DIARRHOEA IS LEADING CAUSE OF MORTALITY IN INDIA AS WELL AS GLOBALLY .THIS IS NICE PPT BASED ON WHO GUIDELINES,DIARRHOEA IS EASY TO TREAT BUT STILL IT IS IS 2ND MOST COMMON CAUSE OF CHILDHOOD MORTALITY AFTER PNEUMONIA
Recurrent diarrhea is associated with many a number of complications. Out of them dehydration,malnutrition ,failure to thrive, electrolyte imbalances, micro nutrient deficiencies (vitamins & minerals) and severe systemic infections. Here an extensive description is given about these and the relevant management facts are given then and there.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Recurrent diarrhea is associated with many a number of complications. Out of them dehydration,malnutrition ,failure to thrive, electrolyte imbalances, micro nutrient deficiencies (vitamins & minerals) and severe systemic infections. Here an extensive description is given about these and the relevant management facts are given then and there.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
Diarrhoea is passage of three or more loose stools or watery stools in a 24-hour period.
The main cause of death from acute diarrhoea is dehydration, which results from the loss of fluid and electrolytes in diarrhoeal stools.
NEONATAL JAUNDICE IS MOST COMMON CAUSE OF MORBIDITY IN 1ST WEEK OF LIFE IT IS ALSO MOST COMMON CAUSE OF READMISSION AFTER DISCHARGE .THIS BEAUTIFUL SLIDE FOR NNJ.
neonatal sepsis is commonest cause of death in neonatal period,but it is preventable by prevention,timely recognition appropriate antibiotics and supportive care.
PNEUMONIA IS MAJOR CAUSE OF MORTALITY IN UNDER 5 YR OF AGE, IN THIS PPT I TRIED TO COVER ALL IMPORTANT FACTOR ABOUT PNEUMONIA, FOLLOW WHO PLAN FOR MANAGEMENT GOD WILL DO REST FOR BETTERMENT OF YOUR PT.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. CHILD PRESENTING WITH DIARRHOEA
• ACUTE DIARRHOEA- >3 LOOSE STOOL/DAY,NO BLOOD IN STOOL(WHO)
• PASSAGE OF ONE LARGE STOOL WATERY IN YOUNG CHILDREN IS DIARRHOEA;;
FREQUENT PASSAGE OF NORMAL STOOL IS NO DIARRHOEA
• CHOLERA-PROFUSE WATERY DIARRHOEA WITH SEVERE DEHYDRATION DURING CHOLERA
OUTBREAK,POSITIVE STOOL CULTURE FOR VIBRIO CHOLERAE O1 OR O139
• DYSENTRY; BLOOD MIXED WITH THE STOOL
• PERSISTENT DIARRHOEA; DIARRHOEA LASTING ≥ 14 DAYS
3. EPIDIOMOLOGY
SECOND MOST COMMON CAUSE OF DEATH WORLDWIDE IN CHILDREN
1.73BILLION EPISODE ANNUALLY ,AROUND 0.71 MILLION DEATH ANNUALLY
(3-5 billion/annual ,approx. 2 million death/year……ghai)
IN INDIA IT IS ALSO 2ND MOST COMMON CAUSE OF MORTALITY < 5 YR OF AGE AFTER RESPIRATORY TRACT
INFECTION
4. ETIOLOGY
• INTESTINAL INFECTION ( BACTERIAL,VIRAL,PROTOZOAL)
• CERTAIN DRUGS,FOOD ALLERGY,SYSTEMIC INFECTION
(UTI,PNEUMONIA,MENINGITIS) CAN PRESENT AS ACUTE
DIARRHOEA
• ROTAVIRUS AND ENTEROTOXIGENIC E.COLI ACCOUT FOR NEARLY
HALF OF TOTAL DIARRHOEAL EPISODE
INFECTION ACQUIRED THROUGH FECOORAL ROUTE BY INGESTION
OF CONTAMINATED FOOD OR WATER
R/F POOR SANITATION AND PERSONAL HYGIENE,NON AVABILITY OF
SAFE WATER,UNSAFE FOOD PREPARATION,LOW RATE OF BREAST
FEEDING AND IMMUNISATION.
