This document discusses the management of diarrhea and dehydration in disaster situations. It begins by explaining that diarrhea is a major cause of illness and death, especially in children, when sanitation is poor after disasters. It then defines diarrhea and describes the most common causes. The rest of the document details the classification, treatment and prevention of different types of diarrhea like acute watery diarrhea, dysentery, persistent diarrhea, and cholera. It emphasizes early detection and treatment to prevent transmission and dehydration, the importance of oral rehydration and continued feeding, and the limited role of antibiotics depending on the cause.
Acute infectious diarrhea and gastroenteritis in childrenLucy Maya
Acute infectious diarrhea and gastroenteritis in children Acute infectious diarrhea and gastroenteritis in children Acute infectious diarrhea and gastroenteritis in children
This document provides information on a lesson plan about diarrhea presented by Ms. B. Hemalatha. It begins with an introduction stating that diarrhea is a leading cause of death in developing countries, killing over 10 million children under 5 each year. It then defines diarrhea and describes the clinical types including acute watery diarrhea, acute bloody diarrhea, persistent diarrhea, and diarrhea with severe malnutrition. It discusses the epidemiological determinants of diarrhea including common pathogens, reservoirs of infection, host factors, and environmental factors. It covers the modes of transmission and prevention and control methods such as oral rehydration therapy and vaccination.
Gastroenteritis is inflammation of the stomach and intestines that causes diarrhea, vomiting and abdominal cramps. It is usually caused by viruses like rotavirus or bacteria like Campylobacter. Common symptoms include diarrhea, vomiting, fever and dehydration. Treatment focuses on rehydration through oral rehydration therapy. Antiemetics may help reduce vomiting, and antibiotics are sometimes used for bacterial causes. Prevention involves handwashing, sanitation and food safety.
This document provides an overview of gastroenteritis in pediatrics. It defines gastroenteritis as an inflammatory disease of the stomach and intestines characterized by sudden onset of diarrhea and/or vomiting. Common causes are viruses, bacteria, protozoa, and non-infectious agents. Symptoms and management depend on the cause. Treatment involves rehydration and replacement of fluids and electrolytes to prevent dehydration, along with any necessary medical treatment of the underlying infection. Nutritional management is also important during treatment and recovery.
Acute gastroenteritis is characterized by changes in stool frequency and consistency lasting less than 14 days. It is commonly caused by viruses, bacteria, and parasites. Treatment involves oral rehydration with solutions like ORS to prevent and treat dehydration. Antimicrobial therapy may be given for specific bacterial infections when indicated. Proper management focuses on rehydration and nutrition while symptoms resolve.
The document discusses an epidemiological study on worm infestation in Surkhet district, Nepal. It provides background on common types of worms that can infect humans. Worm infestation is a major public health problem, especially among children, due to poor sanitation and hygiene. The study aims to understand the epidemiology of worm infestation in the district by examining factors like time, place, and person. Secondary data from the past 3 years will be reviewed to analyze trends and distributions of worm infestation cases. The findings will help authorities better plan prevention and treatment services.
1) Diarrhea can cause secondary lactase deficiency and lactose intolerance by damaging the intestinal mucosa. This reduces absorption of lactose from cow's milk and regular formula.
2) Studies show low lactose formula improves early weight gain and recovery in infants with acute diarrhea compared to regular formula. Low lactose formula also improves recovery of lactose tolerance after diarrhea resolves.
3) For infants and children with diarrhea, guidelines recommend continued breastfeeding and early refeeding with low lactose foods and formula instead of complete milk avoidance to support adequate nutrition and faster recovery.
Acute infectious diarrhea and gastroenteritis in childrenLucy Maya
Acute infectious diarrhea and gastroenteritis in children Acute infectious diarrhea and gastroenteritis in children Acute infectious diarrhea and gastroenteritis in children
This document provides information on a lesson plan about diarrhea presented by Ms. B. Hemalatha. It begins with an introduction stating that diarrhea is a leading cause of death in developing countries, killing over 10 million children under 5 each year. It then defines diarrhea and describes the clinical types including acute watery diarrhea, acute bloody diarrhea, persistent diarrhea, and diarrhea with severe malnutrition. It discusses the epidemiological determinants of diarrhea including common pathogens, reservoirs of infection, host factors, and environmental factors. It covers the modes of transmission and prevention and control methods such as oral rehydration therapy and vaccination.
Gastroenteritis is inflammation of the stomach and intestines that causes diarrhea, vomiting and abdominal cramps. It is usually caused by viruses like rotavirus or bacteria like Campylobacter. Common symptoms include diarrhea, vomiting, fever and dehydration. Treatment focuses on rehydration through oral rehydration therapy. Antiemetics may help reduce vomiting, and antibiotics are sometimes used for bacterial causes. Prevention involves handwashing, sanitation and food safety.
This document provides an overview of gastroenteritis in pediatrics. It defines gastroenteritis as an inflammatory disease of the stomach and intestines characterized by sudden onset of diarrhea and/or vomiting. Common causes are viruses, bacteria, protozoa, and non-infectious agents. Symptoms and management depend on the cause. Treatment involves rehydration and replacement of fluids and electrolytes to prevent dehydration, along with any necessary medical treatment of the underlying infection. Nutritional management is also important during treatment and recovery.
Acute gastroenteritis is characterized by changes in stool frequency and consistency lasting less than 14 days. It is commonly caused by viruses, bacteria, and parasites. Treatment involves oral rehydration with solutions like ORS to prevent and treat dehydration. Antimicrobial therapy may be given for specific bacterial infections when indicated. Proper management focuses on rehydration and nutrition while symptoms resolve.
The document discusses an epidemiological study on worm infestation in Surkhet district, Nepal. It provides background on common types of worms that can infect humans. Worm infestation is a major public health problem, especially among children, due to poor sanitation and hygiene. The study aims to understand the epidemiology of worm infestation in the district by examining factors like time, place, and person. Secondary data from the past 3 years will be reviewed to analyze trends and distributions of worm infestation cases. The findings will help authorities better plan prevention and treatment services.
1) Diarrhea can cause secondary lactase deficiency and lactose intolerance by damaging the intestinal mucosa. This reduces absorption of lactose from cow's milk and regular formula.
2) Studies show low lactose formula improves early weight gain and recovery in infants with acute diarrhea compared to regular formula. Low lactose formula also improves recovery of lactose tolerance after diarrhea resolves.
3) For infants and children with diarrhea, guidelines recommend continued breastfeeding and early refeeding with low lactose foods and formula instead of complete milk avoidance to support adequate nutrition and faster recovery.
A 9-month-old male infant presented with gastroenteritis and dehydration. He was experiencing vomiting, diarrhea, and weight loss. Initial assessments found tachycardia, poor skin turgor, and signs of dehydration. Lab work showed anemia and elevated white blood cell count, indicating infection. The infant was admitted and started on IV fluids and antibiotics to treat the infection and rehydrate him. Nursing care focused on monitoring fluid intake and output, vital signs, and symptoms to manage the diarrhea and prevent further dehydration.
Gastroenteritis is an inflammatory disease of the stomach and intestines characterized by sudden onset of diarrhea and vomiting. It is commonly caused by viruses, bacteria, parasites, and other non-infectious agents. The main symptoms include diarrhea, fever, abdominal cramps, and dehydration. Treatment involves oral rehydration therapy to replace lost fluids based on the level of dehydration, along with continued breastfeeding and nutritional supplements. Antibiotics may be given for specific bacterial infections. The goal of management is to prevent and treat dehydration through oral or intravenous fluid replacement.
This document discusses the control of diarrhoeal diseases. It begins by defining diarrhoea and describing the types of diarrhoeal diseases such as acute watery diarrhoea, acute bloody diarrhoea, and persistent diarrhoea. It then discusses the magnitude of diarrhoeal diseases globally and in India, describing that diarrhoea is the second leading cause of death in children under 5 years old worldwide. The document outlines the three essential elements in managing diarrhoea - rehydration therapy, zinc supplementation, and continued feeding. It provides details on assessing and treating dehydration, including treatment plans for severe and some dehydration.
Gastroenteritis is an infection of the gut that causes diarrhea and sometimes vomiting and abdominal pain. It is commonly caused by viruses, bacteria, or parasites and spreads easily. Symptoms usually clear up in a few days but dehydration is a risk, especially for elderly or frail people. Treatment focuses on preventing dehydration by drinking fluids and eating lightly as tolerated. Medical care should be sought if dehydration is suspected or symptoms are severe or prolonged.
an-Approach to diarrhea-by dr. rkdhaugoda,ctgu- 2014Rajkumar Dhaugoda
Diarrhea is a common presenting problem that can be caused by infections, toxins, or other factors. The most common infectious causes are bacteria like E.coli, Salmonella, Shigella, Vibrio cholerae, and viruses such as rotavirus. Management involves fluid and electrolyte replacement as well as treating the underlying cause with antibiotics, antivirals, or antiparasitic medication depending on the pathogen. Preventing fecal-oral transmission through proper sanitation and hygiene is important for controlling infectious diarrhea.
This document discusses diarrhea, its disease burden, and strategies for control and treatment. It notes that diarrhea is the second leading cause of death in children under 5 globally and kills over 750,000 young children each year. The national program for control of diarrheal diseases aims to reduce mortality, morbidity, hospital admissions, and outbreaks through standardized case management, training, social mobilization, surveillance, and improved sanitation. Proper use of oral rehydration salts is emphasized as a major breakthrough in combating diarrhea by replacing fluids and electrolytes lost.
This document discusses dysentery and persistent diarrhea in children. It defines dysentery as diarrhea with visible blood in stools, most commonly caused by Shigella. Dysentery is more severe in malnourished children and those with measles. The clinical diagnosis is based on blood or pus in stool. Treatment involves antibiotics like trimethoprim-sulfamethoxazole and fluid replacement. Persistent diarrhea lasts 14 days or longer and is associated with malnutrition. Its management focuses on fluid, electrolyte replacement, and nutritional therapy tailored to the individual case. Antimicrobials should only be given when indicated by culture and sensitivity testing.
This document discusses bronchiolitis and asthma in children. It describes bronchiolitis as a serious viral infection affecting the small airways (bronchioles) in infants, causing inflammation and difficulty breathing. Asthma is defined as a chronic inflammatory airway disease characterized by wheezing, coughing, and shortness of breath. Both conditions are more common in young children due to the immaturity of their respiratory systems. The document outlines signs, symptoms, diagnostic testing, and treatment approaches for managing bronchiolitis and asthma exacerbations in children.
This document provides an overview of gastroenteritis (GE), also known as acute diarrhea. It defines GE as diarrhea of rapid onset, with or without accompanying symptoms. Viruses are the most common cause, primarily rotavirus in 70-80% of cases. Bacteria account for 10-20% of cases and parasites less than 10%. The document discusses evaluating patients for GE through history, physical exam, and laboratory tests. It provides details on assessing and treating dehydration, which can range from mild to severe. Treatment involves oral rehydration or intravenous fluids based on the dehydration severity.
