressure,tachycardia,rapid respiration,cold limbs
and collapse.
Decreased or absent urinary output.
Convulsions and loss of consiousness may also
present in some children with diarrheal diseases.
14. DIAGNOSIS:
History taking and physical assessment.
Stool examination can be done for routine and
microscopic study and identification of causative
organisms.
Blood examination can be performed to detect
electrolyte imbalance,acid- base
disturbances,hematocrit value,TC,DC,ESR etc.The
suspected associated cause should be ruled out for
adequate management.
15. MANAGEMENT:
Rehydration Therapy:
The management of diarrhea is a vast majority of
children is best done with ORS solution and
continued feeding.
ORT means drinking of solution of clean water, sugar
and mineral salt to replace the water and salt lost
from the body during diarrhoea,especially when
accompanied by vomitting,i.e gastroenteritis.
16. MGMT CONT:
After 4 hours of rehydration therapy the child should
be reassess for degree of dehydration. If there is no
sign of dehydration the child should be managed at
home with necessary instructions to the mother.
If the signs of severe dehydration have appeared
the child should be admitted in the hospital for I/V
fluid therapy.
During ORS therapy ,if child is having puffy
eyelids,then ORS should be stopped and plain
water and breastfeeding to be given.
17. MGMT CONT:
The child with severe diarrheal dehydration
should be treated quickly. Intravenous fluid to be
started immediately with Ringerlactate solution
100ml/kg. If the patient can drink,ORS to be given
by mouth about 5ml/kg/hour.
Ringer-lactate to be infused at first 30ml/kg/hour
and then 70 ml/kg in 5 hours for infants.
In older children, it should be given first 30 ml/kg in
30 minutes and then 70ml/kg in 2.5 hours.
The patient should be reassess every one to two
hours.
18. MGMT CONT:
Bacterial or protozoal diarrhea can be treated with
specific drugs. Ampicillin,nalidoxic
acid,norfloxacin,ciprofloxacin,furazolidine,metronida
zole can be used.
19. DIETARY MANAGEMENT:
Diet to be planned to prevent malnutrition and allow
normal nutritional requirement.
Food items may include energy rich food with
rice,potatoes,wheat,pulses,vegetables oil,curd,fish,high
fiber content foods and soft drinks should be avoided.
Breast feeding to be continued during diarrheal
episodes even along with ORS.
Cereal mixture like rice- milk, dalia- sagu, or khichri can
be given to the infants more than 6 months of age.
If the infant is non breast fed,cow’s or buffalo’s milk
should not be diluted with water.
Feeding to be given in small quantity frequently every 2
to 3 hours.
20. PREVENTIVE MEASURES:
Improvement of food hygiene and
environmental
hygiene.These includes:
Safe water,adequate sewage
disposal, hand washing
practices,clean utensils,avoidance of
exposures of food
to dust and dirt,fly control, washing of
fruits and
vegetables etc.
23. PROGNOSIS
Mortality is higher in neonate and infants
than the
older children.
Malnourished children are having poor
prognosis
and greater mortality.
Antibiotic resistant type E.Coli and
shigella cause
very severe illness and poor prognosis.
Presence of severe dehydration
,electrolyte
imbalance and pneumonia have poor
prognosis.
