Definition: Diarrhea is defined as the frequent passage of loose or watery stools, typically occurring more than three times in a 24-hour period. The change in the consistency and character of stools is more important than the number of stools passed. Incidence: • Diarrhea is a leading cause of child mortality and morbidity globally. • Diarrheal disease is the second leading cause of death in children under 5 years of age. • Children under 3 years in developing countries experience an average of three episodes of diarrhea each year. Etiology: Diarrhea in children can be caused by various factors, including: • Infectious Agents: Viral (e.g., rotavirus, norovirus), bacterial (e.g., Escherichia coli, Salmonella), and parasitic (e.g., Giardia lamblia) infections. • Non-Infectious Causes: Food intolerances (e.g., lactose intolerance), inflammatory bowel diseases, and certain medications (e.g., antibiotics). • Environmental Factors: Poor sanitation, contaminated water, and inadequate nutrition. • Psychosocial Factors: stress and anxiety, change in environment: Classification of Diarrhea: Based on Duration: Based on the duration that diarrhea persists, it is divided as follows: • Acute Diarrhea: Lasts less than 14 days, often caused by infections or dietary changes. • Persistent Diarrhea: Lasts between 14 days and 4 weeks, may indicate underlying health issues. • Chronic Diarrhea: Lasts more than 4 weeks, often associated with chronic diseases or conditions. Based on Physiology: Based on the physiology diarrhea can be classified as: • Osmotic Diarrhea: Occurs due to non-absorbable substances in the intestines, leading to water retention. Commonly caused by lactose intolerance or malabsorption syndromes. • Secretory Diarrhea: Results from excessive secretion of fluids and electrolytes into the intestinal lumen, often seen in infections or hormonal disorders. • Exudative Diarrhea: Characterized by the presence of blood and mucus in the stool, typically associated with inflammatory bowel diseases or infections. • Motility-related Diarrhea: Occurs when there is increased intestinal motility, reducing absorption time, often seen in conditions like irritable bowel syndrome. Pathophysiology: Diarrhea occurs due to an imbalance in the absorption and secretion of fluids in the intestines. Infectious agents, toxins, or inflammation disrupt the intestinal lining, leading to increased secretion of electrolytes and water into the lumen. This results in loose stools. Inflammatory conditions can impair absorption, while rapid transit through the gastrointestinal tract reduces the time for nutrient absorption. Dehydration occurs when the body loses more fluids than it can replace, leading to electrolyte imbalances and potential complications if untreated. Clinical Manifestations: • Frequent loose or watery stools, occurring more than three times a day. • Abdominal cramping and pain. • Bloating and gas. • Nausea and vomiting. • Fever, which may indicate an infectious

1. DIARRHOEA
MR. PRADEEP ABOTHU, M.SC (N), PHD SCHOLAR,
ASSOCIATE PROFESSOR, DEPT. OF CHILD HEALTH(N)
ASRAM COLLEGE OF NURSING

2. DEFINITION
Diarrhea: Diarrhea is defined as the frequent
passage of loose or watery stools, typically
occurring more than three times in a 24-hour
period. The change in the consistency and
character of stools is more important than the
number of stools passed.

3. Dehydration: Dehydration is a condition where the body loses more fluids than
it takes in, leading to an imbalance that affects normal bodily functions, resulting
in symptoms like thirst, dry mouth, and reduced urine output.

4. INCIDENCE
 Diarrhea is a leading cause of child mortality and morbidity
globally.
 Diarrheal disease is the second leading cause of death in children
under 5 years of age.
 Children under 3 years in developing countries experience an
average of three episodes of diarrhea each year.

5. ETIOLOGY
Diarrhea in children can be caused by various factors, including:
 Infectious Agents: Viral (e.g., rotavirus, norovirus), bacterial
(e.g., Escherichia coli, Salmonella), and parasitic (e.g.,
Giardia lamblia) infections.

6.  Non-Infectious Causes: Food intolerances
(e.g., lactose intolerance), inflammatory
bowel diseases, and certain medications
(e.g., antibiotics).
 Psychosocial Factors: stress and anxiety,
change in environment.

7. CLASSIFICATION
Based on Duration: Based on the duration that diarrhea persists, it is divided as
follows:
 Acute Diarrhea: Lasts less than 14 days, often caused by infections or dietary
changes.
 Persistent Diarrhea: Lasts between 14 days and 4 weeks, may indicate underlying
health issues.
 Chronic Diarrhea: Lasts more than 4 weeks, often associated with chronic diseases
or conditions.

8. Based on Physiology: Based on the physiology diarrhea can be classified as:
 Osmotic Diarrhea: Occurs due to non-absorbable substances in the intestines, leading
to water retention. Commonly caused by lactose intolerance or malabsorption
syndromes.
 Secretory Diarrhea: Results from excessive secretion of fluids and electrolytes into the
intestinal lumen, often seen in infections or hormonal disorders.
 Exudative Diarrhea: Characterized by the presence of blood and mucus in the stool,
typically associated with inflammatory bowel diseases or infections.
 Motility-related Diarrhea: Occurs when there is increased intestinal motility, reducing
absorption time, often seen in conditions like irritable bowel syndrome.