Acute Gastroenteritis is a major cause of morbidity and hospitalization in children. It is commonly caused by viruses like rotavirus in infants and norovirus in older children. Rotavirus causes severe dehydrating diarrhea primarily in children 6 months to 2 years of age during winter months. Diagnosis involves detection of virus or antigens in stool samples. Treatment focuses on rehydration and preventing complications through oral rehydration solutions and zinc supplementation in young children. Antibiotics are generally not needed unless a specific bacterial cause is identified. Vaccines have proven effective in preventing rotavirus infections.
Have you ever had
the "stomach flu?" What you probably had was gastroenteritis - not a
type of flu at all. Gastroenteritis is an inflammation of the lining of the
intestines caused by a virus, bacteria or parasites. Viral gastroenteritis is
the second most common illness in the U.S. It spreads through contaminated food
or water, and contact with an infected person. The best prevention is frequent
hand washing.
Symptoms of
gastroenteritis include diarrhea, abdominal pain, vomiting, headache, fever
and chills. Most people recover with no treatment.
The most common
problem with gastroenteritis is dehydration. This happens if you do not drink
enough fluids to replace what you lose through vomiting and diarrhea. Dehydration
is most common in babies, young children, the elderly and people with weak
immune systems.
This document summarizes the key components of a diarrhoeal disease control program. It discusses the importance of oral rehydration therapy and zinc supplementation for treatment. It also emphasizes preventative strategies like improved sanitation, health education, immunization, and fly control. The long-term goals include better maternal and child health practices to reduce malnutrition and the risk of diarrhoeal diseases. The program aims to reduce mortality and morbidity from diarrhoeal diseases through both clinical management of cases and preventative public health measures.
1. Diarrhea is defined as an increase in stool frequency and decrease in stool consistency resulting in a stool weight exceeding 200g in 24 hours.
2. Acute diarrhea lasts less than 2 weeks and is usually infectious in origin such as viral gastroenteritis, while chronic diarrhea lasts over 4 weeks and is often non-infectious such as irritable bowel syndrome.
3. A thorough history relating the diarrhea to the patient's medical history, medications, travel, diet and symptoms is important to determine the cause and guide evaluation and treatment.
This document provides an overview of diarrheal disease including its causes, classification, management, and prevention. It discusses that diarrheal disease is the second leading cause of death in children under 5 globally. The main points are: acute watery diarrhea accounts for over 75% of cases; continued feeding and oral rehydration solutions are the primary treatment; zinc and probiotics can help prevent and treat diarrhea; and diarrhea management should focus on preventing dehydration through oral rehydration.
This document provides guidelines from the World Gastroenterology Organisation on the diagnosis and treatment of acute diarrhea. It discusses the global epidemiology and impact of acute diarrhea. It also reviews the major causative agents of acute diarrhea including bacteria (such as E. coli, Campylobacter, Shigella, Vibrio cholerae, Salmonella), viruses (such as rotavirus, norovirus, adenovirus), and parasites (such as Cryptosporidium, Giardia). It provides details on the clinical manifestations and diagnosis of acute diarrhea and recommends treatment options based on the severity of dehydration and the likely causative agent. The guidelines are intended to provide a global perspective on acute diarrhea in
Gastroenteritis is an infection or inflammation of the stomach and intestines that is commonly caused by viruses, bacteria, parasites, toxins, chemicals or drugs. Common symptoms include nausea, vomiting, diarrhea, abdominal pain and cramps, fever and weakness. The main risk is dehydration, which can be life-threatening. Treatment focuses on rehydration and may include antibiotics, antiparasitic drugs or intravenous fluids depending on the cause. Prevention involves proper handwashing and food safety practices. Most cases resolve within a few days but dehydration can prolong recovery.
The Role of Hemolytic Enteropathogenic Escherichia Coli EPEC in the Developme...YogeshIJTSRD
The article deals with a group of infectious diseases caused by pathogenic serotypes of Escherichia coli. Most often, these bacteria cause acute intestinal disorders intestinal coli infection , and in young children and in weakened persons, they can also cause damage to the urinary tract, sometimes the development of cholecystitis, meningitis, and sepsis. Distinguish between enteropathogenic, enterotoxigenic, enteroinvasive, enterohemorrhagic, enteroadhesive infection and other infections. Yusupov Mashrabismatillayevich | Shaykulov Hamza Shodiyevich "The Role of Hemolytic Enteropathogenic Escherichia Coli (EPEC) in the Development of Diarrhea in Children, its Features of Prevention and Treatment" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Special Issue | International Research Development and Scientific Excellence in Academic Life , March 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38270.pdf Paper Url: https://www.ijtsrd.com/biological-science/microbiology/38270/the-role-of-hemolytic-enteropathogenic-escherichia-coli-epec-in-the-development-of-diarrhea-in-children-its-features-of-prevention-and-treatment/yusupov-mashrabismatillayevich
Gastroenteritis is an infection of the gut that causes diarrhea and sometimes vomiting. It is usually caused by viruses like rotavirus. The main risk is dehydration. Treatment involves giving plenty of fluids to prevent dehydration and encouraging eating once dehydration is treated. Seek medical advice if symptoms are severe or do not improve in a few days.
The document discusses diarrheal diseases and provides information on acute and chronic diarrhea. For acute diarrhea, over 90% of cases are caused by infectious agents transmitted through feces. Common infectious causes include various bacteria, viruses, and parasites. Treatment focuses on fluid and electrolyte replacement. Antibiotics may be used to reduce severity and duration. Chronic diarrhea lasting over 4 weeks can have various causes including secretory, osmotic, steatorrheal, inflammatory, dysmotile, and factitial. A thorough evaluation is needed to identify the underlying cause and guide management.
This document discusses diarrhea, dehydration, and their management in disaster situations. It begins by explaining that poor sanitation after disasters increases risk of diarrhea, especially in children. Early diagnosis and treatment are essential to reduce impact. The document then defines diarrhea and dehydration. It describes different types of diarrhea including acute watery, acute bloody (dysentery), and persistent diarrhea. It provides treatment guidelines for each type. Key points emphasized include treating dehydration, continuing nutrition, and using antibiotics selectively based on IMCI guidelines. The document also discusses specific infections like cholera, giardiasis, and amebiasis. Overall it aims to describe management of acute diarrhea in disaster settings according to best practices.
Diarrhea and vomiting in children
Vomiting (throwing up) and diarrhea (frequent, watery bowel movements) can be caused by viruses, bacteria, parasites, foods that are hard to digest (such as too many sweets) and other things.
A 9-month-old male infant presented with gastroenteritis and dehydration. He was experiencing vomiting, diarrhea, and weight loss. Initial assessments found tachycardia, poor skin turgor, and signs of dehydration. Lab work showed anemia and elevated white blood cell count, indicating infection. The infant was admitted and started on IV fluids and antibiotics to treat the infection and rehydrate him. Nursing care focused on monitoring fluid intake and output, vital signs, and symptoms to manage the diarrhea and prevent further dehydration.
Gastroenteritis is an inflammatory disease of the stomach and intestines characterized by sudden onset of diarrhea and vomiting. It is commonly caused by viruses, bacteria, parasites, and other non-infectious agents. The main symptoms include diarrhea, fever, abdominal cramps, and dehydration. Treatment involves oral rehydration therapy to replace lost fluids based on the level of dehydration, along with continued breastfeeding and nutritional supplements. Antibiotics may be given for specific bacterial infections. The goal of management is to prevent and treat dehydration through oral or intravenous fluid replacement.
This document discusses the control of diarrhoeal diseases. It begins by defining diarrhoea and describing the types of diarrhoeal diseases such as acute watery diarrhoea, acute bloody diarrhoea, and persistent diarrhoea. It then discusses the magnitude of diarrhoeal diseases globally and in India, describing that diarrhoea is the second leading cause of death in children under 5 years old worldwide. The document outlines the three essential elements in managing diarrhoea - rehydration therapy, zinc supplementation, and continued feeding. It provides details on assessing and treating dehydration, including treatment plans for severe and some dehydration.
Gastroenteritis is an infection of the gut that causes diarrhea and sometimes vomiting and abdominal pain. It is commonly caused by viruses, bacteria, or parasites and spreads easily. Symptoms usually clear up in a few days but dehydration is a risk, especially for elderly or frail people. Treatment focuses on preventing dehydration by drinking fluids and eating lightly as tolerated. Medical care should be sought if dehydration is suspected or symptoms are severe or prolonged.
an-Approach to diarrhea-by dr. rkdhaugoda,ctgu- 2014Rajkumar Dhaugoda
Diarrhea is a common presenting problem that can be caused by infections, toxins, or other factors. The most common infectious causes are bacteria like E.coli, Salmonella, Shigella, Vibrio cholerae, and viruses such as rotavirus. Management involves fluid and electrolyte replacement as well as treating the underlying cause with antibiotics, antivirals, or antiparasitic medication depending on the pathogen. Preventing fecal-oral transmission through proper sanitation and hygiene is important for controlling infectious diarrhea.
This document discusses diarrhea, its disease burden, and strategies for control and treatment. It notes that diarrhea is the second leading cause of death in children under 5 globally and kills over 750,000 young children each year. The national program for control of diarrheal diseases aims to reduce mortality, morbidity, hospital admissions, and outbreaks through standardized case management, training, social mobilization, surveillance, and improved sanitation. Proper use of oral rehydration salts is emphasized as a major breakthrough in combating diarrhea by replacing fluids and electrolytes lost.
This document discusses dysentery and persistent diarrhea in children. It defines dysentery as diarrhea with visible blood in stools, most commonly caused by Shigella. Dysentery is more severe in malnourished children and those with measles. The clinical diagnosis is based on blood or pus in stool. Treatment involves antibiotics like trimethoprim-sulfamethoxazole and fluid replacement. Persistent diarrhea lasts 14 days or longer and is associated with malnutrition. Its management focuses on fluid, electrolyte replacement, and nutritional therapy tailored to the individual case. Antimicrobials should only be given when indicated by culture and sensitivity testing.
This document discusses bronchiolitis and asthma in children. It describes bronchiolitis as a serious viral infection affecting the small airways (bronchioles) in infants, causing inflammation and difficulty breathing. Asthma is defined as a chronic inflammatory airway disease characterized by wheezing, coughing, and shortness of breath. Both conditions are more common in young children due to the immaturity of their respiratory systems. The document outlines signs, symptoms, diagnostic testing, and treatment approaches for managing bronchiolitis and asthma exacerbations in children.
This document provides an overview of gastroenteritis (GE), also known as acute diarrhea. It defines GE as diarrhea of rapid onset, with or without accompanying symptoms. Viruses are the most common cause, primarily rotavirus in 70-80% of cases. Bacteria account for 10-20% of cases and parasites less than 10%. The document discusses evaluating patients for GE through history, physical exam, and laboratory tests. It provides details on assessing and treating dehydration, which can range from mild to severe. Treatment involves oral rehydration or intravenous fluids based on the dehydration severity.
