AD

1. Defi: passage of three or more stools in a day , of
consistency softer than usual for the child , or one
watery stool is defined as diarrhea . In diarrhea there is
excessive lose of water and electrolytes.
DIARRHEA

2. Clinical types
Acute watery diarrhea
Acute bloody diarrhea
Persistent diarrhea
Chronic diarrhea
Diarrhea with sever malnutrition

3. SEVERITY OF DIARRHEA
1/ Mild diarrhea 3-5t/day , no dehydration
2- mod.diarrhea 10t/24hours ,mild dehydration
3- sever diarrhea many t/24hours ,mod to sever
dehydration

4. Incidence:
3-4 episodes of diarrhea per child per year .
Maximum in the first year of life.
Causes 2,5 lac deaths per year <5 year.
In america 125 deaths per year .

5. ETIOLOGY
Infection
Bacteria
Ecoli(25% )
invasive , entero toxic , entero pathogenic ,entero
hemorrhagic
Salmonella ( 10%)
Shigella ( 5%)
Vibreo cholera ( 5-10 %)

6. Staphylococcus aureus
Campylo bacter jejuni
Yersenia entro colitica

7. Viruses
Rota virus
Enteric adenovirus
Parasites
Entamoeba histolytica
Giardia lumblia
Cryptosporidium
Fungi
Candida albicans

8. Parenteral infections
Otitis media
Pneumonia
UTI
-Dietary factors
Over feeding
Food poisoning
Food allergy
-Drugs
Antibiotics

9. EPIDEMIOLOGY
Transmission →feco _ oral (contaminated food
and water)

10. FACTORS INCREASING
SUSCEPTIBILITY TO DIARRHEA
ARE :
1- lack of breast feeding .
2- Exposure to unsanitary conditions.
3- malnutrition .
4- measles and level of parents education.

11. Mechanism is different by various organisms.
ETEC
LT → Adenyl cyclase →CAMP →secretion of
chloride and inhibition of sodium absorption.
ST→ guanylate cyclase system →secretion of
chloride and inhibition of sodium absorption.
Invassion , Ecoli , shigella , salmonella
→necrosis of enterocytes →diarrhea , blood in
stool .

12. Rota virus →invasion on enterocytes →cause
→lactase loss→osmotic diarrhea.
Vibrio cholera →Adher and multiply on the
intestinal mucosa →adenylate
cyclase→CAMP→ decreased sodium and
chloride absorption →water and electrolyte
loss.
2- Osmotic diarrhea 3- decreased surface
absorption 4- changes of intestinal motility

13. Effects of diarrhea
1- lose of water(dehydration)
Lose of skin turgor
Weak or absent puls
Tachy cardia
Sunken fontanel
Sunken eyes
Husky voice

14. Cyanosis of fingers
Dry mucus membranes
Cold skin
Oliguria , anuria, uremia
2- lose of nutrients
Hypoglycemia, convulsions , coma
Lose of weight.

15. 3- lose of bicarbonate
Vomiting
Deep and rapid respiration
Irritability (increased O2 demand of brain)
Myocardial contractility decreased
4- K lose
Abd: distention
paralytic ileus

16. BIOCHEMICAL
Isotonic{70%} (serum sodium level between 130-
150mmol/l )
Hypotonic{20%} ( serum sodium level less than
130mmol/L
Hypertonic{10%} ( serum sodium level more than
150mmol/L

17. INVESTIGATIONS
1- blood count
2- stool examination for
PH and reducing substances
Cyst of giardia and entamoeba
Bioassay for E.coli
Leukocytes and RBCS
Culture and sensitivity
Elisa test for rotavirus

18. Serum electrolytes (Na , k) and bicarbonate (Hco3)
4- urine examination and culture
5- blood culture (salmonellosis or shigellosis)
6- x-ray of chest

19. COMPLICATION
1- Dehydration and shock
2- metabolic acidosis
3- paralytic ileus
4- convulsion and coma
5- malnutrition
6- acute renal failure
7- persistent diarrhea

20. 8- Super added infections
9- Thrush
10- Diaper dermatitis
11- DIC
12- Death
TREATMENT

21. ANTIBIOTIC THERAPY
Antibiotic is used for cholera , shigella ,
amebiasis and giardia .
-Dietary management
Feeding should be continued to prevent body
catabolism and weight lose .
Breast feed should continued as much as want
the infant in addition to ORS .
Malnourished or prematur infant with diarrhea
must be persumed to have sepsis and should
receive systemic antibiotic

22. PROBIOTIC
Micro organism colonise on the bowel . Reduces the
duration of acute diarrhea .
Zinc therapy : zinc loses during
diarrhea < 6mo 10mg/day
>6mo 20mg/day
(10-14 day)

23. PREVENTION
-Breast feeding up to 2 years
-Health education
-Three “Cs” clean hands , clean water and clean
environment

24. DEHYDRATION

25. Definition : loss of water and
electrolyte

26. Mild: weight loss less than 5 %
Mod: weight loss between 5-10%
Sever: more than 10%
WHO Classification
No sign of dehydration
Some dehydration
Sever dehydration

27. Sign and symptom of no sign of dehydration
The child is alert,normaly drinks,nomal skin pinched.
Sign and symptom of some dehydration ( patient is
irritable, thirsty,eagerly drinks ,sunken eye and
slow skin pinched less than 2 seconds )
Sever de hydration( lethargic or unconscious, unable
to drink sunken eye , and very slow skin pinched (
more than 2 seconds).
Sign and symptom of no sign of dehydration
The child is alert,normaly drinks,nomal skin pinched.
Sign and symptom of some dehydration ( patient is
irritable, thirsty,eagerly drinks ,sunken eye and
slow skin pinched less than 2 seconds )
Sever de hydration( lethargic or unconscious, unable
to drink sunken eye , and very slow skin pinched (
more than 2 seconds).
2 or more sings and symptoms of some and sever
Dehydration diagnosis the dehydration.
IF THERE IS NO ANY SIGNS AND SYMPTOMS
OF THEM , THAT IS NO SIGN OF DEHYDRATION

28. Treatment is done according to the level
of De hydration .
No sign of dehydration (planA)
Some dehydration (planB)
Sever dehydration (planC)

29. PLAN A
Treatment at home 3 components…
Advise extra fluids , vegetable soup, yogurt….
Continue feeding, / breast feeding/solid food.
Give ORS 50-100 cc/each purging up to 1 year and 100-
200 cc/purging 1-2 year and more than 200cc/purging
Above 2 years or as much as want.

30. PLAN B
ORS 75 ML/KG/ 4H Reasess AFTER 4H
and decide accordingly may be need to repeat this
amount or goes to plan A or planB.

31. PLAN C
IV THERAPY , in children LESS THAN 1 YEAR
100 ML/KG in 6h OF Ringer lactate or narmal saline, 30
ML/Kg in 1h AND 70 ML/Kg in NEXT 5h,
IN children from 1YEAR and above 30 ML/ kg in ½ h and
70 ML/Kg in 2,5 h.if the child is able to drink give ORS
5ml/kg/h.
IF IV THERAPY IS NOT POSSIBLE, give ORS by NGT
20ml/kg /h for 6h.