5. CAUSE OF ACUTE DIARRHOEA
• BACTERIAL;
• E.COLI
(ENTEROTOXIGENIC,ENTEROPATHOGENIC,ENTEROHAEMORRHAGIC,ENTEROINVASIVE)
• SHIGELLA :S.SONNEI,S .FLEXNERI,S.BOYDIi,S.DYSENTERIAE
• VIBRIO CHOLERAE; SEROTYPE O1 AND O139
• SALMONELLA; S .TYPHI,S. PARATYPHI
• OTHER; AEROMONAS SPP,BACILLUS CEREUS,CLOSTRIDIUM DIFFICALE,STAPHYLOCCOCUS
AUREUS
• VIRAL; ROTAVIRUS,
HUMAN CALCIVIRUS ;NOROVIRUS SPP,SAPOVIRUS SPP
ENTERIC ADENOVIRUS
OTHERS; ASTEROVIRUS,CORONA VIRUS,CMV
PARASITIC; GIARDIA LAMBIA,CRYPTOSPORODIUM PARVUM, ENTAMOEBA HISTOLYTICA,
CYCLOSPORA CAYETANESIS,ISOSPORA BELLI
6. GOAL OF ASSESSMENT
DETERMINE TYPE OF DIARRHOEA (ACUTE WATERY DIARRHOEA,DYSENTRY,OR PERSISTING DIARRHOEA)
LOOK FOR DEHYDRATION AND OTHER COMPLICATION
ASSESS FOR MALNUTRITION
R/O NON DIARRHOEAL ILLNESS ESPECIALLY SYSTEMIC INFECTION
ASSESS FEEDING BOTH, PREILLNESS AND DURING ILLNESS
7. CHILD PRESENTING WITH DIARRHOEA; HISTORY
FREQUENCY OF STOOL
NO OF DAYS
BLOOD IN STOOL
CHOLERA OUTBREAK IN AREA
RECENT ANTIBIOTIC OR OTHER DRUG T/T
ATTACKS OF CRYING WITH PALLOR IN AN INFANT
PRESENCE OF FEVER,COUGH OR OTHER SIGNIFICANT SYMPTOM (EG CONVULSION ,RECENT MEASLE)
TYPE AND AMOUT OF FOOD TAKEN DURING THE ILLNESS
DRUGS OR OTHER LOCAL REMEDIES TAKEN( INCLUDING OPIODS AND ANTIMOTALITY DRUGS
IMMUNISATION HISTORY
8. EXAMINATION ;LOOK FOR SIGN OF DEHYDRATION
• RESTLESSNESS OR IRRATIBILITY
• LETHARGY AND REDUCE LEVEL OF CONSIOUSNESS
• SUNKEN EYE
• SKIN PINCH RETURNS SLOWLY OR VERY SLOWLY
• THIRSTY/DRINK EAGERLY OR DRINKING POORLY OR NOT ABLE TO DRINK
• SIGN OF SEVERE MALNUTRITION( ANTHROPOMETRY FOR WEIGHT AND HEIGHT
,WASTING,OEDEMA,VITAMIN DEFICIENCY
• ABDOMINAL MASS/DISTENSION
• WT LOSS (<3%/3-9%/>9% NO/SOME /SEVERE DEHYDRATION)
• OTHERS; HEART RATE,QUALITY OF PULSE,TEAR,TONGUE AND MOUTH,CFT,EXTREMITIES,URINE OUTPUT
9.
