Pediatrics 5th year, 2nd lecture (Dr. Adnan)


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The lecture has been given on Oct. 14th, 2010 by Dr. Adnan.

Published in: Health & Medicine

Pediatrics 5th year, 2nd lecture (Dr. Adnan)

  1. 1. Diarrhea Dr. Adnan Hamawandi Professor of Pediatrics
  2. 2. Consequences of diarrhea <ul><li>Dehydration </li></ul><ul><li>Three types are considered </li></ul><ul><li>Isotonic dehydration 70-80% </li></ul><ul><li>1. There is balanced deficit of water and sodium. 2. Serum sodium concentration is normal 130-150meq./L. 3. Serum osmolality is normal. 4. Hypovolemia occurs as a substantial loss of ECF. </li></ul>
  3. 3. Consequences <ul><li>Hypertonic dehydration : </li></ul><ul><li>1. There is deficit of water and sodium but the deficit of water is greater. </li></ul><ul><li>2. Serum sodium concentration is elevated > 150meq./L. 3. Serum osmolality is elevated >295mosmol/L. 4. Thirst is sever and out of proportion to the degree of dehydration, the child is irritable and have a doughy feeling skin. Seizures can complicate the course. </li></ul>
  4. 4. Consequences <ul><li>Hypotonic dehydration : </li></ul><ul><li>1. There is deficit of water and sodium, but the deficit of sodium is greater. </li></ul><ul><li>2. Serum concentration is low < 130meq./L. </li></ul><ul><li>3. Serum osmolality is low <275mosmol/L. </li></ul><ul><li>4. The child is lethargic; infrequently there are seizures. </li></ul>
  5. 5. Consequences <ul><li>Metabolic acidosis </li></ul><ul><li>During diarrhea large amounts of bicarbonate may be lost in the stools. If the kidneys continue to function normally much of the lost bicarbonate is replaced . However, when renal function deteriorate as happens with hypovolemic shock base deficit and metabolic acidosis develop rapidly. </li></ul>
  6. 6. Consequences <ul><li>Acidosis also result from excessive production of lactic acid when patients have hypovolemic shock. The features of metabolic acidosis include: </li></ul><ul><li>1. Reduced serum bicarbonate. </li></ul><ul><li>2. Arterial PH is reduced. </li></ul><ul><li>3. Breathing become deep and rapid. </li></ul><ul><li>4. There is increased vomiting. </li></ul>
  7. 7. Consequences <ul><li>Hypokalemia </li></ul><ul><li>Owing to large losses of potassium in the feces, patients with diarrhea often develop potassium depletion. This can be dangerous in malnorished infants who are potassium deficient before diarrhea starts. </li></ul><ul><li>Clinical signs: 1. General muscle weakness. 2. cardiac arrhythmias. 3. paralytic ileus. </li></ul>
  8. 8. Consequences <ul><li>Malnutrition </li></ul><ul><li>Diarrhea is an important cause of malnutrition. This is because patients with diarrhea eat less and their ability to absorb nutrients is reduced; moreover, their nutrient requirements are increased as a result of the infection. Each episode of diarrhea can cause weight loss and growth flattering. </li></ul>
  9. 9. Clinical features <ul><li>No Dehydration: </li></ul><ul><li>Fluid deficit < 5% body weight, although they lack distinct signs of dehydration, they should be given more fluid than usual to prevent signs of dehydration from developing. </li></ul><ul><li>Some dehydration: </li></ul><ul><li>Fluid deficit equal to 5 -10% of body weight </li></ul>
  10. 10. Clinical features <ul><li>1. Increased thirst. </li></ul><ul><li>2. Irritability and restlessness. </li></ul><ul><li>3. Eyes are slightly sunken. </li></ul><ul><li>4. Mouth and tongue are somewhat dry. </li></ul><ul><li>5. Skin pinch goes back slowly. </li></ul><ul><li>6. Radial pulse is detectable but rapid. </li></ul><ul><li>7. Anterior fontanel in infants is more sunken than usual. </li></ul>
  11. 11. Clinical features <ul><li>Sever dehydration: </li></ul><ul><li>Fluid deficit is >10% body weight </li></ul><ul><li>1. Lethargy, stupor or even coma. </li></ul><ul><li>2. Eyes are deeply sunken and without tears. </li></ul><ul><li>3. Mouth and tongue are very dry. </li></ul><ul><li>4. Breathing is rapid and deep. </li></ul><ul><li>5. Drink poorly or unable to drink. </li></ul>
  12. 12. Clinical features <ul><li>6. A skin pinch flattens very slowly </li></ul><ul><li>7. Radial pulse is very rapid and weak or undetectable. </li></ul><ul><li>8. In infants the anterior fontanel is very sunken. </li></ul><ul><li>9. Blood pressure is low or undetectable. </li></ul><ul><li>10. The arms and legs are cool and moist and the nail beds may be cyanosed. </li></ul>
  13. 13. Clinical features <ul><li>Weigh the child: The body weight is important for: 1. Determining the degree of dehydration exactly when the weight before the illness is known. </li></ul><ul><li>2. Determining the amount of oral or IV fluid to be given in the treatment. </li></ul><ul><li>3. After rehydration weight should be plotted on growth chart for follow up. </li></ul>
  14. 14. Assessment of dehydration <ul><li>According to WHO recommendation </li></ul><ul><li>Look at </li></ul><ul><li>Condition well restless* lethargic or* </li></ul><ul><li>and behavior alert irritable unconscious </li></ul><ul><li>Eyes normal sunken very sunken </li></ul><ul><li>Tears present absent absent </li></ul><ul><li>Mouth moist dry very dry </li></ul><ul><li>Thirst drinks drinks * drinks* </li></ul><ul><li>normally eagerly poorly </li></ul><ul><li>Feel </li></ul><ul><li>skin turgor normal slow* very slow* </li></ul><ul><li>Decide NO SOME SEVER </li></ul><ul><li>----------------- </li></ul><ul><li>* Key sign </li></ul>
  15. 15. Assessment of dehydration <ul><li>Additional signs </li></ul><ul><li>Anterior fontanel </li></ul><ul><li>Skin of lower arms and legs </li></ul><ul><li>Pulses </li></ul><ul><li>Capillary refill </li></ul><ul><li>Breathing </li></ul>