Management of Diarrhea in Pediatrics[

1. MANAGEMENT OF ACUTE
DIARRHEA IN PEDIATRIC:
what the pharmacist need
to know
Presenter:
PHARM. ATEBEFIA
AGHOGHO ERICA

2. CONTENT
u INTRODUCTION
u ACUTE AND CHRONIC DIARRHEA
u MANAGEMENT OF ACUTE WATERY DIARRHEA
u MANAGEMENT OF ACUTE BLOODY DIARRHEA
u CONCLUSION
u REFERENCE

3. INTRODUCTION
uDefinition:
Diarrhea is the abnormal passage of
loose or liquid stools with increased
frequency or volume or both.

4. INTRODUTION CONTINUES...
Causes:
u trouble digesting certain foods
u infection(bacteria or viral)
u side effect of a drug (such as antibiotics,
antacid etc.)
u symptom of a chronic GI disorder (such as
IBD, IBS)

5. INTRODUCTION CONTINUES…
Signs and symptoms:
The clinical presentation and course
of diarrhea may depend on its cause
and on the host. Consider the
following factors to determine the
source/cause of the patient’s
diarrhea:

6. INTRODUCTION CONTINUES…
uStool characteristics (eg, consistency, color,
volume, frequency)
uPresence of associated enteric symptoms (eg,
dysentry, fever, flatulence, etc)
uUse of child daycare (common pathogens:
rotavirus,Campylobacter, Shigella, Giardia,
and Cryptosporidium species [spp])

7. INTRODUCTION CONTINUES…
uFood ingestion history (eg,
raw/contaminated foods, food poisoning)
uPredisposing conditions (eg,
hospitalization, antibiotic use,
immunocompromised state)
uWater exposure (eg, swimming pools,
marine environment)

8. INTRODUCTION CONTINUES…
Signs and symptoms of diarrhea
may include the following:
ufrequent watery stool
u abdominal pain/cramping
u flatulence
u weakness

9. INTRODUCTION CONTINUES…
udehydration
u fever
u nausea and vomiting

10. INTRODUCTION CONTINUES…
Types:
u Acute (Watery/ Bloody)
u Chronic

11. DIFFERENCE BETWEEN ACUTE,AND
CHRONIC DIARRHEA
ACUTE DIARRHEA CHRONIC DIARRHEA
1-2weeks >4 weeks

12. ASSESSMENT OF CHILDREN WITH
DIARRHEA
u Dehydration (Severe complication)
u Bloody Diarrhea
u Persistent diarrhea
u Malnutrition
Dehydration occurs as a result of inadequate
replacement of fluid lost during diarrhea.

13. ASSESSMENT OF THE SEVERITY OF
DEHYDRATION IN CHILDREN
Assessment MILD
Dehydration
Moderate
Dehydration
Severe
Dehydration
General
condition
Well, alert Irritable,
restless
Lethargic
Eye Normal Sunken Very sunken
Thirst Drink normal,
not thirsty
Thirsty, drinks
eagerly
Drink poorly or
not able to
drink
Mouth Moist Dry Very dry

14. MANAGEMENT OF
ACUTE WATERY DIARRHEA IN PAEDIATRIC
PLAN A (MILD
DEHYDRATION )
PLAN B
(MODERATE
DEHYDRATION)
PLAN C
(SEVERE
DEHYDRATION)
Oral fluid and
food, advice
mother to come
for follow up, if
no improvement.
Oral fluid
Food
IVF.
Rehydration

15. MANAGEMENT CONTINUE…
PLAN A
Age range Amount of ORS
Less than 2years 50ml -100ml/loose stool
2 to 10years 100ml-200ml/loose stool
Above 10years As much as he/she wants

16. MANAGEMENT CONTINUE…
PLAN B
Treatment of moderate dehydration
Over the first four hours:
Weigh
t (kg)
5 -
7.9
(kg)
8 -
10.9
(kg)
11 -
15.9
(kg)
16 -
29.9
(kg)
> 30
(kg)
ORS
(ml)
400 -
600
600 -
800
800 -
1200
1200 -
2200
2200 -
4000

17. MANAGEMENT CONTINUE…
PLAN B
uAfter four hours:
If there are no signs of dehydration: follow
Treatment plan A.
If there are signs of moderate dehydration:
repeat Treatment plan B.
If there are signs of severe dehydration: start
IV therapy (Treatment plan C).

