Diarrhoea, ar is & malnutrition dr ajay tyagi


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Diarrhoea, ARIs & malnutrition- OVERVIEW FOR UGs

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  • At leasthalf of the child's energy intake should come from foods other than milk or milkproducts.
  • Normal saline does not correct acidosis or replace potassium losses, but can be used. Plain glucose or dextrose solutions are not acceptable for the treatment of severedehydration.
  • Bacillary dysentery, caused by Shigella, a bacterium. In Western Europe and the USA it is the most common type of dysentery among people who have not recently been to the tropics.Amoebic dysentery (amoebiasis) This is caused by Entamoebahistolytica, a type of amoeba, and is more common in the tropics. An amoeba is a protozoan (single-celled) organism that constantly changes shape
  • Any chest indrawing, even if it is not severe, is an indicator of severe pneumonia in a child age 2 months up to 5 years.; and
  • Any chest indrawing, even if it is not severe, is an indicator of severe pneumonia in a child age 2 months up to 5 years.; and
  • Both antibiotics are relatively inexpensive, widely available, and are on the essential drug list of the Ministry of Health.
  • Very low weight for age
  • Diarrhoea, ar is & malnutrition dr ajay tyagi

    2. 2. Causes of U5MR OTHER, 27% NEONATAL DEATH, 41% MALARIA, 8% DIARRHOEA, ARI, 14% 14%Source: Partnership for maternal, neonatal and child health (2011) MDG 4.Geneva: WHO.
    3. 3. DIARRHOEA Clinical Assessment• All children with diarrhoea should be assessed to determine – The duration of diarrhoea, – If blood is present in the stool and – If dehydration is present.• A number of clinical signs are used to determine the level of dehydration – Infant’s general condition – Sunken eyes – Elasticity of skin
    4. 4. DIARRHOEA FLUID DEFICIT CLINICAL SIGNS TREATMENT SEVERE greater than 10 • Lethargic or unconscious WHO TreatmentDEHYDRATION percent of their • Sunken eyes Plan C body weight • Skin pinch goes back very Slowly (longer than 2 seconds) SOME 5 to 10 percent of Two of the following signs: WHO TreatmentDEHYDRATION their body weight • Restless, irritable Plan B • Sunken eyes • Skin pinch goes back slowly (skin stays up even for a brief instant) NO Less than 5 percent • No sign to classify as WHO Treatment of their body weight some or severe Plan ADEHYDRATION dehydration • Skin pinch goes back immediately.
    5. 5. DIARRHOEA WHO Treatment Plan C• Severe dehydration require immediate IV infusion, nasogastric or oral fluid replacement according to WHO treatment guidelines• Give 100 ml/kg IV fluids. Age 30 ml/kg 70 ml/kg Infant 100 ml/kg In 6 hrs First hour Next 5 hrs Older 100 ml/kg In 3 hrs First 30 mins Next 2.5 hrschildren
    6. 6. DIARRHOEA• Ringers lactate solution is the preferred commercially available solution.• If IV infusion is not possible, urgent referral to the hospital for IV treatment is recommended.• When referral takes more than 30 minutes, fluids should be given by nasogastric tube.• If none of these are possible and the child can drink, ORS must be given by mouth.
    7. 7. DIARRHOEA WHO Treatment Plan B• Some dehydration• The approximate amount of ORS required is 75 ml/kg; during first four hours, the mother slowly gives the recommended amount of ORS by spoonfuls or sips.• After four hours, the child is reassessed and reclassified for dehydration, and feeding should begin• If dehydration persists- the same amount of ORS may be repeated for another 4 hours. If the child is breastfed, breast-feeding should continue
    8. 8. DIARRHOEA WHO Treatment Plan A• Plan A focuses on the three rules of home treatment: – Give extra fluids, – Continue feeding, and – Advise the caretaker when to return to the health facility if the child develops blood in the stool, drinks poorly, becomes sicker, or is not better in 48 hours
    9. 9. DIARRHOEA PERSISTENT DIARRHOEA (diarrhoea that lasts more than 14 days)• Encourage the mother to continue breastfeeding.• At least half of the childs energy intake should come from foods other than milk or milk products.• Food needs to be given in frequent, small meals, at least six times a day.• All children with persistent diarrhoea should receive supplementary multivitamins and minerals (copper, iron, magnesium, zinc) each day for two weeks.
    10. 10. DIARRHOEA DYSENTERY (bloody diarrhoea)• The four key elements of dysentery treatment are: – Antibiotics – Fluids – Feeding – Follow-up
    11. 11. DIARRHOEA• Selection of an antibiotic is based on sensitivity patterns of strains of Shigella isolated in the area (nalidixic acid is the drug of choice in many areas).• Recommended duration of treatment is five days. If after two days (during follow-up) there is no improvement, the antibiotic should be stopped and a different one used. Indication of Antibiotics in Diarrhoea• Malnourished or premature infant• Blood in stool• Associated non-GI infection e.g. pneumonia
    12. 12. DIARRHOEA LOW OSMOLARITY ORS grams Composition mmol/ Composition /Litre Litre Glucose, Glucose 75 13.5 anhydrous Sodium 75Trisodium citrate, 2.9 dihydrate Chloride 65Sodium chloride 2.6 Potassium 20 Potassium 1.5 Citrate 10 chloride Total weight 20.5 Total osmolarity 245
