This document discusses acute gastroenteritis in children. It defines acute gastroenteritis and diarrhea and notes the main causes are rotavirus, E. coli, and cholera. Acute diarrhea is a major cause of childhood deaths worldwide, with over 20% of under-5 deaths. Proper assessment and management of children with diarrhea is important. Management involves oral rehydration therapy with WHO oral rehydration solution and zinc supplementation. Additional supportive therapies may include probiotics, antiemetics, and racecadotril. Improving complementary feeding and rotavirus immunization can also help reduce the risk and severity of diarrhea in children.

1. ACUTE
GASTROENTERITIS
IMNCI
BY : Dr UMESH KUMAR SINGH
DNB PEADIATRICS

2. CONTENTS
1. Acute gastroenteritis
2. Acute diarrhea
3. Epidemiology
4. Etiology
5. Pathogenesis
6. Assessment of child ( IMNCI )
7. Management

3. ACUTE GASTROENTERITIS
• The term gastroenteritis denotes infections
of the gastrointestinal tract caused by
bacterial, viral, or parasitic pathogens .

4. ACUTE DIARRHEA
• > 10 ml/kg/day – infants
• > 200gm/ 24 hour – older children
• If there is associated blood in stools, it is termed
dysentery.
• In the vast majority of cases, these acute
episodes subside within 7 days.
• Acute diarrhea may persist for >2 weeks in 5-
15% cases, which is labeled as persistent
diarrhea.

5. EPIDEMIOLOGY
• 9% of childhood deaths, with an estimated 0.71
million deaths per year globally.
• Second most common cause of child deaths
worldwide.
• over 20% of all deaths in under five children.

6. CONSEQUENCES OF DIARRHEA
• The two most important consequences of
diarrhea in children are
malnutrition increases the risk
and severity of diarrhea.
Impaired absorption, loss of
nutrients, increased
catabolism
and improper feeding in
diarrhea aggravate the severity
of
malnutrition.
Dehydration which results in
loss of water and electrolytes.
Significant dehydration with
abnormal
electrolyte and acid-base
status occurs in 2-5% of all
cases
of diarrhea, which may be fatal

7. ETIOLOGY
• It can be
Infective origin
Certain drugs
Systemic infection

9. • Rotavirus and enterotoxigenic E.coli = nearly half
of the total diarrheal episodes among children.
• In rota virus diarrhea, vomiting is an early feature
and diarrhea is more severe.
• Cholera accounts for 5-10% cases, stools are like
rice water, vomiting is common and rapid onset
of severe dehydration occurs within hours.
• Clostridium difficile should be suspected in
patients who have received broad spectrum
antibiotics

10. • RISK FACTORS
Sanitation
hygiene
Non availability of safe drinking water
Unsafe food preparation practices
Low ratio of breast feeding
Immunization
Malnutrition

14. ASSESSMENT OF CHILD ( IMNCI )
1. Upto 2 months
2. 2 month to 5 years

15. .

17. MANAGEMENT

18. ORAL REHYDRATION THERAPY
• The glucose dependent sodium and water
absorption is the principle behind replacing
glucose and sodium in 1:1 molar ratio in the
WHO oral rehydration solution (ORS).
•
• An important consideration in making ORT is that
the osmolarity of the replacement fluid should
not exceed that of blood (290 mmol/1).
• Use of standard WHO ORS (having osmolarity of
311 mmol/1) was changed to low osmolarity
WHO ORS (having osmolarity of 245 mmol/1).

25. ZINC SUPPLEMENTATION
• It is helpful in decreasing severity and duration of
diarrhea and also risk of persistent diarrhea.
• 46% mortality
• 23% hospital admission
• Zinc is recommended to be supplemented as
sulphate, acetate or gluconate formulation, at a
dose of 20 mg of elemental zinc per day for
children >6 months for a period of 14 days.

26. ADDITIONAL THERAPIES
1. Probiotics .
2. Antiemetic .
3. Racecadotril .

27. 4. Improved Complementary Feeding Practices =
There is a strong inverse association between
appropriate, safe complementary feeding and
mortality in children age 6-11 mo; malnutrition is
an independent risk for the frequency and
severity of diarrheal illness.
Complementary foods should be introduced at 6
mo of age, and breastfeeding should continue for
up to 2 yr.
5. Rotavirus immunisation

28. THANK YOU