This is a brief outline to understand the diarrhoeal diseases that plague infants.

1. Diarrhoeal Diseases
Dr. Sudir
Vigneshwar
Medical Intern,
RRMCH

2. Overview
• Ranks the top 3 causes of death in the pediatric population of the
developing world with 4.5 million deaths per year.
• 8 out of the 10 deaths are in the first 2 years of life.
• Malnutrition increases their vulnerability .

3. Definition of Diarrhoea
• Passage of 3 or more loose or watery motions per 24
hours, resulting in excessive loss of fluid an
electrolytes in stools.

4. Types of Diarrhoea
• Secretory – Without any feeding
• Osmotic- With solute ingestion
• Motility- Increased/decreased motility
• Acute- Terminates within a week
• Chronic- Beyond 2 weeks
• Persistent- Acute diarrhoea more than 2 weeks
• Intractable- Before the age of 3 months

5. Etiology of Acute Diarrhoea/ Acute
Gastroenteritis
Enteric infetions
Bacteria- E.coli, Shigella,Salmonella
Viruses- Rotavirus, Norwalk
Parasites- E.histolytica, G.lamblia
Fungi- Candida albicans
Parentral- URI, Otitis media
Drugs- Antibiotics
Dietitic- Overfeeding, starvation

6. Pathogenesis
• Adhesion to the intestinal mucosal wall
• Elaboration of an exotoxin
• Mucosal Invasion

7. Clinical Features
• Mild Diarrhoea – Insidious onset, 2-5 motions, no major constitutional
symptoms
• Moderate Diarrhoea- More than 10 stools per day with fever,
irritability, anorexia, vomiting and mild dehydration.
• Severe Diarrhoea- Acute onset, no retention of oral fluids, moderate or
severe dehydration

9. WHO Treatment Of Diarrhoeal Dehydration
• Plan A – No Dehydration AIM- Prevention of Dehydration
Home Treatment
ORS Administration in amounts exceeding normal
<6 months 50 ml
7 months- 2 years 50ml-100ml
2-5 years 100-200 ml
Older - As much as the child accepts
Continue Normal Feeding/Breast Feeding
Evaluation after 2 days

10. Plan B for – Some Dehydration
• Administering ORS 75ml/kg over a period of 4 hours
• Continuing Breastfeeding/other feedings
• Reassessment after 4 hours
If adequately rehydrated, opt Plan A
If poor response to ORS, treat as in Plan C

11. Plan C- Severe Dehydration
AIM- Quick correction of severe dehydration with IV fluids, preferably Ringer Lactate in a
hospital/facility
< 1 Year 30 ml /kg within 1st hour followed by 70ml/kg over next 5 hours
> 1 Year 30 ml/kg within ½ hour followed by 70 ml/kg over next 2.5 hours
Assess every 2 hours
If no improvement rapid IV infusion
If improvement compliment with ORS
Opt Plan A, Plan B, Plan C accordingly

12. Conservative Treatment
• Antibiotics
• Nutrition- Continue Breastfeeding and ORS and
other feedings during
Energy dense foods with minimum bulk
• Ancillary supplements- Zinc, Vitamin A

13. O.R.S Oral Rehydration Solution
• Standard ORS (311 mOsm/L)
• Low Osmolarity ORS (245 mOsm/L)
• ReSoMal
• Home-made ORS

15. ReSoMal
Who recommended for severely malnourished children
• High Potassium and Low Sodium.
• Diluting standard WHO ORS in 2 litres of water, adding 50g sugar and
40 ml of mineral mix with high KCl.
• Administered in a dose of 70-100ml/ kg over 12 hours.

16. Home-made ORS
• Take one 3 finger pinch of salt upto crease of index finger
(half teaspoon level)
• Take 2 finger 4 finger scoop of sugar ( 6 teasppon level )
• Mix them in 1 Litre of potable water.

17. Advantages of Low Osmolar ORS
• Fewer unscheduled intravenous infusions (33%)
• Lower stool volumes (20%)
• Less vomiting (30%)

18. Complications
• Dehydration & dyselectrolytemia – Acute Kidney Injury, Paralytic
Ileus, thromboembolism,seizures
• Overhydration and CCF
• Malnutrition
• Hypoglycemia
• SIADH
• DIC

19. Prevention
• Improving the nutritional status of the children to prevent malnutrition
• Improvement in community water supply, sanitation and hygiene
• Breatfeeding should be encouraged
• Seeking prompt medical care at the onset of diarrhoea
• Knowledge of ORS
• Rotavirus Vaccine –Rotarix, Rotateq and Rotavac
RV- 5 in 3 doses in 6, 10 and 14 week schedule.