The document discusses diarrhoea, defining it as loose or watery stools more than 3 times per day. It outlines the main causes as diarrhoeal pathogens like viruses, bacteria, parasites and fungi, as well as host factors like young age and environmental factors like season. The types of diarrhoea are described based on pathogens, duration, mechanism and clinical presentation. Management involves rehydration therapy with oral rehydration solution or intravenous fluids based on the degree of dehydration. Nursing care focuses on fluid replacement and monitoring for signs of dehydration.

1. DIARRHOEA
MANISHA PRAHARAJ
MSC 1ST YEAR

2. DEFINITION
• Diarrhoea is defined as passage of loose,
liquid or watery stools, more than 3 times
per day.
• Diarrhoea is excessive loss of fluid &
electrolyte in stool, increase in liquidity.

3. CAUSES OF DIARRHOEA
Diarrhoea
pathogens
Environment
al factors
Host factors

4. Diarrhoea Pathogen
The infectious agents causing diarrhoea:
1. viruses: Rotavirus, adenovirus, enterovirus,
measles virus etc.
2. Bacteria: E.coli, Shigella, salmonella, etc.
3. Parasites: E. histolytica, cryptosporidium,
malaria etc.
4. Fungi: candida albicans

5. Host factors:
• The disease is most common in children
especially those between 6months to 2 years.
Environmental factors:
• Bacterial diarrhoea is more frequently occur
in summer & rainy season, whereas viral
diarrhoea is more common in winter.

6. TYPES OF DIARRHOEA
• According to pathogens
• According to duration
• According to mechanism of diarrhoea
• According to clinical type of diarrhoea.

7. According to pathogens
• Infective, non – infective
Non - Infective:
• Congenital anomalies of GI tract
• Malabsorption syndrome
• Inflammatory bowel disease
• Inappropriate use of laxatives.
• Over feeding or under feeding
• Food allergy
• Some drugs (antibiotics) can also cause
diarrhoea

8. According to duration
• Acute diarrhoea: lasts less than 14days.
• Chronic or persistent diarrhoea: episodes
lasts more than 14days.

9. Mechanism of diarrhoea
• Secretory diarrhoea: it is caused by external
or internal (cholera toxin, lactase deficiency).
It has tendency to be watery, voluminous &
persistent. There is less absorption & more
secretion.
• Osmotic diarrhoea: it is due to ingestion of
poorly absorbed food, indigestion. It tends to
be watery & acidic with reducing substances.

10. • Motility diarrhoea: it is associated with
increased motility of the bowel. There is
decreased transit time or stasis of bacteria
leading to overgrowth.

11. Clinical type of diarrhoea
• Acute watery stool: this is the most common
type. Its usually self limiting, and most
episodes subsides within 7days. The main
complication is dehydration.
• Acute bloody stool: also referred to dysentry.
His is usually passage of bloody stool. It is
caused due to damage to the intestinal
mucosa by microorganisms. The complication
is dehydration, sepsis, malnutrition.

12. PATHOPHYSIOLOGY
• The pathogenic organism produce diarrhoea
with following mechanism.
1. Adhesion to intestinal wall
2. Elaboration of exotoxin as in secretory
diarrhoea.
3. Mucosal invasion.

13. In diarrhoea fluid losses from extracellular
compartment i.e. from blood, interstitial
fluid.
Due to loss of sodium
cause decrease osmolality of ECF
Which leads to fluid movement from ECH to ICF
Which cause impaired skin elasticity

14. Depletion of ECF compartment leads to reduction
of blood volume.
Which cause peripheral circulatory failure, oliguria,
anuria, shock.
Loss of potassium in stool cause hypokalemia,
abdominal distension & ECG changes.
Loss of bicarbonate in stool cause
acidemia/acidosis & rapid respiration.
Due to loss of nutrients, anorexia & inadequate
intake of food cause malnutrition and
susceptible for infection.