10. LABORATORY INVESTIGATION
• CBC, S.ELECTROLYTE,RFT ( ASSOCIATED FINDING
PALLOR,ALTERED SENSORIUM,SZ,PARALYTIC ILEUS,OR
• OLIGURIA WHICH SUGGEST ACID BASE
BALANCE,RF,DYSELECTROLYTEMIA
• STOOL MICROSCOPY : IN SELECTED CASES EG
CHOLERA,GIARDIASIS (TROPHOZOITE)
• STOOL CULTURE: IT IS HELPFUL TO ANTIBIOTICS
THERAPY WITH SHIGELLA DYSENTRY WHO DON’T
RESPONDING TO EMPERIC ANTIBIOTICS
11. PRINCIPLES OF MANAGEMENT
• FOUR MAJOR COMPONENT
• 1.REHYDRATION AND MAINTAING HYDRATION
• 2. ENSURING ADEQUATE FEEDING
• 3. ORAL SUPPLIMENT OF ZINC
• 4. EARLY RECOGNIZE OF DANGER SIGN AND TREATMENT OF COMPLICATION
12. ASSESSING DEHYDRATION;CLASSIFICATION OF HYDRATION STATUS
CLASSIFICATION SIGN/SYMPTOM TREATMENT
SEVERE DEHYDRATION TWO OR MORE OF FOLLOWING PLAN C (GIVE IVFLUID)
1.LETHARGY OR UNCONSIOUSNESS
2. SUNKEN EYE
3.UNABLE TO DRINK OR DRINKS POORLY
4. SKIN PICH GOES BACK VERY SLOWLY > 2 SEC
SOME DEHYDRATION TWO OR MORE OF FOLLOWING PLAN B
GIVE FLUID AND FOOD FOR SOME
DEHYDRATION
1.RESTLESSNESS,IRRATIBILTY AFTER REHYDRATION ADVISE FOR
2. SUNKEN EYE TREATMENT
3.DRINK EAGERLY,THIRSTY TELL WHEN TO COME BACK IMME
4. SKIN PICH GOES BACK VERY SLOWLY DIATLY
F/U IN 5 DAY IF NOT IMPROVING
13. No dehydration NOT ENOUGH SIGN TO CLASSIFY AS SOME GIVE FLUID AND FOOD TO TREAT
OR SEVERE DEHYDRATION DIARRHOEA AT HOME
TREATMENT PLAN A
ADVISE MOTHER WHEN TO RETURN
IMMEDIATELY
F/U IN 5 DAYS IF NOT IMPROVING
14. SEVERE DEHYDRATION
• RAPID IV HYDRATION WITH CLOSE MONITORING, F/B ORAL REHYDRATION AND ZINC,IF CHOLERA
OUTBREAK GIVE ANTIBIOTICS AGAINST CHOLERA
• IVFLUID ; ISOTONIC SOLUTIONS ( RL OR NS)
• GIVE 100ML/KG FLUID
• AGE 30ML/KG 70ML/KG
• < 12 M 1 HR 5 HR
• >/12 M 30 MIN 2.5 HR
• Reasess child after 15-30 min if not improving give rapid fluid
15. • ORS SOLUTION SHOULD BE STARTED SIMULTANEOUSLY IF CHILD
AND TAKE ORALLY/ BREAST FEEDING MUST CONTINUE DURING
REHYDRATION PROCESS
• 1.PERSISTENCE OF SEVERE DEHYDRATION;IV INFUSION AS ABOVE
CAN BE REPEATED
• 2. HYDRATION IMPROVED BUT SOME DEHYDRATION PRESENT ;IV
DISCONTINUED,SHIFT TO PLAN B
• 3. THERE IS NO DEHYDRATION ; DISCONTINUE IV FLUID
TREATMENT AS PLAN A
16. SOME DEHYDRATION
• ALL CASES WITH OBVIOUS SIGN OF DEHYDRATION NEED TO BE TREATED IN A HEALTH CENTER OR
HOSPITAL
• FLUID REQUIREMENT IS CALCULATED IN FOLLOWING THREE HEADINGS
• 1. NORMAL DAILY FLUID REQUIREMENT