9. Levels of Dehydration:
 Mild Dehydration: Occurs with a 1-2% loss of body weight due to fluid loss.
Symptoms include thirst, dry lips, and slightly decreased urine output.
 Moderate Dehydration: Involves a 3-5% loss of body weight. Symptoms
intensify to include dry skin, dizziness, and more noticeable reduction in urine.
 Severe Dehydration: Involves a loss of over 6% of body weight. This level is
critical, with symptoms such as rapid heartbeat, confusion, and very low or
absent urine output, requiring urgent medical attention.

11. PATHOPHYSIOLOGY

12. CLINICAL MANIFESTATIONS:
 Frequent loose or watery stools, occurring more
than three times a day.
 Abdominal cramping and pain.
 Bloating and gas.
 Nausea and vomiting.
 Fever, which may indicate an infectious cause.

13.  Urgency to have a bowel movement.
 Dehydration signs: dry mouth, decreased urine output,
lethargy, and sunken eyes.
 Hypotension, Tachycardia
 Electrolyte imbalances, leading to muscle cramps and
weakness.
 In severe cases, weight loss and malnutrition may occur.

14. DIAGNOSTIC EVALUATION:
 Medical History: Assessment of symptoms, duration, and
any recent travel or exposure to contaminated food or
water.
 Physical Examination: Evaluation for signs of
dehydration, abdominal tenderness, and other systemic
effects.
 Serological Tests: Blood tests to check for signs of
infection or inflammation.

15. Cont…
 Stool Tests: Microscopic examination to identify pathogens, blood, or
mucus in the stool. Stool cultures may be performed to detect bacterial
infections.
 Imaging Studies: Ultrasound or CT scans may be used to identify
underlying conditions if indicated.
 Endoscopy: In certain cases, endoscopic procedures may be performed to
visualize the gastrointestinal tract and obtain biopsies if necessary.

16. MANAGEMENT
The management of child with diarrhea
includes:
 Rehydration Therapy
 Nutritional Support
 Medication administration

17. Rehydration Therapy
Diarrhea management in children primarily involves Oral Rehydration Salts
(ORS) and continued feeding. Rehydration is crucial and can be achieved through
Oral Rehydration Therapy (ORT) or intravenous fluids.
 Oral Rehydration Solution (ORS): ORS is vital for preventing dehydration,
rehydrating dehydrated children, and maintaining hydration after rehydration. To
prepare ORS, mix the entire packet in 1 liter of potable water and use the
solution within 24 hours.

18. CONTENT AMOUNT g/l
Sodium chloride 3.5
Sodium bicorbonate 2.5
Potassium chloride 1.5
Glucose 20
CONTENTS OF ORS SACHETS

20. Non-Dehydrated Children: Children with diarrhea but showing no signs of
dehydration can be managed at home. Key guidelines include:
 Fluid Intake: Provide more fluids than usual using ORS and home-available
fluids (HAF) until diarrhea stops.
 Nutrition: Offer food at least 6 times a day, including: cereals, pulses,
vegetables, fruits. Encourage frequent breastfeeding if the child is on breast
feeding.
 Seek medical help if the child has persistent watery stools, repeated vomiting,
marked thirst, fever, or blood in stools.

21. Mild to Moderate Dehydration: For children with some dehydration, ORS
amounts for the first 4 hours:
• Less than 4 months or less than 5 kg: 200-400 mL
• 4 to 11 months or 5 to 7.9 kg: 400-600 mL
• 12 to 23 months or 8 to 10.9 kg: 600-800 mL
• 2 to 4 years or 11 to 15.9 kg: 800-1200 mL
• 5 to 14 years or 16 to 29.9 kg: 1200-2200 mL
• 15 years or older or 30 kg or more: 2200-4000 mL

22. Severe Dehydration: For severe cases, initiate intravenous fluid therapy
immediately:
• Start with Ringer’s lactate: 100 mL/kg (or normal saline if unavailable).
• If the patient can drink, administer ORS orally at 5 mL/kg/hour.
• Reassess hydration status every 1-2 hours and adjust treatment as necessary.

23. Nutritional Support
 Breast feeding should be continued along with ORS.
 Continue feeding with a bland diet.
 Include easily digestible foods such as rice, bananas, applesauce, and toast.
 Avoid sugary drinks, caffeine, and high fiber and fat foods.
 Zinc supplementation should be provided.

24. Medication Administration
 Antimicrobial Agents: Prescribe antibiotics if bacterial
infection is suspected (e.g., azithromycin for bacterial
diarrhea).
 Antidiarrheal Medications: Loperamide may be used
for symptomatic relief in non-bacterial diarrhea, but
should be avoided in cases of bloody diarrhea or high
fever.
 Probiotics: May help restore gut flora and shorten the
duration of diarrhea.

25. PREVENTIVE MEASURES
 Encourage regular handwashing with soap and water,
especially before meals and after using the bathroom.
 Educate on proper cooking, storage, and handling of food to
prevent contamination.
 Promote the use of safe, treated, or boiled water for drinking
and food preparation.

26.  Ensure children receive vaccines for preventable diseases, such as
rotavirus.
 Advocate for safe disposal of human waste and proper sanitation practices
in the household.
 Encourage a balanced diet rich in fruits, vegetables, and whole grains to
support immune health.
 Implement deworming programs in communities at risk of intestinal
parasites.
 Teach families about the signs of dehydration and when to seek medical
attention.

27. THANK YOU!