This document discusses acute diarrheal disease. It defines diarrhea and describes the clinical types. The most common causes are viruses like rotavirus and bacteria such as E. coli. Diarrhea can lead to dehydration as fluids and electrolytes are lost from loose stools. Treatment involves oral rehydration therapy with oral rehydration solution or home fluids. For severe dehydration, intravenous fluids are needed. Zinc supplementation is also recommended. Diet should continue with energy-dense foods, and antibiotics may be used for specific bacterial infections.

1. ACUTE DIARRHEAL
DISEASE
kottayam medical college
Dr.Mohemed sanowfer

2. What is diarrhea?
Diarrhea is the passage of loose watery stools at least
3 times in a 24hr day
Recent change in the consistency of stools

3. CLINICAL TYPES
Acute watery diarrhea
Acute bloody diarrhea (dysentery)
Persistent diarrhea (>14 days)
Diarrhea with severe malnutrition

4. WHAT CAUSES ACUTE DIARRHEA?
VIRUS - ROTAVIRUS
BACTERIA - ENTEROTOXIGENIC E.coli
Shigella, Salmonella
Vibrio cholerae(5-10%)
EIEC,EHEC,LA-EC,DA-EC
 C.JEJUNI
OTHERS- E.histolytica, g.lamblia
50%

5. Pathophysiology
Diarrhea  water & water soluble substances like
electrolyte , metabolites, vitamins are lost
 ECF
50% cases – Na remains normal [140 mEq/L]
45% - hyponatremia
5% - hypernatremia
[ underestimated]

6. Na+
Na+ Na+
Na+

7. ECF
ICF
ECF
ICF
H2O H2O
H2O H2O
H2O
H2O
H2O
H2O
Na
Na
Na
Na

8. ASSESSMENT OF CHILD WITH DIARRHEA
CLINICAL ASSESSMENT
HISTORY-Duration
-watery/bloody
-severity
-associated symtoms
-feeding
ASSESS IN EXAMINATION-1 Physical signs of dehydration
-2 nutritional status of the child
-3 pneumonia,otitis media
LABORATORY INVESTIGATIONS
1 STOOL MICROSCOPY
2 STOOL CULTURE
3SERUM ELECTROLITES,RFT
4TESTS FOR STOOL pH

9. ORAL REHYDRATION THERAPY ORT
1 ORS Solution
2Solutions made from sugar & salt
3Food based solutions
-rise water with salt
-butter-milk with salt
4Other home made fluids-
-1 plain water, lemon water, coconut water
-2 thin rise kanji

10. Comparison b/w low osmolarity ORS&WHO-
ORS
INGRADIENTS CONC(MMOL/L)
LOW OSMOLARITY WHO-ORS
ORS [NEW]
SODIUM 75 90
POTASSIUM 20 20
CHLORIDE 65 80
CITRATE 10 10
GLUCOSE 75 111

11. ADVANTAGES OF LOW OSMOLARITY ORS
1 MORE EFFICIENT ABSORPTION OF SODIUM&WATER
2 REDUCED NEED OF IV FLUIDS
3 REDUCTION IN STOOL OUTPUT
4 LOWER VOMITING
5 NO SIGNIFICANT HYPONATREMIA

12. ASSESSMENT OF SEVERITY OF DEHYDRATION
LOOK AT CONDITION
EYES
TEARS
MOUTH&TONGUE
THIRST
WELL ALERT
NORMAL
PRESENT
MOIST
DRINKS
NORMALY,NO
T THIRSTY
RESTLESS
IRRITABLE,
SUNKEN
ABSENT
DRY
DRINKS
EAGERLY
LETHARGIC/UNCON
SCIOUS
VRY SUNKEN
ABSENT
VERY DRY
DRINKS POORLY
,NOT ABLE TO
DRINK
FEEL SKIN PINCH GOES BACK
QUICKLY
GOES BACK
SLOWLY
GOES BACK
VRY SLOWLY
DECIDE NO SIGNS OF
DEHYDRATIO
N
SOME
DEHYDRATI
ON
SEVERE
DEHYDRATION
TREAT PLAN A PLAN B PLAN C

13. TREATMENT OF ACUTE DIARRHEA
TREATMENT OF DEHYDRATION
ZINC SUPPLIMENTATION
NUTRITIONAL MANAGEMENT
DRUG THERAPY
SYMPTOMATIC TREATMENT