Acute Gastroenteritis is a major cause of morbidity and hospitalization in children. It is commonly caused by viruses like rotavirus in infants and norovirus in older children. Rotavirus causes severe dehydrating diarrhea primarily in children 6 months to 2 years of age during winter months. Diagnosis involves detection of virus or antigens in stool samples. Treatment focuses on rehydration and preventing complications through oral rehydration solutions and zinc supplementation in young children. Antibiotics are generally not needed unless a specific bacterial cause is identified. Vaccines have proven effective in preventing rotavirus infections.
Have you ever had
the "stomach flu?" What you probably had was gastroenteritis - not a
type of flu at all. Gastroenteritis is an inflammation of the lining of the
intestines caused by a virus, bacteria or parasites. Viral gastroenteritis is
the second most common illness in the U.S. It spreads through contaminated food
or water, and contact with an infected person. The best prevention is frequent
hand washing.
Symptoms of
gastroenteritis include diarrhea, abdominal pain, vomiting, headache, fever
and chills. Most people recover with no treatment.
The most common
problem with gastroenteritis is dehydration. This happens if you do not drink
enough fluids to replace what you lose through vomiting and diarrhea. Dehydration
is most common in babies, young children, the elderly and people with weak
immune systems.
This document summarizes the key components of a diarrhoeal disease control program. It discusses the importance of oral rehydration therapy and zinc supplementation for treatment. It also emphasizes preventative strategies like improved sanitation, health education, immunization, and fly control. The long-term goals include better maternal and child health practices to reduce malnutrition and the risk of diarrhoeal diseases. The program aims to reduce mortality and morbidity from diarrhoeal diseases through both clinical management of cases and preventative public health measures.
1. Diarrhea is defined as an increase in stool frequency and decrease in stool consistency resulting in a stool weight exceeding 200g in 24 hours.
2. Acute diarrhea lasts less than 2 weeks and is usually infectious in origin such as viral gastroenteritis, while chronic diarrhea lasts over 4 weeks and is often non-infectious such as irritable bowel syndrome.
3. A thorough history relating the diarrhea to the patient's medical history, medications, travel, diet and symptoms is important to determine the cause and guide evaluation and treatment.
This document provides an overview of diarrheal disease including its causes, classification, management, and prevention. It discusses that diarrheal disease is the second leading cause of death in children under 5 globally. The main points are: acute watery diarrhea accounts for over 75% of cases; continued feeding and oral rehydration solutions are the primary treatment; zinc and probiotics can help prevent and treat diarrhea; and diarrhea management should focus on preventing dehydration through oral rehydration.
This document provides guidelines from the World Gastroenterology Organisation on the diagnosis and treatment of acute diarrhea. It discusses the global epidemiology and impact of acute diarrhea. It also reviews the major causative agents of acute diarrhea including bacteria (such as E. coli, Campylobacter, Shigella, Vibrio cholerae, Salmonella), viruses (such as rotavirus, norovirus, adenovirus), and parasites (such as Cryptosporidium, Giardia). It provides details on the clinical manifestations and diagnosis of acute diarrhea and recommends treatment options based on the severity of dehydration and the likely causative agent. The guidelines are intended to provide a global perspective on acute diarrhea in
Gastroenteritis is an infection or inflammation of the stomach and intestines that is commonly caused by viruses, bacteria, parasites, toxins, chemicals or drugs. Common symptoms include nausea, vomiting, diarrhea, abdominal pain and cramps, fever and weakness. The main risk is dehydration, which can be life-threatening. Treatment focuses on rehydration and may include antibiotics, antiparasitic drugs or intravenous fluids depending on the cause. Prevention involves proper handwashing and food safety practices. Most cases resolve within a few days but dehydration can prolong recovery.
The Role of Hemolytic Enteropathogenic Escherichia Coli EPEC in the Developme...YogeshIJTSRD
The article deals with a group of infectious diseases caused by pathogenic serotypes of Escherichia coli. Most often, these bacteria cause acute intestinal disorders intestinal coli infection , and in young children and in weakened persons, they can also cause damage to the urinary tract, sometimes the development of cholecystitis, meningitis, and sepsis. Distinguish between enteropathogenic, enterotoxigenic, enteroinvasive, enterohemorrhagic, enteroadhesive infection and other infections. Yusupov Mashrabismatillayevich | Shaykulov Hamza Shodiyevich "The Role of Hemolytic Enteropathogenic Escherichia Coli (EPEC) in the Development of Diarrhea in Children, its Features of Prevention and Treatment" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Special Issue | International Research Development and Scientific Excellence in Academic Life , March 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38270.pdf Paper Url: https://www.ijtsrd.com/biological-science/microbiology/38270/the-role-of-hemolytic-enteropathogenic-escherichia-coli-epec-in-the-development-of-diarrhea-in-children-its-features-of-prevention-and-treatment/yusupov-mashrabismatillayevich
Gastroenteritis is an infection of the gut that causes diarrhea and sometimes vomiting. It is usually caused by viruses like rotavirus. The main risk is dehydration. Treatment involves giving plenty of fluids to prevent dehydration and encouraging eating once dehydration is treated. Seek medical advice if symptoms are severe or do not improve in a few days.
The document discusses diarrheal diseases and provides information on acute and chronic diarrhea. For acute diarrhea, over 90% of cases are caused by infectious agents transmitted through feces. Common infectious causes include various bacteria, viruses, and parasites. Treatment focuses on fluid and electrolyte replacement. Antibiotics may be used to reduce severity and duration. Chronic diarrhea lasting over 4 weeks can have various causes including secretory, osmotic, steatorrheal, inflammatory, dysmotile, and factitial. A thorough evaluation is needed to identify the underlying cause and guide management.
This document discusses diarrhea, dehydration, and their management in disaster situations. It begins by explaining that poor sanitation after disasters increases risk of diarrhea, especially in children. Early diagnosis and treatment are essential to reduce impact. The document then defines diarrhea and dehydration. It describes different types of diarrhea including acute watery, acute bloody (dysentery), and persistent diarrhea. It provides treatment guidelines for each type. Key points emphasized include treating dehydration, continuing nutrition, and using antibiotics selectively based on IMCI guidelines. The document also discusses specific infections like cholera, giardiasis, and amebiasis. Overall it aims to describe management of acute diarrhea in disaster settings according to best practices.
Diarrhea and vomiting in children
Vomiting (throwing up) and diarrhea (frequent, watery bowel movements) can be caused by viruses, bacteria, parasites, foods that are hard to digest (such as too many sweets) and other things.
presentation.presentation slides by ptxyakemichael
This document discusses diarrhea and vomiting in pediatric patients. It begins by defining diarrhea and vomiting and listing learning objectives. It then covers etiology, risk factors, clinical manifestations, complications, medical management including rehydration therapy, nursing management, and preventative measures for diarrhea. For vomiting, it defines vomiting, discusses physiology and causes. It also covers differential diagnosis and clinical manifestations of vomiting and red flag symptoms. Diagnostic evaluation for acute vomiting is also mentioned.
Acute diarrhea is defined as having at least 3 liquid stools per day for less than 2 weeks. It can be caused by viruses, bacteria, or parasites and is transmitted through direct or indirect contact with contaminated food, water, or surfaces. The main risks of acute diarrhea are dehydration and malnutrition. Treatment involves oral rehydration with fluids and electrolytes to prevent and treat dehydration. Zinc supplements are also given to children under 5 to reduce duration and recurrence of diarrhea. Antimicrobial treatment may be needed for specific cases of cholera or giardiasis. Prevention relies on breastfeeding, proper food preparation and storage, access to clean water, and good hygiene practices.
Is defined as diarrhea with visible blood in
stools.
The most important and frequent cause of
acute dysentery is Shigella. Other causes
include Campylobacter jujeni, Salmonella,
and enteroinvasive E. coli.
Entameba histolytica causes dysentery in
older children but rarely in children under 5
years of age
Dysentery is specially sever in :-
1. Malnourished infants and children.
2.Those who develop clinically evident
dehydration during their illness. 3. Those who
are not breast fed. 4. Children with measles
or had measles in the preceding month.
5. Those who present with convulsion or
develop coma.
Apedemiology and countrol of acute diarrhoeal Dsi.pptEnricoChaesan
This document discusses acute diarrheal diseases. It defines diarrhea and notes that it is a major killer of children under 5 years old, responsible for one in four child deaths. The document outlines the major causes of diarrhea including bacteria like E. coli and viruses like rotavirus. It discusses the magnitude of diarrhea as a public health problem in India, affecting 8-11 million children annually. The document also summarizes guidelines for managing acute watery diarrhea, including assessing dehydration and appropriate fluid and nutritional therapy. It emphasizes prevention through sanitation, handwashing, breastfeeding and vaccines.
Apedemiology and countrol of acute diarrhoeal Dsi.pptshiroyasha26
This document discusses acute diarrheal diseases. It defines diarrhea and notes that it is a major killer of children under 5 years old, responsible for one in four child deaths. The document outlines the major causes of diarrhea including bacteria like E. coli and viruses like rotavirus. It discusses the magnitude of diarrhea as a public health problem in India, affecting 8-11 million children annually. The document also summarizes guidelines for managing acute watery diarrhea, including assessing dehydration and appropriate fluid and nutritional therapy. It emphasizes prevention through sanitation, handwashing, breastfeeding and vaccines.
Understanding Cholera: Epidemiology, Prevention, and Control.pdfSasikiranMarri
Understanding Cholera: Epidemiology, Prevention, and Control
Cholera, caused by the bacterium Vibrio cholerae, remains a significant global health concern, particularly in regions with poor sanitation and limited access to clean water. This infectious disease spreads through contaminated food and water, leading to severe diarrheal illness and dehydration, often proving fatal if left untreated.
Epidemiologically, cholera outbreaks are linked to environmental factors such as flooding, overcrowding, and inadequate sanitation facilities. The bacterium thrives in water sources contaminated with human feces, making communities with compromised water and sanitation infrastructure especially vulnerable.
Prevention strategies focus on improving sanitation, ensuring access to clean water, and promoting hygiene practices such as handwashing. Vaccination campaigns targeting high-risk populations can also help mitigate the spread of the disease.
Control efforts involve early detection through surveillance systems, prompt treatment with oral rehydration solutions to manage dehydration, and antibiotics for severe cases. Public health interventions like case isolation and contact tracing are crucial for containing outbreaks and preventing further transmission.
In summary, combating cholera requires a multi-faceted approach addressing both the underlying socio-economic factors contributing to its spread and implementing effective prevention and control measures. By investing in infrastructure development, vaccination programs, and public health initiatives, we can work towards reducing the burden of cholera and improving the health outcomes of affected communities worldwide.
Diarrhoea is a major cause of death in children under 5 years old worldwide. Oral rehydration salts (ORS) are the primary treatment for diarrhoea to prevent dehydration. Zinc supplementation for 14 days is also recommended. Probiotics like Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 can help treat diarrhoea. Continued feeding and providing extra fluids is important during and after diarrhoea to prevent malnutrition and further illness.
