Diarrhea is a common problem in paediatric age group and has different etiologies of acute and chronic diarrhea

1. ACUTE AND CHRONIC DIARRHOEA:
UNDERSTANDING THE DIFFERENCES,
CAUSES, SYMPTOMS, DIAGNOSIS, AND
TREATMENT.

2. WHAT IS DIARRHOEA
• It is the passage of three or more stools in a
day, of consistency softer than usual for the
child, or one watery stool is defined as
diarrhoea

3. AETIOLOGY
• Diarrhoea can be caused by a variety of factors
including:
• Infection: Bacteria (e.g., Escherichia coli,
Salmonella, Shigella, Campylobacter), viruses (e.g.,
norovirus, rotavirus), and parasites (e.g., Giardia,
Cryptosporidium) are common causes of acute
diarrhoea.
• Food intolerances and allergies: Lactose
intolerance, celiac disease, and food allergies can
all cause chronic diarrhoea.
• Medications: Certain medications such as
antibiotics, chemotherapy drugs, and laxatives can
cause diarrhoea.

4. FACTORS INCREASING SUSCEPTIBILITY
• Lack of breastfeeding
• Exposure to unsanitary conditions
• Ingestion of contaminated food
• Malnutrition
• Measles
• Level of maternal education

5. ACUTE DIARRHOEA
• Acute diarrhoea is a sudden onset of
diarrhoea that usually lasts for a short period,
typically less than two weeks. The most
common cause of acute diarrhoea is infection
with a virus, bacteria, or parasite. Other
causes include food allergies, medication side
effects, and stress.

6. CHRONIC DIARRHOEA
• Chronic diarrhoea is diarrhoea that persists
for more than four weeks. It can be caused by
a variety of factors, including underlying
medical conditions, such as inflammatory
bowel disease, celiac disease, or lactose
intolerance, or medications.

7. ACUTE DIARRHOEA
• Frequent loose, watery
stools
• Abdominal cramps and pain
• Nausea and vomiting
• Fever
• Dehydration
• Weight loss
• Blood in the stool
• Persistent abdominal pain
or discomfort
• Fatigue and weakness
CHRONIC DIARRHOEA
SYMPTOMS OF DIARRHOEA

8. ASSESSMENT OF DIARRHOEA FOR
DEHYDRATION
No Dehydration Some Dehydration Severe Dehydration
Not enough sings to
classify as some or
severe dehydration
Two of the following
signs
• Restless, Irritable
• Sunken Eyes
• Drinks eagerly
• Skin pinch goes
back slowly
Two of the following
signs
• Lethargic or
Unconscious
• Sunken Eyes
• Not able to drink/
Drink poorly
• Skin pinch goes
back very slowly
Treatment Plan A Treatment Plan B Treatment Plan C

9. GRADING OF STOOLS
• Stool consistency is
assessed to check the
stool water loss
• Also helps in
assessing prognosis
i.e. if grade increases
from III to IV then V, it
means it is worsening
Grade I Normal formed stools
Grade II Soft Stools
Grade III Liquid stools taking shape of container
Grade IV Watery stools with flakes, appears opaque in
glass container
Grade V Watery stools with few flakes, appearing
translucent in container

10. INVESTIGATIONS
• Blood counts
• Stool examination for:
• pH and reducing
substances
• Giardia cysts and
entamoeba
• Bioassay for E. coli.
• Leucocytes and RBC
• Culture and sensitivity
• Elisa test (for Rota virus)
• Serum electrolytes (Na and
K) and bicarbonate (HCO3).
• Urine examination and
culture (for parenteral
diarrhoea)
• Blood culture (salmonellosis
or shigellosis)
• X-ray chest (for pneumonia)

11. COMPLICATIONS
• Dehydration and shock
• Metabolic acidosis.
• Paralytic ileus
(hypokalaemia)
• Convulsions and coma
(hypernatremia, cerebral
thrombosis)
• Malnutrition (long standing
diarrhoea)
• Persistent diarrhoea
(disaccharidase deficiency)
• Superadded infections
• Thrush
• Diaper dermatitis
• Sclerema
• DIC
• Death

