This document discusses the management of diarrhea in children and pregnant women. It provides information on common pathogens that cause diarrhea, rehydration strategies like oral rehydration solution and intravenous fluids, maintaining nutrition during diarrhea, and choices of drug treatment based on the identified pathogen. The key points are: more than 5 million children under 5 die from diarrhea annually in India; oral rehydration with WHO's new lower sodium and glucose formula is preferred if fluid loss is mild; intravenous fluids like Ringer's lactate are given for more severe dehydration; maintaining nutrition with foods like milk and bananas during diarrhea; and targeted antibiotic treatment depending on the identified diarrhea-causing bacteria or parasite.

1. Management of diarrhoea in
child & pregnant women :-
Dr Nikhil Bansal
J.N.M.C.
Wardha

2. Introduction in brief :-
 More than 5 million children under the age
of 5 years die every year due to diarrhoea.
 In India, more than 1 million children every
year die due to this disease.

3. Pathogen % of cases
Viruses Rotavirus 15 to 25%
Bacteria Enterotoxigenic Escherichia
coli 10 to 20%
shigella 5 to 15%
Campylobacter jeijuni 10 to 15%
Vibrio cholerae 5 to 10%
salmonella 1 to 5%
Protozoans Cryptosporidium 5 to 15%
No pathogen
- 20 to 30%
found
Pathogens frequently identified in treatment centres
in children

4. Rehydration :-
i) Intravenous rehydration –
Given when fluid loss > 10% of the body
weight OR 10 ml/kg/hr
Dhaka fluid :-
NaCl : 85 mM = 5g
In 1 litre of water or glucose
KCl : 13mM = 1g solution
NaHCO3 : 48mM = 4g

5.  Ringer lactate by WHO :-
Na : 130 mM
Cl : 109 mM
K : 4 mM
Lactate : 28 mM
Volume equivalent to 10% of the body weight
should be infused over 2 to 4 hrs

6. ii) Oral rehydration:-
Given if the fluid loss
is just mild (7.5 to 10%
of the body weight)

7. Rationale of ORS
composition:-
 Oral rehydration possible only if glucose is
added with salt helping glucose coupled
sodium absorption
General principles:-
1. Isotonic or somewhat hypotonic(200 to 310
mOsm/L)
2. The molar ratio should not exceed 110mM
3. Enough potassium(15-25mM) &
bicarbonates(8-12mM) must be provided

8. WHO recommends (old):-
 Na 90mM
 K 20mM
 Cl 80mM
 Citrate 10mM
 Glucose 110mM
(Total osmolarity of 310mOsm/L)

9. New formula of WHO–ORS:-
 Introduced in 2002 with low sodium & low
glucose formulated by WHO
 Both sodium & glucose tend to increase the
stool volume in higher concentrations &
hence they must be reduced
 Ideally the total osmolarity should be
245mOsm/L

10. New formula WHO-ORS
Content Concentration
NaCl : 2.6 g Na : 75mM
KCl : 1.5 g K : 20mM
Trisod. Citrate : 2.9 g Cl : 65mM
Glucose : 13.5 g Citrat : 10mM
Water : 1L Glucose : 75mM
(total osmolarity is 245mOsm/L)

11. Administration of ORS:-
 At ½ - 1 hr intervals
 Initially body weight equivalent is given in 2-4
hours(5ml/kg/hr)
 Intragastric drip is used in case of childrens.
Super ORS:-
Main aim is to reduce the stool volume other
than the rehydration task
Amino acids helping in sodium co-transport are
included viz. alanine & glycine

12. Maintenance of Nutrition :-
Fasting decreases brush border disaccharide
enzymes & reduce absorption of salt,water
& nutrients
Nutrients like buffalo milk,boiled
potato,rice,chicken soup,banana should be
given to patient.

13. Drug therapy:-
Choice of drug for pregnant women in
dehydration – anti diarrhoeals like
diphenoxylate-atropine,loperamide.
Oral rehydration salts is used as an
alternative

14. Choice of drug for children in
dehydration -
Pathogen Drug given
Nalidixic acid
Enterotoxigenic Escherichia
, cotrimoxazole, ampicillin,inj.
coli
gentamicin
shigella Nalidixic acid,cotrimoxazole,ampicillin
Campylobacter jeijuni Erythromycin, furazolidin,chlorampheni
col,gentamycin
Furazolidin,cotrimoxazole,tetracycline,
Vibrio cholerae erythromycin
salmonella Ampicillin,chloramphenicol
Entamoeba histolytica Metronidazole,tinidazole,secnidazole
Metronidazole,tinidazole,secnidazole
L.giardia