14. TREATMENT PLAN A
PATIENT WITHOUT PHYSICAL SIGNS OF
DEHYDRATION
Homely management with ORAL REHYDRATION THERAPY
AGE Amount of ORS other ORT fluids Amount of ORS to provide for
give after each loose stools use at home
<24 m 50-100 ml 500mL/day
2-10 yr 100-200ml 1000mL/day
>10yr as much as wants 2000mL/DAY

15. Mother should be educated to increase the amount of
culturally appropriate home available fluids
Describe and show the amount to be given after each
stool using a local measure
Show mother how to mix ORS and how to give.
Give a teaspoon full every 1 – 2 min under 2yrs
If the child vomits wait for 10min then give slowly 2-3
min interval
If diarrhea continues after ORS packets are used up
give other fluids or return for more ORS

16. TREATMENT PLAN B
PATIENT WITH PHYSICAL SIGNS OF DEHYDRATION
Rehydration therapy
Correction of existing water and elecrolyte deficit as
indicated by presence of signs of dehydration
Maintenance therapy
Replacement of ongoing loses due to continuing
diarrhea to prevent the recurrence of dehydration
Provision of normal daily fluid requirements

17. Rehydration therapy
75ml/kg of ORS in the first 4 hr

18. Maintenance therapy
ORS should be administered in volume equal to
diarrhea losses [10-20 ml/kg] for each liquid stool
Offer plain water in between
Encourage breast feeding
If the child continues to have some dehydration after
4hrs repeat another 4hrs treatment with ORS solution [
as in rehydration therapy]

19. How effective is ORT
 95 -97%
When ORT ineffective
High stool purge more than 5ml/kg/hr
Persistent vomiting - >3/hr
Abdominal distention and ileus
Glucose malabsorption

20. TREATMENT PLAN C
CHILDREN WITH SEVERE DEHYDRATION
I V fluids immediately
RL solution
[ ideal – RL + 5% dextrose]
0.9% NS

21. IV not accessible – ORS using naso-gastric tube @
20ml/kg/hr [total 120ml/kg]
Reassess every 1-2hr
Repeated vomiting & abdominal distention – IV
slowly

22. Monitoring
Every 15-30min reassess
Not improving – IV rapidly
After full IV fluids – REASSESS
If signs of dehydration still present  repeat iv fluids as
outlined earlier
Improving but some dehydration  discontinue iv and
give ORS for 4hrs [plan B]
Observe the child at least 6hrs before discharge to
confirm that mother is able to maintain child’s
hydration by ORS solution

23. Zinc in diarrhea
Zinc plays a critical role in metalloenzymes
polyribosomes, cell membranes, cellular functions.
<6month – 10mg/day
>6month – 20mg/day
Adv –
16% faster recovery
31% reduction in stool output
10-14 days

24. Dietary recommendations for management
of diarrhea
Continue feeding
Breast feeding – continued
Optimally energy dense foods with least bulk [small
quantities but frequently]
Staple foods enriched with fats and oils
Avoid foods with high fiber content
In non breast fed infants – cow milk given undiluted
During recovery a intake of atleast 125% of normal
RDA should be attempted with nutrient dense foods

25. Drug Therapy
Antibiotics & chemotherapeutic agents [dysentery &
cholera]

28. Malnourished/ prematurely born with diarrhea
Well nourished child diarrhea
Poor sucking
Abdominal distention
Fever/ hypothermia
Fast breathing
Significant lethargy

29. Binding agents
Formulations based on pectin, kaolin, bismuth salt
Anti motility agents – diphenoxylate hydrochloride
[lomotil], loperamide
Anti secretory agents – racecadotril [ acetorphan]
Inhibit intestinal enkephalinase
Probiotics – Lactobacillus rhamnosus, L. plantarum,
several strains of bifidobacteria

30. Symptomatic treatment
Vomiting
Severe- metoclopromide 0.1 – 0.2 mg/kg
Phenothiazine 0.5mg/kg
• Abdominal distention
•Bowel sounds present – no treatment
Absent/ Gross distention
KCl iv 30-40mEq/L
Intermittent nasogastric suction

31. Prevention
Health education
Exclusive breast feeding
Supplementary feeding
Sanitation & hygiene
Clean hand, Clean container & Clean environment

32. Thank You