Ors sanooz

Ors sanooz

• 2.
  What is Diarrhea?
• 3.
  Types of seriousdiarrhoea in children Acute watery diarrhea- If <14 days ,sever dehydration Ecoli,cholera ,malnutrition  Persistent diarrhea-If >14 days, 20-30 % death, under nourished and HIV exposed Dysentery-(atisar) with blood ,with or without mucus 10%-15 % of deaths
• 4.
  Why are childrenmore prone to diarrhoea Proportion of water is more in children ,so dehydration occur early. Metabolic rate is high and use more water as compared to adults Kidney can conserve less water ,so loss is more Sodium loss can be 70-110 m mol/kg Chloride and potassium loss is balanced &same
• 5.
  Assessment of diarrhea Didchild vomit? Did child pass urine? What type of liquids did the child get ? Did the child get sufficient food before this episode ? During diarrhea is child getting food that is different and is less calorie dense? Look for cough ,fever ,otitis media ,sepsis ,h/o measles Weight /nutrition
• 6.
  ASSESS: Degree of Dehydration DECIDE: Planof treatment
• 7.
  Does the childhave diarrhea? If yes, ask: For how long? How many? Has the child been vomiting Is there blood in stool?
• 8.
  LOOK AT THECHILD’S GENERAL CONDITION IS THE CHILD ◦ Lethargic or Unconscious? ◦ Restless or Irritable? LOOK FOR SUNKEN EYES  Look for skin pinch -goes back promptly/slowly/ very slowly OFFER THE CHILD FLUID TO DRINK – THIRSTY Not able to drink or drinking poorly? Drinking eagerly, appears thirsty? Drinking normally? LOOK
• 9.
  Look at Eyesfor Dehydration Shrunken Eyes Normal eyes
• 13.
  Two or moreof the following Degree of dehydration decided on: •Restless, Irritable •Sunken Eyes •Drinks eagerly, Thirsty •Skin Pinch goes back “slowly” Some Dehydration Severe Dehydration •Lethargic or unconscious •Sunken Eyes •Not able to drink or drinking poorly •Skin Pinch goes back “very slowly” OR NO DEHYDRATION
• 14.
  No Dehydration: PLAN-A SomeDehydration: PLAN-B Severe Dehydration: PLAN-C
• 15.
  Treat Diarrhea atHome. 4 Rules of Home Treatment: GIVE EXTRA FLUID CONTINUE FEEDING WHEN TO RETURN [ADVICE TO MOTHER] GIVE ORAL ZINC FOR 14 DAYS PLAN – A
• 16.
  Plan-B is carriedout at ORT Corner in OPD/clinic/ PHC Treat ‘some’ dehydration with ORS (50-100 ml/kg If the child wants more, give more After 4 hours: Re-assess and classify degree of dehydration. PLAN – B
• 17.
  PLAN -C Signs ofsever dehydration Child not improving after 4 hours Refer to higher center –give ORS on way /keep warm /BF When child comes back follow up as other children
• 18.
  Start I. V.Fluid immediately PLAN – C
• 19.
  Dysentery Cholera Severe malnutrition Associated systemicinfection Antimicrobials should be given during diarrhea only for:
• 20.
  Increase amount ofcalories during convalescence with energy dense foods (enrich foods with fats and sugar) •Feed an extra meal (for at least 2 weeks after diarrhea stops) •Give an extra amount •Use extra rich foods •Feed with extra patience •Give extra breastfeeds as often as child wants
• 21.
  Increase amount ofcalories during convalescence with energy dense foods (enrich foods with fats and sugar) •Feed an extra meal (for at least 2 weeks after diarrhea stops) •Give an extra amount •Use extra rich foods •Feed with extra patience •Give extra breastfeeds as often as child wants
• 22.
  What Is ORS
• 23.
  PRINICIPLE OF ORS Thesodium-coupled co-transport with glucose and other carrier organic solutes remains intact, even with viral enteritis associated with epithelial damage .
• 24.
