This document discusses fluid management in pediatric patients. It begins by defining fluid deficit therapy, maintenance therapy, and fluid replacement therapy. It then provides guidelines for calculating fluid deficits based on percentage of dehydration and patient weight. The document outlines the goals of maintenance fluids and examples of fluid needs for different clinical scenarios. It also describes signs of no, some, and severe dehydration and the appropriate treatment plans-A, B, or C-based on the degree of dehydration. These plans involve oral rehydration with WHO formula, ORS, or intravenous fluids depending on the severity. The document emphasizes continued feeding during diarrhea to prevent malnutrition.
A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected.
A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected.
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
A presentation created and delivered by me in the pediatric department of Ibrahim Malik Teaching Hospital (Khartoum, Sudan) on the 10th of May 2017. It is composed of the following parts:
- Definition
- Epidemiology
- Causes
- Assessment
- Management
The total number of slides is 19 slide. One of the slides contain a video from the IMCI program by World Health Organization (WHO) for assessment of children with dehydration. The youtube link of the video added in this online version instead of the complete video that was shown in the original presentation.
Development Urinary system by Shapi. MD.pdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
DEVELOPMENT OF RESPIRATORY SYSTEM by Shapi. MD.pdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
Bilaminar and trilaminar discs formation.pdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
Gametogenesis and Pre-ebryonic life by Shapi. MDpdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
NOTOCHORD, NEURULATION AND NTDs by Shapi. MD.pdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
1. PAEDIATRICS AND CHILD HEALTH
• Paediatrics and Child Health
• Deficit Therapy
• Maintenance Therapy
• Dehydration In No Malnutrition
• Dehydration In Malnutrition
Dr. Chongo Shapi (BSc.HB, MBChB, CUZ)
- Medical Doctor.
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3. Calculation of Fluid Deficit
• First determine the fluid deficit by clinically determining
the percent dehydration
• Then, multiply this percentage by the patient's weight
• For example:
- 10% dehydration (severe dehydration) = 100mL/kg
- Hence, a 10 kg child with 10% dehydration has a fluid
deficit of 1000 L (1L)
Deficit therapy is given if dehydration is present
- Give it within 36-48 hrs
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3
5. Goals of Maintenance Fluids
1. Prevent dehydration
2. Prevent electrolyte disorders
3. Prevent ketoacidosis
4. Prevent protein degradation
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6. Fluid Replacement Therapy (FRT)
A. If no ongoing losses (OGLs):
- FRT = Fluid Deficit (FD) + Maintenance Fluid (MF)
- Hence, FRT = FD + MF
B. If there is ongoing losses:
FRT = FD + MF + OGLs
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7. Examples
1. A child awaiting surgery may need only
maintenance fluids
2. A child with diarrheal dehydration needs
maintenance and deficit therapy if no
significant diarrhoea continuation
3. A child requires further replacement fluids to
account for ongoing losses if significant
diarrhoea continues
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8. Dehydration
• Dehydration is a common problem in children
• Is most often due to gastroenteritis
• Most cases can be managed with oral rehydration
• Children with hyponatremic or hypernatremic
dehydration can also be managed with ORS
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9. Clinical Manifestations
• The first step is assessing the degree of dehydration
• This dictates both the urgency of the situation and the
volume of fluid needed for rehydration
1. No dehydration:
a. Infant: < 5%
b. > 1 yr: < 3%
2. Some dehydration:
a. Infant : 5–10%
b. > 1 yr: 3–6%
3. Severe dehydration:
a. Infant : > 10%
b. > 1 yr: > 6%
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10. • For older children and adults the degree of
dehydration represents a lower percentage of
body weight lost
• This difference occurs because water is a
higher percentage of body weight in infants
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11. Clinical Features of No Dehydration
• Sensorium: Conscious
• No respiratory distress
• Normal PR
• Normal HR
• Normal CRT < 3 sec
• Skin turgor: instant recoil
• Peripheries: warm
• Normal to decreased urine output
• Drinks fluid normally
• Moist mucous membranes
• Tears present
• Eyes and AF not sunken
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12. Clinical Features of Some Dehydration
• Sensorium: Irritable/restless
• Tachypnea
• Increased PR
• Increased HR (Tachycardia)
• Delayed CRT > 3 sec
• Skin turgor: recoil in < 2 sec
• Peripheries: cold and pale
• Decreased urine output (oliguria)
• Eager to drink fluid
• Dry mucous membranes
• Decreased tears
• Sunken eyes and AF
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13. Clinical Features of Severe Dehydration
• Sensorium: Lethargic/apathy