This document provides an overview of the evaluation and causes of diarrhea in children. It discusses how viral gastroenteritis is the most common cause of diarrhea in developed countries. Some life-threatening conditions that can present with diarrhea include intussusception, hemolytic uremic syndrome, pseudomembranous colitis, appendicitis, toxic megacolon, and congenital secretory diarrheas in young infants. Common causes of diarrhea are infections from viruses and bacteria, diarrhea associated with other systemic infections or antibiotic use, and feeding-related diarrhea. The document also outlines some less common causes such as infections from Cryptosporidium, toxic ingestions, and conditions like immunodeficiencies, celiac
This document provides information on acute diarrheal diseases including cholera. It begins with definitions of diarrhea and different types. It then discusses the global burden of diarrhea, noting it is a leading killer of children under 5, especially in South Asia and sub-Saharan Africa. The document outlines the causal pathway of diarrhea including agent, host, and environmental factors. It provides details on specific causes like rotavirus and E. coli. The clinical features, assessment, management including oral rehydration, zinc supplementation, and feeding are described. Prevention through water/sanitation, handwashing and rotavirus vaccination is also covered.
This document provides information on acute gastroenteritis in children. It defines acute diarrhea as the passage of loose or watery stools three or more times in a 24 hour period for up to 14 days. It notes that diarrhea is a leading cause of death among children under 5 years old globally and in India. The document discusses the causes, clinical presentation, assessment and management of acute diarrhea including use of oral rehydration solution and zinc supplementation. It also covers prevention of diarrhea and malnutrition in children.
Epidemiology and Control of acute diarrhoeal Dsi.pptsergeipee
This document discusses acute diarrheal diseases. It defines diarrhea and states that it is a major cause of death in children under 5 years old worldwide and in India. The causes of diarrhea include bacteria like E. coli and Vibrio cholerae, viruses like rotavirus, and parasites. Clinical assessment is needed to determine the degree of dehydration. Treatment involves oral rehydration solution for mild or moderate dehydration and IV fluids for severe dehydration. Prevention strategies include handwashing, breastfeeding, water sanitation, vaccination, and improved nutrition. National programs in India focus on oral rehydration, zinc supplementation, and hygiene promotion.
This document discusses acute diarrheal diseases. It defines diarrhea and notes it is a major killer of children under 5 worldwide. Common infectious agents causing diarrhea are described, including E. coli, Vibrio cholerae, Shigella, Campylobacter, Salmonella, rotavirus, and parasites. The magnitude of diarrhea as a public health problem in India is highlighted. Risk factors, types, assessment, management, prevention, and national control programs for diarrhea in India are summarized.
This document provides guidelines from the World Gastroenterology Organisation on the diagnosis and treatment of acute diarrhea. It discusses the global epidemiology and impact of acute diarrhea. It also reviews the major causative agents of acute diarrhea including bacteria (such as E. coli, Campylobacter, Shigella, Vibrio cholerae, Salmonella), viruses (such as rotavirus, norovirus, adenovirus), and parasites (such as Cryptosporidium, Giardia). It provides details on the clinical manifestations and diagnosis of acute diarrhea and recommends treatment options based on the severity of dehydration and the likely causative agent. The guidelines are intended to provide a global perspective on acute diarrhea in
Acute diarrhea is caused by infections spread through the fecal-oral route. It affects over 1.7 billion people globally each year and causes 760,000 deaths in children under 5. The key to management is fluid replacement to prevent dehydration through oral rehydration solutions. Antimicrobial treatment is usually not needed for acute infectious diarrhea but may be used for invasive bacteria like Shigella or Salmonella to prevent systemic complications. Proper hygiene and sanitation can help limit the spread of diarrhea-causing illnesses.
Acute diarrhea is caused by infections spread through the fecal-oral route. It affects over 1.7 billion people globally each year and causes 760,000 deaths in children under 5. The key aspects of management are fluid replacement to prevent dehydration, using oral rehydration solutions, and antimicrobial treatment only for invasive infections or immunocompromised patients to prevent antibiotic resistance. Proper sanitation and hygiene can help limit the transmission of infectious agents causing acute diarrhea.
Acute Diarrheal Disease is defined as the passage of loose, liquid or watery stools more than three times a day. It is caused by a variety of pathogens including viruses like rotavirus, and bacteria like ETEC. Clinical management involves oral rehydration therapy to prevent dehydration, intravenous fluids for severe cases, and continued feeding. Prevention strategies target both short-term control through appropriate case management and long-term control through improved sanitation, hygiene, and access to healthcare.
- Acute gastroenteritis (AGE) is a common condition in children that causes diarrhea and vomiting. It is usually caused by viruses like rotavirus. While causative agents do not change management, evaluation focuses on differentiating AGE from other potential causes and assessing dehydration severity. Management involves oral rehydration for mild cases and intravenous fluids for moderate to severe dehydration to correct fluid and electrolyte losses. Antibiotics are not routinely used while oral medications like racecadotril and ondansetron may assist rehydration in some cases. Close monitoring is important to watch for complications or need for further treatment.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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.
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
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
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Osteoporosis - Definition , Evaluation and Management .pdf
Diarrea and dehydration
1. 6
M O D U L E 6
Diarrhea and Dehydration
Clifton Yu | Douglas Lougee | Jorge R. Murno
2.
3. 6
INTRODUCTION
Poor sanitary conditions in disaster-stricken areas result in higher risk for
diarrheal illness in vulnerable populations, especially children. This disease
negatively impacts the nutritional status of affected children and causes significant
morbidity and mortality. Early diagnosis and treatment are thus essential to
reduce the impact of diarrheal diseases on people affected by disasters. Early
identification of cases allows the implementation of measures needed to prevent
or lessen outbreaks that can occur in displaced populations in this context. The
use of primary care management tools, such as the Integrated Management of
Childhood Illness (IMCI) strategy is highly important.
This module will first discuss diarrheal diseases and their management, and
dehydration and its treatments.
Diarrhea and Dehydration
Clifton E. Yu, MD, FAAP
Douglas A. Lougee, MD, MPH
Dr. Jorge R. Murno
4.
5. Definition of Diarrhea
Diarrhea is the passage of loose or
watery stools at least 3 times in a 24-
hour period. However, it is the consis-
tency of the stools rather than the num-
ber that is most important. Acute diar-
rhea may be caused by different viruses,
bacteria, and parasites. Rotavirus and
Norwalk-like virus are the most com-
mon agents, causing up to 50% of acute
diarrhea cases during the high-incidence
seasons. It is most practical to base the
treatment of diarrhea on the clinical
type of the illness, which is easy to
establish when a child is first examined.
Usually there is no need for laboratory
tests.
CASE.
In disaster situations, due to overcrowded living conditions, lack of adequate clean
water supply, and stool disposal, diarrhea is one of the most significant causes of
morbidity and mortality, particularly among children. Early detection and treatment
are therefore key elements in public health interventions, not only to manage
individual cases but also to prevent transmission of the disease to the rest of the
population. Effective hygiene measures markedly reduce the frequency of diarrheal
diseases.
1 What is the most probable etiology of this infant’s illness?
2 What treatment should be given?
3 What measures should be taken to prevent recurrences?
Continues on page 14.
OBJECTIVES
l Describe the management of acute
diarrhea.
l Identify the clinical indications for
antibiotic therapy for diarrheal illness in
an acute emergency setting.
l Identify the clinical features of dysentery,
the most frequent causative pathogens,
and the antibiotics that can be used to
treat the infection.
l Use the Integrated Management of
Childhood Illness (IMCI) guidelines in the
treatment of children with diarrhea.
DIARRHEAL ILLNESSES
SECTION I /
DIARRHEAL ILLNESSES
6. 6 SECTION 1 / DIARRHEAL ILLNESSES
In disaster situations, due to over-
crowded living conditions, lack of ade-
quate clean water supply, and stool dis-
posal, diarrhea is one of the most signifi
cant causes of morbidity and mortality,
particularly among children. Early detec-
tion and treatment are therefore key ele-
ments in public health interventions, not
only to manage individual cases but also
to prevent transmission of the disease to
the rest of the population. Effective
hygiene measures markedly reduce the
frequency of diarrheal diseases.
Types of Diarrhea
In a disaster scenario a child with diarrhea
may present with three potentially severe
or very severe clinical conditions: (1)
acute watery diarrhea (including cholera),
which lasts several hours or days, and can
cause dehydration, (2) acute bloody diar-
rhea or dysentery, which may cause intes-
tinal damage, sepsis, malnutrition and
dehydration, and (3) persistent diarrhea
(diarrhea that lasts more than 14 days).
All children with diarrhea should be
assessed to determine the duration of
diarrhea, if there is blood in the stools,
and if dehydration is present.
Acute watery diarrhea is mainly caused
by rotavirus, Norwalk-like virus, entero-
toxigenic Escherichia coli (ETEC), Vibrio
cholerae, Staphylococcus aureus, Clostridium
difficile, Giardia, and cryptosporidia. Most
frequent pathogens associated with acute
bloody diarrhea are Shigella and Entamoeba
histolytica. Campylobacter sp, invasive
Escherichia coli, Salmonella, Aeromonas
organisms, C. difficile, and Yersinia sp can also
cause bloody diarrhea.
IMCI recommends
use of oral
antimicrobials only for
children with bloody
diarrhea (amoebic or
bacterial dysentery),
cholera, and giardasis.
Management of Acute
Watery Diarrhea
Dehydration is the most common compli
cation of acute watery diarrhea in chil-
dren. Assessment and treatment of this
complication are discussed in Section III.
Watery diarrhea caused by
organisms
other than Vibrio cholerae is usually self-
limited and requires no antibiotic ther-
apy. It is important to note that antibi
otics have the potential to prolong the
disruption of intestinal homeostasis and
delay the recovery of normal bowel
flora. Therefore, the Integrated
Management of Childhood Illness (IMCI)
recommends use of oral antimicrobi-
als only for children with bloody diar-
rhea (amoebic or bacterial dysentery),
cholera, and giardiasis. Treatment for
these infections is discussed later in this
section.
Antidiarrheal or antiemetic medications
are not recommended to treat acute diar-
rhea, since they reduce intestinal
motility,
lengthen the course of the disease, pro-
long the contact of the causal pathogen
with the intestinal mucosa, and can wors-
en systemic symptoms.
Nutrition is also an important issue in
children with diarrhea. It is widely rec
ognized that fasting does not modify the
outcome or severity of the diarrheal dis-
ease. Therefore, in a child with diarrhea
and normal hydration status breastfeed-
ing (or bottle feeding with usual milk or
formula if the infant is not breastfed), as
well as feeding with age-appropriate
food should be continued. A lactose-
reduced or lactose-free diet provides no
benefit to children with acute diarrhea.
7. 7
SECTION 1 / DIARRHEAL ILLNESSES
In children with dehydration,
feeding
should be resumed as soon as
normal
hydration is achieved through any rehy-
dration therapy appropriate for the
severity of the dehydration. Remember
that malnourished children are at higher
risk of diarrhea due to intestinal
mucosa
alteration. The diarrheal illness in these
patients can last longer because of the
reduced enterocyte turnover. Thus,
reduced food intake only worsens the
degree of malnutrition prior to the
episode of acute diarrhea.