  Ingredient Standard WHO ORSmmol/l Reduced osmolarity ORS mmol/l (2002) Glucose 111 75 Na 90 75 K 20 20 Cl 80 65 Citrate 10 10 Osmolarity mOsm/kg 311 245
• 25.
  Limitation of highosmolarity ORS Does not lower volume, frequency and duration of diarrhoea. Induces vomiting due to taste, so acceptability poor. More chances of dehydration, more chances of requiring iv fluid. Hypernatremia. Good to correct fluid deficit, not good for maintenance fluid.
• 26.
  LOW OSMOLARITY ORS Comparedto WHO standard ORS , hypo-osmolar ORS is associated with a) fewer unscheduled intravenous fluid infusions(33%) b)lower stool volumes (20%), and c) less vomiting(30%)
• 27.
  Clinical relevance -low osmolarity ORS Reduction in need of IV therapy results in reduced hospitalization and in turn results: Reduced risk of hospital acquired infections.  Reduced disruption of breastfeeding.  Reduced use of needles and interventions  Reduced therapy cost.  Reduced risk of diarrheal deaths in areas where IV therapy is not readily available.
• 28.
  Rice-based ORS, Maltodextrin-containingand Amino acid-containing ORS—SUPER ORS They are not superior to glucose-based ORS for acute non-cholera diarrhea, provided that feeding was promptly resumed after initial rehydration of the child.
• 29.
  Flavored/Colored ORS Studies showedneither an advantage nor disadvantage for the flavoured and coloured ORS when compared to the standard ORS with regard to safety, acceptability and correct use. Concerns about the type of sweetners ,coloring and flavouring agents used. More expensive
• 30.
  Limitations for ORS Alteredmental status with concern for aspiration Abdominal ileus Underlying disorder that limits intestinal absorption of ORT (e.g, short gut, carbohydrate malabsorption)
• 31.
  PRACTICAL PROBLEMS Vomiting: Giveless amount more frequently,wait for 10 minutes and try again.Give food in the form of Kanji,Amylase rich food. Taste: It is a MEDICINE and the most important medicine in diarrhea. Convince the parents. First drug in your prescription. If affording, flavoured ORS may help.
• 32.
  ORS IV fluids OnceORT has been initiated, intervention with intravenous hydration is indicated: If stool output continues to be excessive, and ORT is unable to adequately rehydrate the child If there is severe and persistent vomiting, and inadequate intake of ORS
• 33.
  WHO Statement 2006: TheWorld Health Organization states that, “there is no evidence to support the ongoing use of IV therapy for the first-line management of most cases of childhood gastroenteritis.”
• 34.
  Safe & effective Canalone successfully rehydrate 95-97% patients with diarrhea, Reduces hospital case fatality rates by 40 - 50% Cost saving Reduces hospital admission rates by 50% and cost of treatment by 90%
• 35.
  39% reduction inneed for unscheduled IV fluids 19% reduction in stool output 29% reduction in vomiting Hahn et al, 2001; WHO/FCH/CAH 0.1.22, 2001
• 36.
  Should be givento young infants (< 2m) including neonates if there is dehydration In exclusively breastfed young infants with no dehydration encourage exclusive breastfeeding more frequently and for longer Low osmolarity ORS is safe and effective for all ages
• 37.
  Advice to parents Storing Howto give Measuring Home remedies
• 38.
  WHY ZINC?
• 39.
  IZiNCG advocacy statement(http://www.izincg.org/pdf/IZiNCG_Advocacy- PrintingFormat.pdf) Zinc deficiency is widespread in low and middle income countries like India
• 40.
   Disrupts intestinalmucosa  Reduces brush border enzymes  Increases mucosal permeability  Increases intestinal secretion Roy 1992, Hoque 2005 Zinc deficiency has direct effects on mucosal functions
• 41.
  20 mg/day (10mg/day for infants 2-6 mo) of zinc supplementation for 14 days starting as early as possible after onset of diarrhea WHO/UNICEF Joint statement (2001), IAP 2003, GOI 2007 Recommendations for Use of Zinc in Acute Diarrhea
• 42.
  Preventing and TreatingDiarrhea
• 43.
  THANK YOU