• Deep breathing (Kussmaul breathing)
• Rapid and weak or absent peripheral pulses
• Tachycardia or bradycardia if severe
• Very delayed CRT: >3 sec
• Skin turgor: recoil in > 2 sec
• Peripheries: cold and mottled, cyanosed
• No urine output (anuria)
• Unable to drink
• Parched mucous membranes
• No tears
• Very sunken eyes and AF
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14. Moderate to Severe Dehydration
• Prompt intervention is needed
• The infant with severe dehydration is gravely ill
• The decrease in BP indicates that vital organs may
be receiving inadequate perfusion
• Immediate and aggressive intervention is
necessary
• If possible, the child with severe dehydration
should initially receive intravenous therapy
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15. • Clinical assessment of dehydration is only an
estimate
• Thus, the patient must be continually re-
evaluated during therapy
• The degree of dehydration is underestimated in
hypernatremic dehydration
• This because the movement of water from the
ICF to ECF helps to preserve the intravascular
volume
• The opposite occurs with hyponatremic
dehydration
• Dangerous intravascular volume depletion can
occur with less severe fluid deficits
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16. • The history usually suggests the aetiology of the
dehydration
• It may predict whether the patient will have:
a. Isotonic dehydration
b. Hyponatremic dehydration
c. Hypernatremic dehydration
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17. Things to consider
• Some children with dehydration are
appropriately thirsty
• Others, the lack of intake is part of the
pathophysiology of the dehydration
• Good urine output may be deceptively present
in:
1. Diabetes insipidus
2. Salt-wasting nephropathy
3. Hypernatremic dehydration
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18. Approach To Dehydration
• The child with dehydration requires acute
intervention to ensure that there is adequate
tissue perfusion
• Resuscitate : ABCs
• Treatment the shock (know how) if any with an
isotonic solution, such as normal saline (NS) or
Ringer lactate (LR)
• When patient is out of shock, calculate daily
replacement fluid therapy
• Subtract the amount you gave in shock and give
the remaining fluid accordingly
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19. • A child with a known or probable metabolic alkalosis
(the child with isolated vomiting), LR should not be
used because the lactate will worsen the alkalosis
• Colloids, such as blood, 5% albumin, and plasma, are
rarely needed for fluid boluses
• A crystalloid solution (NS or LR) is satisfactory, with
both less infectious risk and lower cost
Blood: significant anaemia or acute blood loss
Plasma: coagulopathy
Hypoalbuminemia: 5% albumin
• The volume and the infusion rate for colloids are
generally modified compared with crystalloids
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20. Dehydration In No Malnutrition
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21. Dehydration In No Malnutrition
• Plan the fluid therapy for the next 24 hr
• There are various protocols
• Use WHO treatment plans: A, B and C
• Plan A: patients treated at home
• Plan B and C: Admit
• Plan A: ORS or other recommended fluids
• Plan B: give ORS
• Plan C: Isotonic IVFs
- RL, ½ NS in 5 % dextrose (D5 ½ NS)
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22. WHO ORS
a. 13.5 g of CHO = 75 mmol/L
b. 20 g of CHO = 111 mmol/L
c. Base = 2.5 g of NaHCO3 (30 mmol/L of HCO3-) or 2.5 g of
Trisodium citrate (10 mmol/L of citrate)
d. The formula containing citrate is much more stable
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24. Plan Fluid Therapy In No Malnutrition
• Use WHO treatment plans:
1. No dehydration: Tx using Plan A
2. Some dehydration: Tx using Plan B
3. Severe dehydration: Tx using Plan C
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25. Plan A
Home therapy to prevent dehydration and malnutrition
• If no dehydration: a child needs extra fluids and salt to
replace their losses of water and electrolytes due to
diarrhoea
• If these are not given, signs of dehydration may develop
The 3 Rules
• Mothers should be taught these rules:
- Rule 1: Give the child more fluids than usual, to prevent
dehydration
- Rule 2: Continue to feed the child, to prevent malnutrition
- Rule 3: Take child to hospital if signs of dehydration or other
problems
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25
26. Plan A
What fluids to give
• Wherever possible, these should include at least one
fluid that normally contains salt
• Plain clean water should also be given
Suitable fluids
Two groups:
1. Fluids that normally contain salt:
- ORS solution
- Salted drinks (e.g. salted rice water or a salted
yoghurt drink)
- Vegetable or chicken soup with salt
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27. Plan A
Teach mothers to add salt (about 3g/l) to an unsalted drink
or soup
2. Fluids that do not contain salt:
- Plain water
- water in which a cereal has been cooked (e.g. unsalted
rice water)
- Unsalted soup
- Yoghurt drinks without salt
- Green coconut water
- Weak tea (unsweetened)
- Unsweetened fresh fruit juice.