• 2. REHYDRATION TO CORRECT EXISTING WATER/ELECTROLYTE DEFICIT
• 3.REPLACE ONGOING LOSSES
17. MAINTENANCE VOLUME ;CALORIC CALCULATION
HOLLIDAY-SEGAR METHOD; MOST COMMON METHOD , OFTEN REFD TO “4-2-1 RULE”
• HOLLIDAY SEGAR FORMULA NOT SUITABLE FOR NEONATES < 14 DAY
BODY WT ML/KG/DAY ML/HR
FIRST 10 KG 100 4
SECOND 10 KG 50 2
EACH ADDITIONAL KG 20 1
EG 25 KG FOR FIRST 10KG 1000+500ML FOR NEXT 10 KG+100ML FR NEXT 5 KG MEANS TOTAL 1600ML/DAY
OR 40+20+5 65ML/HR
18. • DEFICIT REPLACEMENT /REHYDRATION THERAPY: 75ML/KG ORS
GIVEN OVER 4 HR
• ORS ORALLY /IF NOT POSSIBLE
GIVE THROUGH NG TUBE
• REASSESS AFTER 4 HR CHILD STILL HAVE SOME DEHYDRATION
THAN REPEAT
• MAINTANENCE FLUID THERAPY TO REPLACE LOSSES; ORS SHOULD
BE ADMINISTERED IN VOLUME EQUAL TO DIARRHOEAL
LOSSESSUSUALLY 10ML/KG PER STOOL, PLAIN WATER CAN BE
OFFERED IN BETWEEN
19. REATMENT PLAN A
• TREAT DIADDHOEA AT HOME
• COUNSIL MOTHER FOUR RULES OF HOME TREATMENT
• 1. GIVE EXTRA FLUID
• 2. GIVE ZINC SUPPLIMENT
• 3 . CONTINUE FEEDING
• 4. KNOW WHEN TO RETURN CLINIC
20. • 1. GIVE EXTRA FLUID;
• BREAST FEEDING FREQUENTLY,AND LONGER TIME EACH FEED,GIVE ORS/CLEAN WATER IN ADDITION TO
BF, WHEN DIARRHOEA STOP RESUME TO EXCLUSIVE BF
• NON BREAST FEED CHILD; GIVE ONE OR MORE OF FOLLOWING
• ORS,
• FOOD BASED FLUID EG SOUP/RICE WATER/YOGHART DRINK
• OR COCONUT WATER/UNSWEETENED FRUIT JUICE
• CLEAN WATER
< 2YR 50-100ML AFTER EACH LOOSE STOOL 500ML/DAYS
2-10 YR 100-200ML AFTER EACH STOOL 1000ML/DAYS
>10 YR 2000ML/DAYS
21. ZINC SUPPLIMENT
• IMP MICRONUTRIENT FOR OVERALL HEALTH AND DEVELOPMENT BUT LOST IN GREATER QUANTITIES
DURING DIARRHOEA
• REPLACEMENT HELP IN CHILD RECOVERY,REDUCES DURATION AND SEVERITY OF EPISODE,LOWER
INCIDENCE FOLLOWING 2-3 MONTHS
• <6MONTH 10MG/DAY FOR 10-14 DAYS
• >6MONTH 20MG/DAY FOR 10-14 DAYS
22. • SYMPTOMATIC TREATMENT;
• IF VOMATING IS SEVERE OR RECURRENT SINGLE DOSE OF
ONDASETRON .1-.2MG/KG
• ABDOMINAL DISTENTION ;NO SPECIFIC TREAMENT BS +NT/IF
ABSENT PARALYTIC ILEUS CAN
OCCUR(HYPOKALENIA/SEPTICEMIA/NEC )ORAL INTAKE WITHHOLD
• CONVULSION MN A/P ETIOLOGY
23. FOLLOW UP
• MOTHER TO RETURN IMMEDIATELY TO CLINIC IF CHILD
• 1. BECOME SICKER
• 2. UNABLE TO DRINK OR BREAST FEED
• 3.DRINKS POORLY
• 4. DEVELOP FEVER OR HAS BLOOD IN STOOL
• 5 IF CHILD STILL NOT IMPROVING ADVISE MOTHER TO RETURN FOR F/U AFTER 5 DAYS
24. ADDITIONAL THERAPY