    13. 13. DIARRHOEA RICE BASED ORS• Tastes better and provides more calories than the glucose- based ORS• Culturally acceptable,• Reduces stool volume (by about 40 %)• Shortens the duration of diarrhea in both cholera and other severe diarrheal diseases.• Starches other than rice, including wheat flour and maize, have also been shown to reduce stool volume in patients with cholera.• Reduce diarrhea by adding more substrate to the gut lumen without increasing osmolality, thus providing additional glucose molecules for glucose-mediated absorption.
    14. 14. DIARRHOEA ZINC THERAPY• 10 mg/day orally for 14 days in children <6 months of age• 20 mg/day orally for 14 days in children ≥6 months of age• It is used as adjunct therapy (in all cases of diarrhoea) that decreases the duration and severity of the episode and the likelihood of subsequent infections on the 2-3 months following treatment.
    15. 15. Causes of U5MR OTHER, 27% NEONATAL DEATH, 41% MALARIA, 8% DIARRHOEA, 14% ARI, 14%Source: Partnership for maternal, neonatal and child health (2011) MDG 4.Geneva: WHO.
    16. 16. ARIs• Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs.• A child with cough or difficult breathing may have pneumonia or another severe respiratory infection.• Both bacteria and viruses can cause pneumonia.• In developing countries, pneumonia is often due to bacteria. The most common are Streptococcus pneumoniae and Hemophilus influenzae Pneumonia is an infection of the lungs
    17. 17. ARIs• Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection).• you can identify almost all cases of pneumonia by checking for these two clinical signs: – fast breathing and – chest indrawing Chest indrawing is a sign of severe pneumonia
    18. 18. ARIs• Clinical Assessment• Three key clinical signs are used to assess a sick child with cough or difficult breathing: – Respiratory rate – Lower chest wall indrawing – Stridor Respiratory rate, distinguishes children who have pneumonia from those who do not
    19. 19. ARIs• Lower chest wall indrawing, which indicates severe pneumonia (it is defined as the inward movement of the bony structure of the chest wall with inspiration)• Chest indrawing should only be considered present if it is consistently present in a calm child
    20. 20. ARIs• Stridor , which indicates those with severe pneumonia who require hospital admission. (Stridor is a harsh noise made when the child breathes in ).• A child who has stridor when calm has a dangerous condition.
    21. 21. ARIs• Child’s Age Cut-off Rate for Fast Breathing Cut Off BR Age Of The Child (Breaths Per Minute Or More) 0 To 2 Months 60 2 Months To 12 Months 50 12 Months To 5 Years 40
    22. 22. ARIs SEVERE PNEUMONIA – Chest indrawing or – Stridor in calm child• Give first dose of IV or intramuscular chloramphenicol (40 mg/kg).• Options for an intramuscular antibiotic for pre-referral use include ampicillin plus gentamicin combination, OR ceftriaxone.
    23. 23. ARIs PNEUMONIA – Fast breathing• Give appropriate antibiotic for five days. The treatment of non-severe pneumonia can utilise a five-day course of either oral cotrimoxazole or amoxicillin.• These two oral antibiotics are usually effective treatment for Streptococcus pneumoniae and Haemophilus influenzae.
    24. 24. ARIs• The advantages of cotrimoxazole are that it is used twice a day, is affordable and compliance is good.• Amoxicillin is almost twice as expensive as cotrimoxazole and standard dosages are usually given three times a day.• Soothe the throat and relieve the cough with a safe remedy.
    25. 25. ARIs NO PNEUMONIA – Cough or cold – No signs of pneumonia• Soothe the throat and relieve the cough with a safe remedy.
    27. 27. MALNUTRITIONAll sick young infants seen in outpatient health facilitiesshould be assessed for weight and adequate feeding, aswell as for breast-feeding techniqueBreastfeeding: Signs of Good Attachment– Chin touching breast;– Mouth wide open;– Lower lip turned outward; and– More areola visible above than below the mouth.
    28. 28. MALNUTRITION• Determine weight for age. Weight for age compares the young infants weight with the infants of the same age in the reference population .• The VERY LOW WEIGHT FOR AGE identifies children whose weight is –3 standard deviations below the mean weight of infants LW in the reference population (Z score <-3).• The LOW WEIGHT FOR AGE identifies VLW children whose weight is –2 standard deviations below the mean weight of infants in the reference population (Z score <-2).
    29. 29. MALNUTRITION SEVERE MALNUTRITION(Visible severe wasting or Oedema of both feet) – Not able to feed or – No attachment at all or – Not suckling at all or – Possible Serious bacterial infection
    30. 30. MALNUTRITION• Vitamin A is given to a child with measles or severe malnutrition.• Vitamin A helps resist the measles virus infection in the eye as well as in the layer of cells that line the lung, gut, mouth and throat.• It may also help the immune system to prevent other infections.• Treat the underlying causes (e.g. Infections – Diarrhoea, Respiratory Infections, Malaria etc. ; Infestations)
    31. 31. MALNUTRITION LOW WEIGHT• Feeding problem• Not well attached to breast or• Not suckling effectively or• Less than 8 breastfeeds in 24 hours or• Receiving other foods or drinks or• Thrush (ulcers or white patches in mouth)• Breast or nipple problems
    32. 32. MALNUTRITION NO FEEDING PROBLEM• Not low weight for age and no other signs of inadequate feeding• Assess the child’s feeding and counsel the mother accordingly on feeding.
    33. 33. THANK YOU