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28. Plan A
How much fluid to give
• The general rule is:
- Give as much fluid as the patient wants until
diarrhoea stops
- As a guide, after each loose stool, give:
• Patients < 2 yrs : 50-100mL/loose stool
- A quarter to half a large cup
• Patients 2 yrs – 10 yrs : 200-400mL/loose stool
- A half to one large cup
• Patients > 10 yrs : As much as possible
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29. Plan A
• Continue feeding during diarrhoea and increase
afterwards. Never withhold food
• Child's usual foods should not be diluted
• Breastfeeding should always be continued
• Aim is to give as much nutrient rich food as the
child will accept
• Food intake support continued growth and
weight gain
• Continued feeding also speeds the recovery of
normal intestinal function
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30. When Should Pt be Brought to Hospital?
If there are signs of dehydration or other problems
- Starts to pass many watery stools
- Has repeated vomiting
- Becomes very thirsty
- Is eating or drinking poorly
- Develops a fever
- Has blood in the stool
- The child does not get better in three days
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31. Plan B: ORT
• Children with some dehydration should
receive oral rehydration therapy (ORT) with
ORS solution in a health facility
• Use the table on the next slide
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33. Plan B: ORT
• Use patient's age ONLY when you do not know the
weight
• Start with 200-400mL for < 5 kg, then increase by
200 mL for intervals of 3 kg (check pattern in the
table). Give in the first 4 hours
• Approximate amount of ORS: 75 mL/kg in 4 hrs
- If the patient wants more ORS than shown, give more
- Encourage the mother to continue b/feeding
- For infants under 6 months who are not breastfed,
give 100-200ml clean water during this period
- If the child vomits, wait 5-10 minutes and then start
giving ORS solution again, but more slowly
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34. Plan B
• During the initial stages of therapy, while still
dehydrated, if necessary:
a. Adults can consume up to 750 ml/hr
b. Children up to 20 mL/kg/hr
Sign of overhydration: Oedematous (puffy) eyelids
• If this occurs, stop giving ORS solution, but give
breastmilk or plain water, and food
• Do not give a diuretic
• When the oedema has gone, resume giving ORS
solution or home fluids according to Plan A
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35. Monitoring Progress of ORT
• Check the child from time to time during
rehydration
• This ensures that ORS solution is being taken
satisfactorily and that signs of dehydration are
not worsening
• If at any time the child develops signs of severe
dehydration, shift to Treatment Plan C
• After 4 hours (after giving calculated ORS),
reassess the child fully
• Then decide what treatment to give next
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37. Plan C: IV Rehydration
• Children who can drink, even poorly, should be
given ORS solution by mouth until the IV drip is
running
• All children should start to receive some ORS
solution (about 5 ml/kg/h) when they can drink
without difficulty
• This is usually within 34 hours (for infants) or 12
hours (for older patients)
• This provides additional base and potassium,
which may not be adequately supplied by the IVF
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39. Monitoring the Patient
Look and feel for all the signs of dehydration:
• If signs of severe dehydration are still present,
repeat the IV fluid infusion for Plan C
- Very unusual, occurs only in children who pass
large watery stools frequently during the
rehydration period
• If signs of some dehydration, discontinue the IV
infusion and give ORS solution for 4 hrs, as
specified in Treatment Plan B
• If there are no signs of dehydration, follow
Treatment Plan A
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40. Role of Antibiotics
• Antibiotics have no role in dehydration even if it
is secondary to infectious diarrhoea
• Give antibiotics in acute or persistent diarrhoea
ONLY in:
1. Dysentery
2. Cholera
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41. Discharge
• If possible, observe child for at least six hours
before discharge while the mother gives the child
ORS solution
• Teach mother Plan A
• Confirm that she is able to maintain the child's
hydration
• Remember that the child will require therapy
with ORS solution until diarrhoea stops
• Give her enough ORS packets for two days
• Teach her the signs that mean she should bring
her child back to hospital
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43. • It is difficult to estimate dehydration status in a
severely malnourished child using clinical signs
alone
• Signs of dehydration used in malnutrition
• Treat those showing the following signs of severe
dehydration:
1. Lethargy or unconsciousness
2. Delayed CRT > 3 sec
3. Weak feeble and fast pulse
4. Reduced urinary output (< 0.5-1 mL/Kg/hr)
5. Cold peripheries
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44. Dehydration In Malnutrition
Malnourished Children Require Special Treatment
- Heart unable to handle large fluids, give per oral
- Malnourished children are ONLY given IVFs when they
are in shock
1. Give ReSoMal (not ORS or IVFs) orally or via NG tube:
a. In the first 2 hours, give 5 mL/kg every 30 min
b. In the next 4-10 hours, give 5-10mL/Kg alternating
every hour with starter F-75
c. Enter child in stabilization phase with starter F-75 2-
3 hourly (including night time)
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