18. ORS PREPARATION AT HOME
u1LITRE of water
uAdd 6 level full teaspoon of sugar
uAdd half teaspoon of salt
uShake very well

19. PLAN C
Rehydration therapy - Intravenous
lactated Ringer solution or normal
saline (20 mL/kg)
After 3 hours (6 hours in infants),
reassess and choose the appropriate
plan A, B or C.

20. WHY Zinc supplementation?
u The introduction of zinc in management of
diarrhea leads to an increase in water and
electrolyte reabsorption.
u Zinc reduce the duration and severity of
diarrhoea, and to prevent subsequent episodes
Age Dose Duration
Less than 6
month
10mg/day For 14 days
More than 6
month
20mg/day For 14 days

21. ROLE OF ANTIBIOTICS IN DIARRHEA
MANAGEMENT
Antibiotics is used in the presence of;
1.Fever
2.Dysentery
3.Culture positive
4.Non responsive to therapy

22. Acute bloody diarrhea (Dysentery)
u There is presence of visible blood in stools
u Often accompanied by ;
1. Fever(>38.5*c)
2. Vomiting
3. Abdominal pain
u Complications may include;
1. Dehydration
2. Sepsis
3. Malnutrition

23. MANAGEMENT OF
ACUTE BLOODY DIARRHEA
u Usually caused Majorly by shigella and few by
ameobiasis
u Management also involves;
1. Assessment of degree of dehydration
2. Correction of fluid/electrolyte losses(using plan
A,B or C)
3. Zinc supplementation
4. Appropriate diet
u Antibiotics are added to treat and also to reduce
spread of the bacteria

24. Management of acute bloody diarrhea
continues…
THERAPY DRUGS
First line Oral metronidazole
10mg/kg tds for 5 to 10 days
Second line IM ceftriaxone
50 -100mg/kg daily for 5 days

25. MISUSE OF ANTIBIOTICS IN AUCTE
DIARRHEA
u Leads to killing of GIT protective bacteria
u Exposure of GIT to pathogenic bacteria
u Disease chance increases
u Poor digestion secondary to disruption of
GIT flora
u Hence, clinical features of diarrhea and
malabsorption become evidence

26. Other drug used
Antidiarrheal microorganism
uProbiotics: dietary supplement
containing potentially beneficial bacteria
e.g saccharomyces boulardii,
lactobacillus acidophilus, etc.
uIndication; Treatment of antibiotics
Associated diarrhea

27. Prevention of diarrhea
u Hygiene (most effective way)
u Eating well cooked food
u Routine immunization of infants with rotavirus
vaccines,
u Water-need to be filtered or boiled when
given to a child

28. CONCLUSION
The major elements a pharmacist needs to know in
the management of acute diarrhea in pediatrics'
are;ORT, ZINC SUPPLEMENTATION, APPROPRIATE DIET.
If there is presence of blood in the stool, it’s a sign
of a bacteria infection, thus antibiotics become
inevitable to prevent the spread of the bacteria.

29. REFERENCE
u WHO,2014: Diarrhea;IMCI INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS: Module 4, Distance Learning course,
available a
https://apps.who.int/iris/bitstream/106651104772161978
9241506823module-4eng.pdf
u Isabelle De zoysa Betty Kirkwood, Richard feachehem and
Euan Undsay-smoth preparation of sugar – salt solution
TransRsoc Troped Hug(1999) 7812: 260-262
u Lukmanjiz. 1989. Formulae of salt solution recommended
for treatment of diarrhea dehydration at home in Africa
countries Ann Trop Paediatric 1988 Mar; 8(1):35-7

30. Reference…
u World health organization. The treatment of diarrhea: a
manual for physicians and other senior health workers
WHO, Geneva 2005(cited 2013 jul 24) available from;
http:/whqlibdoc.who.int/publications/2005/9241593180.p
df
u Leung A, Prince T, Oral rehydration therapy and early
refeeding in the management of childhood gastroenteritis
Canadian paediatric society (update 2006 Nov 1); (cited
jul 24). Available
from:http//www.cpsca/documents/position/oral-
rehydration-therapy.

31. THANK YOU