Patients with diarrhea but no signs of
dehydration usually have a fluid
deficit
less than 5% of their body weight.
Although these children lack distinct
signs of dehydration, they should be
given more fluid than usual to prevent
dehydration from developing. Table 1
shows the classification of diarrhea with-
out dehydration or blood in stools,
according to the IMCI strategy.
Management of Acute
Bloody Diarrhea
Bacterial Dysentery
A child is classified as having dysentery if
the mother or caregiver reports blood in
the child’s stools. Bloody diarrhea in young
children is usually a sign of invasive enteric
infection that carries a substantial risk of
serious morbidity and death. About 10%
of all diarrhea episodes in children under 5
ears old are dysenteric, but these
cause up to 15% of all diarrheal deaths.
Dysentery is especially severe in infants
and children who are undernourished or
who develop clinically-evident dehydration
during their illness. Diarrheal episodes that
begin with dysentery are more likely to
become persistent than those that start
without blood in the stools.
The goal of dysentery treatment is clini-
cal improvement, as well as shortening the
fecal shedding of the causative pathogen to
limit transmission. Evaluate children with
acute bloody diarrhea. Administer appro-
priate fluids to prevent or treat dehydra-
tion, and provide food. In addition, they
should receive for 5 days an oral antimi
crobial active against Shigella, since this is
the responsible organism in most cases (up
to 60%) of dysentery in children.
It is essential to know the sensitivity of
Shigella local strains, because antimicrobial
resistance is common. A number of antimi
crobials often used for the management of
TABLE 1. Classification of children with diarrhea without dehydration or blood in
stools
Assess signs Classify Treat
(GREEN)
Not enough signs to
classify as
dehydration
(GREEN)
No dehydration
(GREEN)
• Give food and fluids for treatment at home
(see Plan A on page 21).
• Tell the mother which signs require immediate
medical attention.
• If diarrhea persists, follow-up in 5 days.
The goal of
dysentery treatment
is clinical
improvement, as well
as shortening the
fecal shedding of the
causative pathogen
to limit transmission.
8. 8 SECTION 1 / DIARRHEAL ILLNESSES
dysentery, such as amoxicillin and
trimethoprim-sulfamethoxazole (TMP/
SMX), may be ineffective for treating shigel
losis irrespective of the local strain sensitiv-
ity. If available, consider ceftriaxone, a
flu
oroquinolone (in patients older than 18
years), or azithromycin for resistant
strains. Ideally a stool culture is performed
to identify the organism and guide treat-
ment according to antimicrobial sensitivity.
Hospital referral is recommended if the
child is malnourished or if there is a previ-
ous underlying illness that can complicate
the diarrheal disease.
Some regions of Latin America, such as
Argentina, have a high incidence of
hemolytic-uremic syndrome, a very severe
condition caused by Shiga toxin-producing
strains of E. coli, and associated with acute
renal failure. Antibiotic treatment may
pre
cipitate renal failure. In these regions,
before starting empiric antibiotic therapy,
take a sample of stools for culture that will
provide results within 48 hours.
Evidence of improvement in bloody
diarrhea include defervescence, less blood
in stools, less frequent evacuations,
improved appetite, and a return to normal
activity. If there is little or no improvement
after 2 days, refer the child to a hospital for
further evaluation and treatment. If referral
is not possible, perform a stool culture in
order to identify the organism and adjust
antibiotic therapy. If the child is improving,
the antimicrobial should be continued for
5 days.
Amoebic Dysentery
Amoebic dysentery is caused by
Entamoeba histolytica, a protozoan para-
site, and also presents with bloody
diar
rhea. It is transmitted by fecal-oral
route, particularly through contaminat-
ed water and food. The most severe
forms occur in infants, pregnant women,
and malnourished children. As in
Shigella-associated dysentery, the stools
often contain visible blood, and
diarrhea
may be associated with fever and
abdominal pain. Hepatomegaly may be
present.
Complications include fulminant coli-
tis, toxic megacolon, bowel perforation,
and liver abscess.
When a microscopic test reveals amoe-
bic trophozoites or cysts, or when a
patient with bloody diarrhea has failed two
different antibiotic series, give metronida-
zole (30 mg/kg/day for 5-10 days).
Management of Persistent
Diarrhea
Persistent diarrhea is an episode of diar-
rhea, with or without blood, which begins
acutely and lasts at least 14 days. It
accounts for up to 15% of all episodes of
diarrhea but is associated with 30% to
50% of deaths. Persistent diarrhea is usu
ally associated with weight loss and often
with serious non-intestinal infections.
Many children who develop persis-
tent diarrhea are malnourished, greatly
increasing their risk of death. Persistent
diarrhea almost never occurs in infants
who are exclusively breastfed.
All children with diarrhea for 14 days or
more should be classified based on the
presence or absence of any dehydration
(Table 2):
9. 9
SECTION 1 / DIARRHEAL ILLNESSES
l Children with severe persistent
diarrhea who also have any degree of
dehydration require special treatment
and should not be managed at the
outpatient facility. Referral to a hospital
is required. As a rule, treatment of
dehydration should be initiated first,
unless there is another severe
classification.
l Children with persistent diarrhea and
no signs of dehydration can be safely
managed in the outpatient clinic, at
least initially. Proper feeding is the most
important aspect of treatment for most
children with persistent diarrhea. The
goals of nutritional therapy are to: a)
temporarily reduce the amount of
animal milk (or lactose) in the diet; b)
provide a sufficient intake of energy,
protein, vitamins, and minerals to
facilitate the repair process in the
Proper feeding is the
most important aspect
of treatment for most
children with
persistent diarrhea
TABLE 2. Classification of children with persistent diarrhea
Has the child had diarrhea for 14 days or more?
Assess signs Classify Treatment
With dehydration Severe persistent
diarrhea
•
Treat dehydration before and during the child’s
transfer, unless the child has another severe
condition
• Refer to hospital
Without dehydration Persistent diarrhea •
Teach the mother how to feed the child with
persistent diarrhea*
•
Tell the mother which signs require immediate
medical attention
•
Give multivitamin and minerals (including zinc)
for 14 days
• Follow-up in 5 days
damaged gut mucosa and improve
nutritional status; c) avoid giving foods
or drinks that may aggravate the
diarrhea; and d) ensure adequate food
intake during convalescence to correct
any malnutrition.
Routine treatment of persistent diar-
rhea with antimicrobials is not effective.
Some children, however, have nonintes-
tinal (or intestinal) infections that require
specific antimicrobial therapy. The per-
sistent diarrhea of such children will not
improve until these infections are diag-
nosed and treated.
Management of Giardiasis
Giardiasis, an intestinal infestation due to
a protozoan parasite, can also cause non-
bloody foul-smelling diarrhea that can be
*Recommend that the mother temporarily reduce the amount of animal milk to 50 mL/kg/day, if animal milk is already part of the
child’s usual diet, and to continue breast-feeding. If the child is older than 6 months, appropriate complementary food should be given in
small, frequent amounts, at least 6 times a day.
10. 10 SECTION 1 / DIARRHEAL ILLNESSES
associated with chronic malabsorption. The
infection may be asymptomatic or may
cause abdominal cramps, epigastric pain, and
flatulence. Fever is uncommon. Transmission
occurs by fecal-oral route, through contami-
nated water (particularly surface water),
from person to person, or fomites. Even a
small inoculum can result in infection.
Consider treatment with metronidazole
(15 mg/kg/day for 5 days) for children pre-
senting with chronic, malabsorptive, non-
bloody diarrhea without fever, as well as for
patients in whom a microscopic stool exam
identifies cysts or trophozoites.
Epidemic Cholera
Cholera is a disease caused by the toxin
produced by Vibrio cholerae. It is an
endemic infection in many parts of the
world, including tropical and subtropical
areas. Transmission of cholera in disaster
situations most frequently involves con-
taminated water and increased fecal-oral
spread related to environmental condi-
tions. Vibrio cholerae can survive in water
for 7 to 10 days. Contaminated food may
also result in outbreaks.
It is important to identify outbreaks as
early as possible and take preventive
measures. Cholera is a public health
emergency. The first suspected case of
cholera in an area needs to be confirmed
by culture, and public health authorities
should be notified immediately.
Confirm the diagnosis with a qualified
laboratory and determine antibiotic sus-
ceptibility. Once cholera is confirmed in an
area, identification of subsequent cases can
be based on clinical findings. Since
diarrheal
illnesses with significant dehydration are
common among children, the first recogni-
tion of cholera in an area is usually based
on the identification of an adult case.
Suspect cholera in any adult presenting with
severe profuse watery diarrhea and severe
dehydration, particularly if the patient dies
because of the illness.
Take measures to control the
outbreak.
Take action to identify milder cases
in
people who might not seek care.
Community efforts should involve
improving sanitation, educating families
about personal hygiene and food safety,
and ensuring a noncontaminated water
supply. Occasionally household chlorina-
tion or boiling of water will be necessary.
Clinical manifestations of cholera
include painless diarrhea without fever.
The volume of stools can vary consider-
ably. In severe cholera, stools have the
appearance of rice water. The severe fluid
loss can cause shock within the first 4 to
12 hours in untreated patients. Additional
findings include anxiety, muscle cramps,
weakness (related to electrolyte alter-
ations and hypoglycemia), and altered
mental status (Table 3).
Management of Cholera
Treatment of patients with oral rehydration
solution (ORS) by itself reduces the case
fatality rate (CFR) to less than 1%. However,
Transmission of
cholera in disaster
situations most
frequently involves
contaminated water
and increased fecal-oral
spread related
to environmental
conditions.
11. TABLE 3. Typical electrolyte composition of a cholera stool
Na+
K+
Cl-
HCO3-
Adult
Child
135
105
15
25
100
90
45
30
From: Mandell, Douglas, Bennett. Principles and Practice of Infectious Disease. 3rd ed. New York, NY: Churchill Livingstone; 1990.
*Children 6 years
TABLE 4. Pediatric antibiotic doses for cholera
Doxycycline
Tetracycline
TMP/SMX
6 mg/kg/dose (1dose)
50 mg/kg every 6 hours for 3 days*
5 mg/kg (TMP) every 12 hours for 3 days
antibiotic therapy with doxycycline, tetracy-
cline, TMP/SMX, erythromycin, chloram-
phenicol, or fluoroquinolones can reduce
the volume and duration of diarrhea, thus
helping to limit transmission (Table 4).
Fluoroquinolones are indicated when there
is multidrug resistance. Manage mental
sta
tus alterations with glucose to
correct
possible hypoglycemia. Once cholera is
confirmed in an area, monitor CFR to
determine the adequacy/availability of
rehydration therapy.
11
SECTION 1 / DIARRHEAL ILLNESSES
Treatment of patients
with ORS alone
reduces the case
fatality rate (CFR) to
less than 1%.