12. TREATMENT
• The treatment of diarrhoea in paediatrics depends
on the severity of symptoms, underlying cause, and
age of the child.
• The goals of treatment are to manage symptoms,
prevent dehydration, and treat the underlying
cause.
• Treatment Options:
• Oral Rehydration Solution (ORS): ORS is the
first-line treatment for dehydration caused by
diarrhoea in children. It replaces lost fluids and
electrolytes and can be given at home.
• Fluids: For mild to moderate dehydration, extra
fluids such as water, clear broths, and fruit juices
can be given in addition to ORS.
• Antibiotics: Antibiotics may be prescribed for
bacterial infections, such as Salmonella or
Shigella, but are not effective for viral infections.
• Probiotics: Probiotics, which are beneficial bacteria,
may help restore the natural balance of bacteria in
the gut and reduce the duration of diarrhoea.
• Zinc: Zinc supplements may be given to reduce the
duration and severity of diarrhoea, especially in
children with malnutrition.
• Diet: A normal diet should be resumed gradually as
tolerated, avoiding foods that can aggravate
diarrhoea, such as fatty, spicy, or high-fiber foods.
• When to Seek Medical Attention:
• If the child is less than 6 months old
• If there is severe dehydration or persistent
vomiting
• If there is blood in the stool
• If the diarrhoea lasts longer than 2 weeks
• If the child has a high fever or appears very ill

13. ORS
• The absorption of sodium and water in small
intestines more rapid in presence of glucose.
• The potassium is important to prevent
hypokalaemia.
• The bicarbonate is absorbed to correct acidosis.
• The contents should not be boiled in water and
fresh solution should be prepared each day.
• The solution can be given by a cup and spoon,
feeding bottle or nasogastric tube.

14. HOW TO MAKE ORS AT HOME
• Ingredients:
• 6 level teaspoons of sugar
• 1/2 level teaspoon of salt
• 1 litre of clean water
• Instructions:
• In a clean container, add 6 level
teaspoons of sugar and 1/2 level
teaspoon of salt.
• Pour in 1 litre of clean water (boiled
and cooled or distilled) and stir well
until the sugar and salt dissolve.
• The solution is now ready to use.
• Administration:
• For children, give ORS in small,
frequent sips using a spoon or oral
syringe.
• The amount of ORS to be given
should be based on the child's weight,
age, and severity of dehydration.
• The recommended amount is 50-100
mL/kg over a 3-4 hour period.

15. DEHYDRATION TREATMENT
ACCORDING TO PLAN A
Following steps
should be
followed

16. DEHYDRATION TREATMENT
ACCORDING TO PLAN B
Following steps
should be
followed

17. DEHYDRATION TREATMENT
ACCORDING TO PLAN C
Following steps
should be
followed

18. CONCLUSION
• Diarrhoea is a common problem in paediatrics, particularly in developing countries.
• Diarrhoea can be caused by viral, bacterial, or parasitic infections, and can lead to dehydration
and other complications if left untreated.
• The treatment of diarrhoea in paediatrics aims to manage symptoms, prevent dehydration, and
treat the underlying cause.
• Oral Rehydration Solution (ORS) is the first-line treatment for dehydration caused by diarrhea in
children, and is safe and effective.
• Antibiotics, probiotics, and zinc supplements may also be used depending on the underlying cause
of diarrhea.
• It is important to seek medical attention if the child's condition worsens or does not improve with
treatment.
• Prevention measures, such as good hygiene, safe drinking water, and proper food handling, are
crucial in reducing the incidence of diarrhoea in children.

19. THANK YOU FOR YOUR ATTENTION.
IF YOU HAVE ANY QUESTIONS,
PLEASE FEEL FREE TO ASK.