• PROBIOTIC NON PATHOGENIC BACTERIA FOR PREVENTION AND THERAPY OF DIARRHOEA HAS BEEN SUCCESSFUL IN
SOME SETTING ,ENHANCE HOST PROTECTIVE IMMUNITY,ORGANISM LIKE LACTOBACILLUS ,BIFIDOBACTERIUM
• SACCHAROMYCES BOULARDII IS EFFECTIVE IN ANTIBIOTICS-ASSOCIATED AND C.DIFFICALE DIARRHOEA
• LACTOBACILLUS RHAMNOSUS GG IS ASSOCIATED WITH REDUCED DIARRHEAL DURATION AND SEVERITY
• REDUCTION IS MORE EVIDENT IN CASE OF CHILDHOOD ROTA VIRUS DIARRHEA
• ANTIMOTALITY DRUG EG LOMOTIL AND LOPERAMIDE OR IMODIUM SHOULD NOT BE USED
• antibiotics is not used routinely give you suspect
• Cholera, parenteral diarrhoea, and dysentry
25. DYSENTRY
• FREQUENT LOOSE STOOL MIXED WITH BLOOD
• ETIOLOGY; BACTERIA OR AMOEBA BACILLARY (SHIGELLA
SPP,ENTEROINVASIVE/ENTEROHAEMORRHAGIC E.COLI/SALMONELLA/CAMPYLOBACTERBJEJUNI
• MOST COMMONLY DUE TO SHIGELLA NEED ANTIBIOTICS UNTREATED MAY LED TO LIFE THREATENING
COMPLICATION INCLUDING INTESTINAL PERFORATION,TOXIC MEGACOLON,AND HEMOLYTIC UREMIC
SYNDROME
• C/F FREQUENT LOOSE STOOL MIXED WITH BLOOD MAY INCLUDE ABDOMINAL
PAIN,FEVER,CONVULSION,LETHARGY,DEHYDRATION,RECTAL PROLAPS/
26. TREATMENT
• MOST CHILDREN CAN BE TREATED AT HOME
• ADMIT IN HOSPITAL; YOUNGER INFANTS <2MONTH, SEVERELY ILL PT LOOK
LETHARGIC,ABDOMINAL DISTENTION,TENDERNESS OR
CONVULSION,CHILD WITH ANY OTHER CONDITION REQUIRE HOSPITAL
TREATMENT
• GIVE ORAL ANTIBIOTICS (5 DAYS) TO WHICH MOST LOCAL STRAINS
SENSITIVE
• GIVE CIPROFLOXACIN 15MG/KG TWICE A DAYS IF ANTIBIOTIC SENSITIVITY
IS UNKNOWN
• GIVE CEFTRIXONE 50-80MG/KG FOR 3 DAYS TO SEVERELY ILL PT OR AS
SECOND LINE TREATMENT
• IF NO IMPROVEMENT AFTER 2 FULL SHIFT TO SECOND LINE
ANTIBIOTICS,IF TWO ANTIBIOTICS WHICH IS USUALLY EFFECTIVE AGAINST
SHIGELLA AFTER 2 DAYS OF TREATMENT WITH NO SIGN OF CLINICAL
IMPROVEMENT CHECK FOR OTHER CONDITION
• IF AMOEBIOSIS IS POSSIBLE GIVE METRONIDAZOLE 10MG/KG THRICE A
DAY FOR 5 DAYS
27. CHOLERA
VIBRIO CHOLERAE GRAM NEGATIVE,COMMA SHAPED BACILLUS, SUB
DIVIDED BY SOMATIC O ANTIGEN EG SEROGROUP 01,SEROTYPE O 139
i.P IS 1-3 DAYS (FEW HOURS – 5 DAYS)
SUSPECT CHOLERA IN CHILDREN > 2 YR OLD HAVING WATERY DIARRHOEA
AND SIGN SEVERE DEHYDRATION OR SHOCK ,IF CHOLERA IS PRESENT IN
AREA
• ASSESS AND TREAT DEHYDRATION+ GIVE ORAL ANTIBIOTICS TO WHICH
STRAIN OF V.CHOLERAE IS SENSITIVE.+ZINC SUPPLIMENT AS SOON AS
VOMIT STOP.
• MOST CASES ARE MILD OR INAPPARENT
• 20% DEVELOP SEVERE DEHYDRATION CAN RAPIDLY LEAD TO DEATH.