12. DIARRHEA IN INFANTS
0 TO 2 MONTHS OF AGE
OBJECTIVES
l Identify the different types of
diarrhea.
l Define treatment for infants 0 to 2
months of age with diarrhea.
SECTION II /
DIARRHEA IN INFANTS
In this age group, diarrheal disease has
some particular issues. The water
content
in the stools is higher than normal.
Frequent evacuation of normal stools is
not diarrhea, and the number of evacua-
tions usually depends on diet and age. In a
breastfed infant from 5 to 10 days of age
loose stools are normal. If the neonate is
in very good general status, with no signs
of illness and feeds appropriately, the
diag
nosis will most probably be transition
stools; these do not require treatment.
After that period, breastfed infants’ stools
continue to be loose, but usually without
mucus or blood. The mother of an infant
will normally recognize diarrhea because
either the consistency of the stools or the
frequency of evacuations will differ from
normal.
Nevertheless, consider diarrhea in an
infant younger than 2 months to be a
severe infection and treat it accordingly.
Persistent diarrhea
Consider infants from 0 to 2 months of age
with persistent (7 days or more) diarrhea
severely ill and refer them to a hospital
whenever possible. These patients require
special care to prevent fluid loss. It might
also be necessary to make dietary changes
and to perform laboratory tests to identify
the cause of diarrhea (Table 5).
TABLE 5. Classification of persistent diarrhea in infants less than 2 months
Signs Classify as Treat
(PINK)
Diarrhea for 7 days
or more
(PINK)
Persistent diarrhea
(PINK)
• Urgent referral to a hospital with mother
offering frequent sips of ORS
• Counsel the mother to continue
breast-feeding
13. Bloody Diarrhea
Most frequent causes of bloody diarrhea
in the neonate include hemorrhagic dis-
ease (due to vitamin K deficiency), allergic
colitis, necrotizing enterocolitis, or other
coagulation disorders, such as disseminat-
ed intravascular coagulation due to sepsis.
In infants older than 15 days of age, blood
in the stools may result from anal fissures,
cow’s milk allergy, or surgical disorders,
such as intussusception. Bacterial dysen-
tery is not common in this age group, but
when it is suspected, consider Shigella and
administer appropriate therapy. Amoebic
dysentery is unusual in very young infants.
Consider bloody diarrhea in this age
group as severe illness requiring urgent
referral to a hospital (Table 6).
Identification of a causal agent is possi
ble in only a small proportion of infants
under 2 months old with diarrhea.
Infection may occur at birth with organ-
isms present in the mother’s feces, or
afterwards by a great variety of
organisms
from other infected children or the moth-
er’s hands. Infecting agents causing diar-
rheal diseases in infants younger than 2
months old usually include Escherichia coli,
Salmonella, echovirus, and rotavirus.
The disease may start abruptly, associ-
ated with poor feeding and/or vomiting.
Stools may initially be yellow and loose,
then greenish and highly watery, and the
number of evacuations may increase. The
most ominous feature of the disease is
acute fluid loss, resulting in dehydration
and electrolytic disorders. Hand washing,
exclusive breastfeeding, and early ade-
quate treatment can prevent dehydration
and potential death.
TABLE 6. Classification of bloody diarrhea in infants less than 2 months
Assess signs Classify as Treat
(PINK)
Blood in stools
(PINK)
Bloody diarrhea
(PINK)
l Urgent referral to a hospital
l Counsel the mother to continue
breast-feeding if tolerated by the
infant
l Give a dose of intramuscular
vitamin K
l Give the first dose of the
recommended antibiotics
Most frequent causes
of bloody diarrhea in
the neonate include
hemorrhagic disease
(due to vitamin K
deficiency), allergic
colitis, necrotizing
enterocolitis, or other
coagulation disorders,
such as disseminated
intravascular
coagulation due to
sepsis.
13
SECTION I1 / DIARRHEA IN INFANTS
14. DEHYDRATION
OBJECTIVES
l Describe and identify the different types
of dehydration.
l Assess the degree of dehydration.
l Describe the physiologic basis of oral
rehydration therapy (ORT).
l Explain the characteristics and routes of
administration of ORT solutions.
l List the advantages of ORT.
l Define when ORT has failed and when
ORT is contraindicated.
l Describe how to give ORT to children
with severe dehydration.
l Outline a strategy for setting up an ORT
unit at the site of a disaster.
SECTION III /
DEHYDRATION
CASE. (cont.)
The child presents again 24 hours later. He has continued to have loose stools that
have now turned watery. He has also continued to vomit all fluids he has been offe-
red. The mother says he is drowsy and much weakened. There has been no urine
output for more than 8 hours. Physical examination shows marked sunken eyes,
reduced skin turgor (4 seconds), capillary refill 5 seconds, and pale and cold skin.
4 What is the appropriate course of action at this moment?
morbidity and mortality associated with
dehydration caused by diarrheal illness
regardless of the etiology.
Dehydration Types
Dehydration is usually classified into 3
types based on the amount of sodium in
the blood: isotonic, hypotonic (hypona
tremia), and hypertonic (hypernatremia).
In clinical practice, the first 2 can be
grouped into a single isohypotonic categ
ory since they share similar
physiologic
characteristics, clinical presentations, and
treatments. In this case, net water and
electrolyte loss is either hypertonic
(resulting in hypotonic dehydration) or
isotonic (resulting in isotonic dehydration)
compared to normal plasma osmolarity. As
a result of these losses, extracellular fluid
volume (EFV) is significantly reduced, with
no or little decrease in intracellular fluid
volume (IFV). Reduced EFV is responsible
for most of the clinical signs of dehydra-
tion, which are therefore very evident.
Hypertonic dehydration occurs when
net fluid losses are hypotonic in compari-
Dehydration resulting
from acute diarrheal
illness is one of the
most significant causes
of morbidity and
mortality in
populations displaced
by disaster.
Dehydration resulting from acute diarrheal
illness is one of the most significant causes
of morbidity and mortality in populations
displaced by disaster. In some cases, it
accounts for more than 50% of the deaths
during the initial stages of a humanitarian
emergency. The use of oral rehydration
therapy (ORT) has markedly reduced the
15. 15
SECTION I1I / DEHYDRATION
son to normal plasma osmolarity. In this
case, the osmolar balance between the
intracellular and extracellular compart-
ment leads to the shift of water from the
intracellular to the extracellular space.
Because EFV is thus compensated and
less affected, clinical signs of dehydration
are less obvious. The loss of intracellular
fluid results in intracellular dehydration
evidenced by specific clinical features.
Dehydration Degrees
The most accurate way to assess the degree
of dehydration is by calculating the percent-
age of weight loss. However, a child’s weight
prior to the episode is rarely known, and it
is usually necessary to rely on clinical signs.
Table 7 describes the clinical signs accord-
ing to different degrees of dehydration.
According to IMCI guidelines the signs
suggesting severe dehydration include the
following 4 signs: lethargy or unconscious,
sunken eyes, skin pinch that goes back very
slowly, and not able to drink or drinking
poorly. A child with at least 2 of these signs
is classified as severe (pink). The 4 signs that
indicate some dehydration (yellow) include
restless or irritable, sunken eyes, thirsty and
drinks eagerly, sunken eyes, and the skin
pinch goes back slowly (not very slowly).
Again the child must have at least 2 of these
signs. Children 2 months to 5 years that do
not have at least 2 signs are considered
green and do not have some or severe
dehydration.
Even if an accurate assessment of the
degree of dehydration might not be possi
ble, a diagnosis of mild (fluid loss 5% of
body weight) or severe (fluid loss 10% and
usually accompanied by significant hemo-
dynamic disturbance) dehydration can be
made through the clinical signs that become
visible in each condition.
Remember that decreased skin turgor
(skin pinch) may be misleading, since it can
be present in malnourished children without
dehydration. The Integrated Management of
Childhood Illness (IMCI) strategy classifies
dehydration and determines its treatment
according to clinical findings (Table 7).
Hypertonic Dehydration
Hypertonic dehydration usually presents
with specific features associated with the
underlying physiologic process that causes
it. Risk factors include previous exposure
to very hot weather or to heated rooms
while wearing too much clothing,
resulting
in significant sweating with low sodium
loss; fever; or the administration of fluids
containing too much salt. Typical clinical
signs (sunken eyes, decreased skin
turgor,
hypotension) are less evident than in iso-
tonic or hypotonic dehydration of the
same severity. The tendency to develop
shock is delayed because the
intravascular
volume is relatively protected by the water
shift from the intracellular space. The
patient is usually very irritable, even with
very severe degrees of dehydration, and
drinks avidly. Seizures and intracranial hem
orrhage may occur. For treatment, if ORT
has failed or is contraindicated, intravenous
(IV) rehydration therapy should correct
the electrolytic disorder within 36 to 48
hours. This situation is different in hypo-
tonic dehydration, where IV correction can
be attained within a few hours using poly-
electrolytic solutions.
Severe dehydration
(fluid loss 10% of body
weight) is usually
accompanied with
significant
hemodynamic
disturbance.
The IMCI strategy
classifies dehydration
and determines its
treatment according to
clinical findings.
16. 16 SECTION I1I / DEHYDRATION
TABLE 7. Classification of dehydration
Assess clinical signs Classify as Treat
(PINK)
Two of the following signs:
l Lethargy/unconsciousness
l Sunken eyes
l Drinks poorly or unable to
drink
l Skin turgor: skin pinch goes
back very slowly to normal
(PINK)
Severe dehydration
(PINK)
l If the child does not have another
severe classification: give fluid for
severe dehydration (See Plan C on
page 23)
l If the child has another severe
classification: urgently refer to a
hospital with the mother giving
frequent sips of ORS during the
trip. Advise the mother to continue
breast-feeding if the child’s state of
consciousness allows it
l If any case of cholera has been
detected in the area, administer an
antibiotic for this disease
(YELLOW)
Two of the following signs:
l Restless, irritable
l Sunken eyes
l Drinks avidly, shows thirst
l Skin turgor: skin pinch goes
back slowly to normal
(YELLOW)
Some dehydration
(YELLOW)
l If there is some degree of
dehydration, administer fluids and
food (See Plan B on page 22)
l If the child has another severe
clasification: urgently refer to a
hospital with the mother giving
frequent sips of ORS during the
trip. Advise the mother to
continue breast-feeding if the
child’s state of consciousness
allows it
l Tell the mother which signs require
immediate medical attention
l If diarrhea persists: schedule a
follow-up visit in 24-48 hours
(GREEN)
Not enough signs to classify as
dehydration
(GREEN)
No dehydration
(GREEN)
l Give food and fluids adequate to
treat diarrhea at home (See Plan A
on page 21)
l Tell the mother which signs require
immediate medical attention
l If diarrhea persists: schedule a
follow-up visit in 5 days
17. 17
SECTION I1I / DEHYDRATION
Management of
Dehydration
Oral Rehydration Therapy
The efficacy and safety of ORT have been
proven worldwide. In 1964, the identifica-
tion of the sodium-glucose cotransport
sys
tem in the intestinal mucosa led to the
development of different solutions for the
oral treatment of dehydration. During the
1971 cholera outbreak in Bangladesh, mor-
tality rates from diarrheal illness dropped
from 25% to 3% when ORT was introduced
instead of IV therapy. In the overwhelming
majority of patients with diarrheal illness in
a disaster, ORT is effective in preventing and
treating the associated dehydration.
