Diarrhea ATP
Diarrhea ATP
Diarrhea ATP
Infectious gastroenteritis :
Bacterial : Escherichia coli: Enterotoxigenic, enteropathogenlc, enteroinvasive,
enterohemorrhagic types ,
Shigellosis ( S. dysenteriae ,Shigella flexneri,Shigella boydii and Shigella
sonnei) = major cause of invasive or bloody diarrhea
Vibrio cholerae serogroups 01 and 0139 Salmonella, Chiefly S. typhi and S.
paratyphi A, B or C , Campylobacter species
Viral : Rotavirus ( most common cause of watery diarrhea in infants and young)
Human caliciviruses, Norovirus spp, Sapovirus spp, Others: Astroviruses,
coronaviruses, cytomegalovlrus, picornavirus
UPTODATE
Physiologic : lactose intolerance
Functional diarrhea: Often associated with excessive sugar or carbohydrate
intake
Irritable bowel syndrome (diarrhea-predominant)
Immune-mediated
Common causes : •Celiac disease
•Inflammatory bowel disease
•Food protein-induced allergic
proctocolitis (eg, due to cow's milk)
Postinfectious complications :
Reactive arthritis Salmonella, Shigella, Yersinia
HUS(hemolytic uremic syndrome ) STEC, Shigella dysenteriae 1
GBS(guillain barre syndrome ) Campylobacter
Glomerulonephritis ,myocarditis Shigella, Campylobacter, Yersinia
Hemolytic anemia Campylobacter, Yersinia
NELSON’S TEXTBOOK OF PEDIATRICS
Assessment of child with diarrhea
Goals :
Look for :
general condition
Appearance of Eyes
Ability to drink
Skin turgor
Capillary refill time
Features of malnutrition
Systemic infections
GHAI essentials of pediatrics
Laboratory investigations
Stool microscopy
Stool culture
Complete blood count
Renal function test
Blood gas studies
Look at
Skin pinch Goes back quickly Goes back slowly Goes back very
slowly
Uptodate
Treatment plan B
AGE*
Up to 4 4-12 months 12 months to 2 2years -5 years
months years
in ML 200-450 450-800 800-960 960-1600
*Use the child's age only when you do not know the weight.
The approximate amount of ORS required (in ml) can also be calculated by multiplying
the child's weight (in kg) times 75
If the child wants more ORS than shown, give more.
For infants under 6 months who are not breastfed, also give 100 - 200 ml clean water
during this period if you use standard ORS. This is not needed if you use new low
osmolarity ORS.
3) AFTER 4 HOURS:
Reassess the child and classify the child for dehydration
Select the appropriate plan to continue treatment
Begin feeding the child in clinic
Uptodate
Treatment plan C
Intravenous fluids should be started immediately
A total of 100 mL/kg of fluid is given, over 6 hours in
children 12 months and over 3 hours in children >12
months as shown below
Reassess the child every 1-2 hours. If hydration status is not improving,
give the IV drip more rapidly.
Also give ORS (about 5 ml/kg/hour) as soon as the child can drink:
NO usually after 3-4 hours (infants) or 1-2 hours (children).
Reassess an infant after 6 hours and a child after 3 hours. Classify
dehydration. Then choose the appropriate plan (A, B, or C) to continue
Is IV treatment treatment
available nearby
(within 30 minutes)? Refer URGENTLY to hospital for IV treatment. If the child can
YES drink, provide the mother with ORS solution and show her
how to give frequent sips during the trip or give ORS by naso-
NO gastric tube
Are you trained to use
a naso-gastric (NG) Start rehydration by tube (or mouth) with ORS solution: give
tube for rehydration 20 ml/kg/hour for 6 hours (total of 120 ml/kg).
YES Reassess the child every 1-2 hours while waiting for transfer:
No If repeated vomiting or abdominal distension, give the fluid
more slowly. If hydration status is not improving after 3
Refer URGENTLY to hours, send the child for IV therapy
hospital for IV or NG
Unique problems in infants below 2
months of age:
Breastfeeding must continue during the rehydration
process, whenever the infant is able to suck
Complications like septicemia, paralytic ileus and severe
electrolyte disturbance are more likely in young infants
with diarrhea than at later ages
Diarrhea in these infants should be ideally treated as
inpatient,
This allows for careful assessment of need of systemic
antibiotics and monitoring
Proper nutrition
Vaccination