28. • C/F ACUTE WATERY DIARRHOEA AND VOMATING ,SOME PT HAVE COMPLAIN OF PRODROME OF
ANOREXIA AND ABDOMINAL DISCOMFORT
• DIARRHOEA CAN PROGRESS TO PROFUSE RICE WATER STOOL(SUSPENDED FLECKS OF MUCUS)WITH
FISHY SMELL….. HALLMARK OF DISEASE
• LABORATORY FINDING ELECTROLYTE IMBALANCE EG NA AND CL NORMAL/DECREASED,METABOLIC
ACIDOSIS,HYPOGLYCEMIA
• DIAGNOSIS; SUSPECTED IN WATERY DIARRHOEA WITH SEVERE DEHYDRATION RESIDING IN CHOLERA
BENDEMIC AREA OR WHO HAVE RECENTLY TRAVELED TO AN AREA KNOWN TO HAVE CHOLERA
• DIARRHOEA BY OTHER ETIOLOGY EH ENTEROTOXIGENIC E.COLI,ROTA VIRUS DIARRHOEA DIFFICULT TO
DISTINGUISH CLINICALLY
• TREAT DEHYDRATION AS SOON AS POSSIBLE
29. • MICROBIOLOGIC ISOLATION OF V.CHOLERA IS GOLD STANDARD
FOR DIAGNOSIS SPECIMENS STOOL,VOMITUS,RECTAL SWABS
TRANSPORTED ON CARY-BLAIR MEDIA AND THAN SELECTIVE
MEDIA THIOSULFATE CITRATE-BILE SALT SUCROSE AGAR
• STOOL EXAMINATION ; LEUKOCYTES,ERYTHROCYTES,DARK FIELD
MICROSCOPY MAY USED FR RAPID IDENTIFICATION OF TYPICAL
DARTING MOVEMENT
• MOLECULAR IDENTIFICATION WITH THE USE OF PCR AND DNA
PROBES IS AVALIEBLE
30. TREATMENT
• REHYDRATION IS MAIN STAY OF THERAPY( TIMELY AND EFFECTIVE MANAGEMENT IDECREASE
MORTALITY)
• MILD TO MODERATE DEHYDRATION SHOULD BE TREATED WITH ORS ( RICE BASED ORS PREFERRED)
• SEVERELY DEHYDRATED PT NEED IV FLUID RL
• ANTIBIOTICS SHOULD BE GIVEN IN MODERATE TO SEVERE DEHYDRATION,SINGLE DOSE
ANTIBIOTICS(DOXYCYCLINE,CIPROFLOXACIN,AZITHROMYCIN)HAS INCREASE COMPLIANCE
• RECOMMENDED ANTIBIOTICS IN CHOLERA;
• WHO ADULTS DOXYCYCLINE 300MG SINGLE DOSE/ OR TETRACYCLINE 500MG 4 TIMES A DAY FOR
• 3 DAYS
• ALTERNATE; ERYTHROMYCIN 250MG 4 TIME A DAYS FOR 3 DAYS
•
• CHILDREN TETRACYCLINE 12.5MG/KG/DOSE 4 TIME A DAY FOR 3 DAYS( MAX 500MG/DOSE)
• ALTERNATE ERYTHROMYCIN 12.5MG/KG/DOSE 4 TIME A DAYS FOR 3 DAY(MAX 250MG/DOSE)
31. • PAHO (PAN AMERICA HEALTH ASSOCIATION)
• ADULT DOXYCYCLINE 300MG PO SINGLE DOSE
• ALTERNATE CIPROFLOXACIN 1 GM PO STAT
• OR AZITHROMYCIN 1 GM PO SINGLE DOSE
• CHILDREN ERYTHROMYCIN 12.5MG/KG/DOSE 4 TIME A DAYS FOR 3 DAYS
• OR AZITHROMYCIN 20MG/KG AS A SINGLE DOSE
• ALTERNATE CIPROFLOXACIN 20MG/KG SINGLE DOSE
• OR DOXYCYCLINE 2-4 MG/KG PO SINGLE DOSE
32.
33.
34. PREVENTION
• 1. PROPER NUTRITION;EXCLUSIVE BREAST FEEDING UPTO 6M TNAN APPROPRIATE COMPLEMENTARY
FEEDING(ENERGY MIXED FOOD MIXTURE
• 2. ADEQUATE SANITATION; IMPROVEMENT OF ENVIRNMENTAL SANITATION,CLEAN WATER
SUPPLY,ADEQUATE WATER DISPOSAL SYSTEM,PROTECTION OF FOOD FROM BACTERIAL
CONTAMINATION
3. VACCINATION : EG ROTAVIRUS VACCINE /CHOLERA VACCINE
KEY MESSAGES THREE Cs (CLEAN HAND,CLEAN CONTAINER,AND CLEAN ENVIRONMENT)
35. THANKS HIMSR
SOURCE:NELSON 20TH EDITION,GHAI ESSENTIAL PEDIATRICS 8TH EDITION;WHO GUIDELINE FOR
MANAGEMENT OF COMMON CHILDHOOD ILLNESSESS