Physiological Basis of ORT
In normal physiologic status, water is
absorbed osmotically across the small
bowel through tight junctions between
epithelial cells due to a sodium gradient that
is maintained by 2 mechanisms of sodium
absorption in the brush border membrane
of the luminal cell: passive sodium/potassi
um diffusion and active cotransport of sodi-
um jointly with monosaccharides such as
glucose. The resulting intracellular sodium is
then actively transported via ATPase carrier
enzymes into the intercellular space, result-
ing in an osmotic gradient between the
intercellular and luminal spaces, allowing for
free diffusion of water (Figure 1).
In diarrheal illness, the passive absorp-
tive mechanism of sodium and chloride is
impaired, but glucose absorption remains
largely intact. This allows the absorption of
enough water and sodium to compensate
for fluid losses as significant as those seen
in cholera. The osmotic gradient in the
intercellular space maintains the absorp-
tion of potassium and bicarbonate. In this
way, the metabolic acidosis usually associ-
ated with dehydration can be corrected
without the risk of overcorrection.
Advantages of Oral Rehydration
Therapy
Oral rehydration therapy has multiple
advantages over parenteral rehydration
(Box 1). Since ORT uses the normal
physiologic mechanisms of intestinal
absorption there is no risk of complica-
tions, such as water overload or overcor-
rection of electrolyte and acid-base distur-
bances associated with dehydration. Thus,
ORT can be used in any dehydrated child,
regardless of the type of dehydration.
Moreover, laboratory tests are not usually
necessary for the patient’s evaluation.
Normal hydration in children
receiving
ORT is usually achieved in 4 to 6 hours,
allowing early refeeding, resulting in
decreased risk of malnutrition associated
with diarrheal disease.
Costs of ORT are minimal compared
with those of IV therapy. Moreover, its
major ingredients (salt, water, and sugar
or starchy foods like rice) are often pres-
ent in the community when premixed
oral rehydration solutions (ORS) are not
readily available. ORT is simple and can
be given by trained health assistants. In
addition, it requires the participation of
the mother, thus encouraging family
involvement in the child’s health. Because
its requirements are minimal, ORT can
be used at the site of the disaster, reduc-
In the overwhelming
majority of patients
with diarrheal illness
in a disaster, ORT is
effective in preventing
and treating the
associated
dehydration.
18. 18 SECTION I1I / DEHYDRATION
ing the demands on medical hospital-
based personnel and allowing patients to
be in close contact with their families
(Box 2). Lastly, complications associ-
ated with invasive procedures, such as IV
therapy, particularly infections, are total-
ly avoided.
Composition of ORS
The most widely used formulation for
oral rehydration is the one designed by
the World Health Organization (WHO).
The most important feature of this
solution is the inclusion of equimolar
quantities of sodium and glucose, which
enhances the intestinal absorption of
both molecules. The solution also con-
tains a source of bases (bicarbonate or
citrate) and potassium (Box 3).
Despite initial concerns for hyperna
tremia associated to the use of the WHO
solution, particularly in hypertonic dehy-
dration, the ORS has been proven to be
efficacious and safe, regardless the
patient’s serum sodium.
The WHO ORS does not reduce the
duration or intensity of diarrhea. For this
reason, research has focused on alterna-
passive active
H2
O
H2
O
H2
O Na+
Na+
Na+
Na+
CI-
CI-
glucose
glucose
Tight
junctions
Active via
ATPPase carrier
enzymes
FIGURE 1. Mechanisms of water absorption in the intestinal mucosa
19. 19
SECTION I1I / DEHYDRATION
tive formulations with different compo-
nents, such as the use of amino acids as
cotransporting molecules; solutions
derived from cooked cereals, usually rice-
based; and glucose-based ORS with lower
osmolarity. Amino acid-based formulations
have not been proven significantly benefi-
cial. Rice-based formulations have demon-
strated improved efficacy in patients with
cholera. They may be used in situations
where rice is readily available.
A number of studies have demonstrat-
ed that lowering the concentrations of
glucose and sodium to a total
osmolarity
of 245 mOsm/L can decrease stool
output
and vomiting in children with acute non-
cholera diarrhea, without significantly
compromising efficacy in cholera patients.
Based on these findings, the WHO has
recently recommended the use of hypoos-
molar solution, particularly for children
with acute, non-cholera diarrhea.
In situations where prepackaged ORS is
not available, rehydration can be per-
formed with different extemporaneous
solutions. The simplest requires rice,
water, and salt. One hundred grams of
rice is cooked in 1 liter of boiling water
for 10 minutes or until the rice pops. The
water is then drained from the rice into a
container, and any remaining water is
squeezed from the rice with a spoon.
When all the water is squeezed from the
rice, enough water is added to the solu-
tion to bring the total volume to 1 liter
and 1 pinch of salt is added.
Use only drinking water to prepare
rehydration solutions. Any other
beverage
(such as mineral water or carbonated
beverages) will modify the concentrations
of the various components and conse-
quently reduce its efficacy. Ideally, once
prepared, keep solutions refrigerated.
Discard any unused solution 24 hours
after preparation.
Contraindications for ORT
Contraindications for ORT are listed in
(Box 4). The presence of other severe
disease, such as sepsis or meningitis, also
Oral rehydration
therapy involves no
risk of complications,
such as water overload
or overcorrection of
the electrolyte and
acid-base disturbances
associated with
diarrheal dehydration.
BOX 1. Advantages of ORT BOX 2. Requirements for ORT
l Use of normal physiologic
mechanisms
l Early re-feeding
l 90-95% effective
l Effective for all types of
dehydration
l No need for laboratory tests
l Low economic and social cost
l Availability
l No infectious, metabolic, or
electrolytic complications
l Oral rehydration salt packets
l Drinking water
l Refrigerator
l Watch
l Pencil and paper
l Scale
l Containers (feeding bottles,
glasses, pitchers)
l Nasogastric tube
l Trained staff
WHO has recently
recommended the use
of hypoosmolar
solution, particularly
for children with
acute, non-cholera
diarrhea.
20. 20 SECTION I1I / DEHYDRATION
BOX 3. Composition of WHO oral rehydration solution
The reduced osmolarity ORS containing 75 mEq/l sodium, 75 mmol/l glucose (total osmolarity of 245 mOsm/l) is as effective as standard ORS in adults
with cholera. However, it is associated with an increased incidence of transient, asymptomatic hyponatraemia. This reduced osmolarity ORS may be used in
place of standard ORS for treating adults with cholera, but careful monitoring is advised to better assess the risk, if any, of symptomatic hyponatraemia.
Because of the improved effectiveness of reduced osmolarity ORS solution, especially for children with acute, non-cholera diarrhoea, WHO and UNICEF
now recommend that countries use and manufacture this formulation in place of the previously recommended ORS solution with a total osmolarity of
311 mOsm/l.
BOX 4. Contraindications for
ORT
l Shock
l Patient younger than 1 month
of age
l Ileus
l Significantly altered sensorium
l Severe difficulty breathing
l Painful abdominal distension
include 3 plans. Administer Plan A (page
21) to children with diarrhea but without
dehydration or to those who have been
successfully rehydrated. Plan B (page 22)
is for children with mild-moderate dehy-
dration, and Plan C (page 23) is for severe
dehydration.
contraindicates the use of ORT, but vom-
iting before or during ORT is not a con-
traindication. Only untreatable vomiting
will require parenteral therapy.
The presence of severe hemodynamic
disturbances prompts immediate IV fluid
replacement. However, if no supplies are
available, perform ORT until IV treatment
is possible.
Before starting ORT, auscultate the
abdomen to check for the presence of
bowel sounds and rule out a diarrhea-
related ileus (severe hypokalemia, anti-
spasmodic-drug toxicity).
Dehydration Management
with the IMCI Guidelines
The IMCI guidelines for the management
of dehydration in children with diarrhea
Reduced osmolarity
ORS
grams/litre Reduced osmolarity
ORS
mmol/litre
Sodium chloride 2.6 Sodium 75
Glucose, anhydrous 13.5 Chloride 65
Potassium chloride 1.5 Glucose, anhydrous 75
Trisodium citrate Potassium 20
Dihydrate 2.9 Citrate 10
Total Osmolarity 245
21. 21
SECTION I1I / DEHYDRATION
PLAN A: TREAT DIARRHOEA AT HOME
1. GIVE EXTRA FLUID (as much as the child will take)
■ TELLTHE MOTHER:
l Breastfeed frequently and for longer at each feed.
l If the child is exclusively breastfed, give ORS or clean water in addition to breast milk.
l If the child is not exclusively breastfed, give one or more of the following: ORS solution, food-
based fluids (such as soup, rice water, and yoghurt drinks), or clean water.
■ It is especially important to give ORS at home when:
l the child has been treated with Plan B or Plan C during this visit.
l the child cannot return to a clinic if the diarrhoea gets worse.
■ TEACHTHE MOTHER HOWTO MIX AND GIVE ORS. GIVETHE MOTHER 2
PACKETS OF ORSTO USE AT HOME.
■ SHOWTHE MOTHER HOW MUCH FLUIDTO GIVE IN ADDITIONTOTHE
USUAL FLUID INTAKE:
Up to 2 years 50 to 100 ml after each loose stool
2 years or more 100 to 200 ml after each loose stool
Tell the mother to:
l Give frequent small sips from a cup.
l If the child vomits, wait 10 minutes.Then continue, but more slowly.
l Continue giving extra fluid until the diarrhoea stops.
2. GIVE ZINC (age 2 months up to 5 years)
■ TELLTHE MOTHER HOW MUCH ZINCTO GIVE (20 mg tab):
2 months up to 6 months 1/2 tablet daily for 14 days
6 months or more 1 tablet daily for 14 days
■ SHOWTHE MOTHER HOWTO GIVE ZINC SUPPLEMENTS
l
Infants — dissolve tablet in a small amount of expressed breast milk, ORS or clean water in a cup.
l Older children — tablets can be chewed or dissolved in a small amount of water.
3. CONTINUE FEEDING (exclusive breastfeeding if age less than 6 months)
4. WHENTO RETURN
Counsel the mother on the 4 Rules of HomeTreatment:
1. Give Extra Fluid
2. Give Zinc Supplements (age 2 months up to 5 years)
3. Continue Feeding
4. When to Return.
22. 22 SECTION I1I / DEHYDRATION
PLAN B: TREAT SOME DEHYDRATION WITH ORS
In the clinic, give recommended amount of ORS over 4-hour period
■ DETERMINE AMOUNT OF ORSTO GIVE DURING FIRST 4 HOURS
WEIGHT 6 kg 6 – 10 kg 10 – 12 kg 12 –19 kg
AGE* Up to 4 months 4 months up to
12 months
12 months up
to 2 years
2 years up to
5 years
In ml 200 – 450 450 – 800 800 –960 960 –1600
*
Use the child’s age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be
calculated by multiplying the child’s weight (in kg) times 75.
l
If the child wants more ORS than shown, give more.
l
For infants under 6 months who are not breastfed, also give 100 –200 ml clean water during this
period if you use standard ORS.This is not needed if you use new low osmolarity ORS.
