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Diarrhoea and dehydration in children

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Diarrhoea and dehydration in children

  1. 1. Dr.Soma Sekhara Reddy
  2. 2. OBJECTIVES INTRODUCTION CAUSES ETIOPATHOGENESIS CLINICAL FEATURES AND COMPLICATIONS DIAGNOSIS EVALUATION OF DEHYDRATION TREATMENT PREVENTION
  3. 3. Introduction common cause of death in developing countries second most common cause of infant deathsworldwide.
  4. 4. DIARRHOEA DEFINITION – Passage of watery stools atleast 3 timesin a 24h period. Recent change in consistency is more important.
  5. 5. ETIO-PATHOGENESISVIRAL – MC – ROTA, ADENOOSMOTIC DIARRHOEALOSS OF MATURE ABSORPTIVE CELLSINVADE S.I. MUCOSAVIRAL - MCROTA ADENO
  6. 6. SECRETORY DIARRHOEAULCERATION – SYNTHESIS OF SECRETAGOGUESACUTE INFLAMMATIONINVADE LARGE INTESTINEBACTERIAL - INVASIVESHIGELLA, SALMONELLA, YERSINIA, V.PARAHEMOLYTICUS
  7. 7. DECREASE ABSORPTIVE SURFACECELL INFLAMMATION, CELL DEATHELABORATION OF CYTOTOXINBACTERIA - CYTOTOXICSHIGELLA,EPEC,V.HEMOLYTICUS,C.DIFFICILE
  8. 8. ALTERED SALT AND WATER TRANSPORTENTEROTOXIN-INCREASE THE CONC. OF INTRACELLULARMEDIATORSCOLONISE SMALL INTESTINEBACTERIA - TOXIGENICSHIGELLA,ETEC,VIBRIO
  9. 9. DECREASE INTESTINAL ABSORPTIVE SURFACEFLATTENING OF MICROVILLICOLONISE & ADHERE SMALL INTESTINEBACTERIAL ADHERENTSEPEC,EHEC
  10. 10. CAUSES OF DIARRHOEA WITHMORBIDITY
  11. 11. CLINICAL FEATURES BLOODY STOOLS – BACTERIAL ETIOLOGYHUS ABDOMINAL PAIN – GE PERITONEAL SIGNS - APPENDICITIS
  12. 12. DIAGNOSIS ATLEAST 3 STOOLS PER 24H ASSESSING DEHYDRATION-H/O NORMAL FLUID INTAKE AND OUT PUT- PHYSICAL EXAMINATION- PERCENTAGE OF BODY WT LOSS
  13. 13. EVALUATING DEHYDRATION GENERAL CONDITION-MENTAL STATUS* THIRST* EXTREMITIES CAPILLARY REFILL TIME SKIN TURGOR BREATHING HEART RATE B.P PULSE QUALITY EYES* TEARS* MUCOUS MEMBRANES* ANTERIOR FONTANELLE URINARY OUTPUT
  14. 14. SIGNS NONE /MINIMALDEHYDRATION(<3%LOSS OF BODY WT)SOME/ MILD TOMODERATE(3 -9%LOSS OF B.WT)SEVERE ( >9%LOSS OF B.WT)
  15. 15. CLINICAL DEHYDRATION SCORE
  16. 16. LAB.EVALUATION AND IMAGING STOOL CULTURE- salmonellashigellayersiniacampylobacterpathogenic E.coli-serotyping RAPID STOOL TEST: for inflammatory markers Hematological tests: white blood cell band count >100/mm3.C-reactive protein cut point of >12milligrams/dl Biochemical tests: BUNSer.bicarbonate <17 mEq/LGRBS USG
  17. 17. TREATMENT ORT [ ORS: CH-75mmol/l; Na-75; k-20; Cl-65;base-10; osmolarity-245m osm/l] ZINC FORTIFIED-ORS NO SUBSTITUTES IV REHYDRATION-only for severe dehydration REHYDRATION PHASE -Give 50 to 100 mL ofORS/kg plus additional 10 mL/kg per stool and 2mL/kg per emesis BREAST FEEDING
  18. 18. I.V. REHYDRATION START I.V.F IMMEDIATELY IF CHILD IS SEVERELYDEHYDRATED. CONSIDER ORS IF CHILD CAN DRINK. I.V.F :R.L + 5 % DEXTROSE***R.L**N.S.* - can be usedONLY 5 % DEXTROSE – not effective
  19. 19. I.V. REHYDRATION TARGET : 100 ml /kg < 1 yr :30 ml/kg in 1 hourrepeat 30 ml/kg in 1 hour70 ml/kg in 5 hours >1 yr :30 ml/kg in 30 minrepeat 30 ml/kg in 30 min70 ml/kg in 2 and ½ hrs
  20. 20.  Start giving ORS if child starts drinking: 5 ml/kg/hr< 1 year : within 3 to 4 hours>1 year : within 1 to 2 hours
  21. 21.  IF UNABLE TO GIVE I.V.FLUIDS:N.G.TUBE20 ml/kg/hourreassess after 1 to 2 hours repeated vomitting/abdominal distensionno improvement after 3 hoursgive the fluids moreStart i.v.fluids as soon as possible slowly
  22. 22. TREATMENT ANTIEMETIC-Ondansetron 0.5mg/kg/dose NO ANTIMOTILITY MEDICATION :Diarrhea may function as an evolved expulsiondefense mechanismCan cause HUS in EHEC infection. ADSORBANTS AND ANTISECRETORY AGENTS:Bismuth – inc.salicylate levels PROBIOTICS - Lactobacillus GG andSaccharomyces boulardii ANTIBIOTICS FOR A/C GE
  23. 23. PREVENTION Good Hygiene Vaccines Prevent global warmingGlobal warming α food borne infectionsα contamination of waterENRICH – ( December 2011 Bulletin from IAP )
  24. 24. Thank you

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