15. CLINICAL MANIFESTATION
• Dehydration
• Loose & watery stool
• Low grade fever, thirst
• Anorexia, vomiting & abdominal distention.
• Behavioural change like irritability,
restlessness, delirium, stupor.
• Weakness, lethargy
• Weight loss

17. • Poor skin turgor
• Dry mucus membranes, dry lips, pallor,
sunken eyes, depressed fontanelles
• Tachycardia, rapid respiration
• Cold extrimities
• Decreased urine output
• Convulsion & loss of consciousness may also
present.

19. DIAGNOSIS
• History collection & Physical examination.
• Stool examination routine & microscopic
study
• Blood examination – to detect electrolyte
imbalance, acid – base imbalance, hematocrit
value, TC, DC, ESR etc.

20. Assessment of degree of dehydration
Loss of body weight:
• Normal: no loss of body weight.
• Mild dehydration: 5-6% loss of body weight.
• Moderate: 7-10% loss of body weight.
• Severe: over 10% loss of body weight.
Clinical features of mild-to-moderate dehydration; 2
or more of:
• Restlessness or irritability.
• Sunken eyes.
• Thirsty and drinks eagerly.

21. Clinical features of severe dehydration; 2 or more
of:
• Abnormally sleepy or lethargic.
• Sunken eyes.
• Drinking poorly or not at all.
• Pinch test (skin turgor): the sign is unreliable in
obese or severely malnourished children.
Normal: skin fold retracts immediately.
Mild or moderate dehydration: slow; skin fold
visible for less than 2 seconds.
Severe dehydration: very slow; skin fold visible
for longer than 2 seconds.

22. • Other features of dehydration include dry
mucous membranes, reduced tears and
decreased urine output.
• Additional signs of severe dehydration
include circulatory collapse (e.g. weak rapid
pulse, cool or blue extremities, hypotension),
rapid breathing, sunken anterior fontanelle.

23. MANAGEMENT
Rehydration therapy:
• The child with loose motion having no
dehydration –
 can be treated at home.
 give more home available fluid than usual &
ORS to prevent dehydration.
 give more food to prevent under-nutrition,
continue breast feeding.
Take the child to health center if the child
doesn’t get better in 3days.

24. • Child having diarrhoea with some dehydration-
 Rehydration therapy - Oral rehydration
solution (50-100 mL/kg over 4 hours)
After 4 hours of rehydration therapy child
should reassess for degree of dehydration.
If no sign of dehydration child should managed
at home & if any sign of severe dehydration
appear child should be admitted to hospital for
IV therapy.

25. • Child with severe dehydration-
 should be treated quickly with IV fluid i.e.
with RL 100ml/kg.
If the child can drink ORS to be be given
about 5ml/kg/hour.
 RL to be infused at first - 30ml/kg in 1 hour
70ml/kg in 5 hours(for infant)
 -30ml/kg in 30mins
70ml/kg in 2.5 hours(for older children)
Child should be assessed in every 2 hours.

26. FLUID REQUIREMENT
AGE AMOUNT OF FLUID
Day 1 60 – 80 ml/kg
Day 2 80 – 100ml/kg
Day 3 100 – 150ml/kg
Up to 10kg 100ml/kg
10 – 20kg 1000ml+ 50ml/kg increase in body
weight beyond 10 kg
20 – 30kg 1000ml+ 20ml/kg increase in body
weight beyond 20 kg
30 – 40kg 60ml/kg/day

27. Example –
Calculate fluid requirement in 24hours for a
child weighing 12kg.
10 – 20 kg = 1000ml+ 50ml/kg increase in body
weight beyond 10 kg
For 12 kg = 1000+50X2
= 1100ml

28. FLOW RATE
125ml of normal saline in 5% dextrose in 6hours.
Drops/min = volume of solution/time interval in
minutes X drops factor
Common drop factors are:
• 10 drops/ml (blood set),
• 15 drops / ml (regular set),
• 60 drops / ml (microdrop).
(Drop factor for microdrip set = 60)
= 125 X 60/6 X60 = 20.83
The rate of flow to be regulated is 20 – 21 drops/min

29. Chemotherapy –
• bacterial or protozoal diarrhoea can be
treated with Ampicilin, nalidoxic, norfloxacin,
ciprofloxacin, metronidazole etc.
• Dietary management

30. NURSING MANAGEMENT