■ SHOWTHE MOTHER HOWTO GIVE ORS SOLUTION.
l
Give frequent small sips from a cup.
l
If the child vomits, wait 10 minutes.Then continue, but more slowly.
l
Continue breastfeeding whenever the child wants.
■ AFTER 4 HOURS:
l
Reassess the child and classify the child for dehydration.
l
Select the appropriate plan to continue treatment.
l
Begin feeding the child in clinic.
■ IFTHE MOTHER MUST LEAVE BEFORE COMPLETINGTREATMENT:
l
Show her how to prepare ORS solution at home.
l
Show her how much ORS to give to finish 4-hour treatment at home.
l
Give her enough ORS packets to complete rehydration.Also give her 2 packets as recommended in
Plan A.
l
Explain the 4 Rules of Home Treatment:
1. GIVE EXTRA FLUID
2. GIVE ZINC (age 2 months up to 5 years)
3. CONTINUE FEEDING (exclusive breastfeeding if age less than 6 months)
4. WHEN TO RETURN
23. 23
SECTION I1I / DEHYDRATION
PLAN C: TREAT SEVERE DEHYDRATION QUICKLY
FOLLOW THE ARROWS. IF ANSWER IS “YES”, GO ACROSS. IF “NO”, GO DOWN.
START HERE
YES
NO
$
YES
NO
$
YES
NO
$
YES
NO
$
■ Start IV fluid immediately. If the child can drink, give ORS by
mouth while the drip is set up. Give 100 ml/kg Ringer’s Lactate
Solution (or, if not available, normal saline), divided as follows
AGE
First give
30 ml/kg in:
Then give
70 ml/kg in:
Infants (under 12 months) 1 hour* 5 hours
Children (12 months up to
5 years)
30 minutes* 2 1/2 hours
*
Repeat once if radial pulse is still very weak or not detectable.
■ Reassess the child every 1–2 hours. If hydration status is not
improving, give the IV drip more rapidly.
■ Also give ORS (about 5 ml/kg/hour) as soon as the child can
drink: usually after 3– 4 hours (infants) or 1–2 hours (children).
■ Reassess an infant after 6 hours and a child after 3 hours. Classify
dehydration.Then choose the appropriate plan (A, B, or C) to
continue treatment.
■ Refer URGENTLY to hospital for IV
treatment.
■ If the child can drink, provide the mother with ORS solution and
show her how to give frequent sips during the trip or give ORS
by naso-gastric tube.
■ Start rehydration by tube (or mouth) with ORS solution:
give 20 ml/kg/hour for 6 hours (total of 120 ml/kg).
■ Reassess the child every 1–2 hours while waiting for
transfer:
l
If there is repeated vomiting or increasing abdominal disten-
sion, give the fluid more slowly.
l
If hydration status is not improving after 3 hours, send the
child for IV therapy.
■ After 6 hours, reassess the child. Classify dehydration.Then
choose the appropriate plan (A, B or C) to continue treatment.
NOTE:
■ If the child is not referred to hospital, observe the child at least
6 hours after rehydration to be sure the mother can maintain
hydration giving the child ORS solution by mouth.
Can you give
intravenous (IV) fluid
immediately?
Is IV treatment
available nearby
(within 30
minutes)?
Are you trained
to use a naso-
gastric
(NG) tube for
rehydration?
Can the child
drink?
Refer URGENTLY
to hospital for IV or
NG treatment
24. 24 SECTION I1I / DEHYDRATION
Organization of ORT units in
disaster settings
Because morbidity and mortality asso-
ciated with diarrhea can be significantly
reduced by early hydration, set up ORT
units at the onset of almost every dis
aster relief situation. Very few supplies
are needed, and it is easy to train aux-
iliary personnel in the IMCI approach
to ORT.
The supplies needed to set up an
ORT unit include a sufficient number of
ORS packets, if possible, an adequate
amount of drinking water, and the rest
of the items previously mentioned.
The staff in charge of the unit must
keep records of the patients treated
and should be trained to identify cases
of severe dehydration and suspected
cases of cholera. Such records are
essential for surveillance purposes, and
the information obtained will prove
useful in improving public health inter-
ventions in disaster situations.
25. 25
SUMMARY / SUGGESTED READING
SUMMARY
Diarrheal disease and dehydration—its most common complication—are the main
causes of morbidity and mortality in populations exposed to a disaster. There are
different types of diarrhea caused by different pathogens. The causative agent can
be suspected from the clinical manifestations, which help in selecting the initial
treatment.
ORT and continued feeding (especially breastfeeding) have notably reduced
the morbidity and mortality classically associated with diarrhea and dehydra-
tion. The substantial advantages of ORT over IV therapy make it the ideal tool
in humanitarian emergencies involving large displaced populations.
The IMCI strategy is a fundamental tool of primary care in emergency set-
tings because it makes use of available resources to provide safe and effective
treatment.
SUGGESTED READING
Atención integrada a las enfermedades prevalentes de la
infancia en Argentina. OPS Washington DC, 2005
Black RE. Persistent diarrhea in children in developing
countries. Pediatr Infect Dis J 1993:12:751-761.
Fontaine O. Acute Diarrhea Pediatric Decision Making. 4th
edi
tion. Philadelphia; Mosby, 2003.
The management of bloody diarrhea in young children.
Document WHO/CDD/94.9 Geneva, OMS, 1994.
Dell RB. Pathophysiology of dehydration. In: Winters RW (ed).
The body fluids in pediatrics. Boston, Little Brown, 1973.
Sordo ME, Roccatagliata GM, Dastugue MG, Murno JR.
Hidratación oral ambulatoria. In: Pediatría ambulatoria.
Buenos Aires; Puma, 1987.
26. 26 ANNEX
Does the child have diarrhea?
IF YES, ASK:
l For how long?
l Is there blood in the
stool?
LOOK AND FEEL:
l Look at the child´s
general condition. Is the
child
Lethargic or uncon-
scious?
Restless and irritable?
l Look for sunken eyes
l Offer the child fluid. Is
the child
Not able to drink or
drinking poorly?
Drinking eagerly, thirsty?
l Pinch the skin of the
abdomen.
Does it go back
Very slowly (longer than
2 seconds)?
Slowly?
for DEHYDRATION
and if diarrhea
14 days or more
and if blood
in stool
Classify
DIARRHOEA
27. 27
ANNEX
Two of the following signs:
l Lethargic or unconscious
l Sunken eyes
l Not able to drink or drinking poorly
l Skin pinch goes back very slowly
Two of the following signs
l Restless, irritable
l Sunken eyes
l Drinks eagerly, thirsty
l Skin pinch goes back slowly
Not enough signs to classify as severe
or some dehydration
l Dehydration present
l No dehydration
l Blood in the stool
SEVERE
DEHYDRATION
SOME
DEHYDRATION
NO DEHYDRATION
SEVERE
PERSISTENT
DIARRHOEA
PERSISTENT
DIARRHOEA
BLOOD
IN STOOL
l If child has no other severe classification
– Give fluid for severe dehydration (Plan C)
O
If child also has another severe classification:
– Refer URGENTLY to hospital with mother giving frequent
sips of ORS on the way
Advise the mother to continue breastfeeding
l If child is 2 years or older and there is cholera in your area,
give antibiotics for cholera.
l Give fluid, zinc supplements and food for some dehydration
(Plan B).
l If child also has a severe classification:
– Refer URGENTLY to hospital with mother giving
frequent sips of ORS on the way
Advise the mother to continue breastfeeding
l Advise mother when to return immediately.
l Give fluid, zinc supplements and food to treat diarrhea at home
(Plan A).
l Advise mother when to return immediately.
l Treat dehydration before referral unless the child has another
severe classification
l Refer to hospital
l Advise the mother on feeding a child who has PERSISTENT
DIARRHOEA
l Give multivitamin and minerals (including zinc) for 14 days
l Follow-up in 5 days
l Treat for 3 or 5 days with an oral antimicrobial recommended
for Shigella in your area. Treat dehydration and give zinc
l Follow-up in 2 days
28. 28 CASE RESOLUTION
Case resolution
1-3. Based on the frequency of the evacuations and the characteristics of the stools,
the infant has acute diarrhea. There is no blood in the stools, so the most probable
causative agent is rotavirus or E. coli. In both cases the disease is usually self-limited and
does not require antibiotic therapy. Since the child is not dehydrated, advise the mother
to give him ORS after every evacuation of loose stools, to provide more fluids than
usually, and to continue breastfeeding and giving the child the other foods he usual eats.
Determine if other household contacts are similarly affected, which might indicate an
outbreak. If adults are experiencing significant watery diarrhea with dehydration, sus-
pect V. cholerae infection.
Continued breastfeeding is an important way to reduce potential recurrences.
Intensify hygiene measures, and provide adequate water supply and stool disposal.
4. Upon his return, the child presents with more than 2 signs in the IMCI classifica
tion for severe dehydration. There are no other signs of severe disease, but there are
findings consistent with hemodynamic disorder (shock). Begin immediate
treatment
for severe dehydration (Plan C in the IMCI guidelines). Once rehydration has been
achieved, the child should be switched to a maintenance plan (Plan A) and reassessed
in 24 hours. Because there is no history of cholera in the population, antibiotic
therapy is not needed.
29. 29
MODULE REVIEW
MODULE REVIEW
SECTION I - DIARRHEAL ILLNESSES
1. What clinical features characterize the different types of diarrhea, and what
are the most frequent etiological agents for each type?
2. What are the fundamental components of the treatment of diarrhea?
3. Why is nutrition important in the treatment of diarrhea?
4. What steps do the IMCI guidelines recommend for treating diarrhea
without blood in the stools and for dysentery?
5. What treatment is indicated for the various agents responsible for bloody
diarrhea?
6. What are the causes of persistent diarrhea and what is the treatment?
7. What are the characteristics of epidemic cholera, and what is the
appropriate approach to managing an outbreak in an emergency setting?
SECTION II - DIARRHEA IN THE INFANT 0 TO 2 MONTHS
OF AGE
1. How should diarrhea be treated in the infant 0 to 2 months?
2. What is the approach to managing persistent diarrhea in this age group?
3. What is the treatment for bloody diarrhea in this age group?
SECTION III - DEHYDRATION
1. What physiological and clinical features differentiate isotonic and hypotonic
dehydration from hypertonic dehydration?
2. What is the physiological basis of oral rehydration therapy (ORT)?
3. How should ORT be administered, and what supplies are needed to
implement ORT?
4. What are the advantages and contraindications of ORT?
5. What variables do the IMCI guidelines use to classify dehydrated children
and to determine their treatment?
6. What is the appropriate approach to managing severe dehydration in
children?