Dr. Muhammad Razzaq malik. DIARRHOEA It is the passage of liquid and watery stool more than three...

Dr. Muhammad Razzaq malik


DIARRHOEA

It is the passage of liquid and watery stool more than three times a day.

It is the recent change in consistency of stools rather than the number of stools.


PERSISTANT DIARRHOEA

Diarrhoea of presumed infectious origin that begins acutely and lasts for 14 days or more.


DYSENTERY

Presence of blood and pus in the stools, abdominal cramps and fever. Gross blood in the stools is the most reliable sign.


DD

Biggest single killer of children Causing nutritional loss, Growth retardation Dehydration and death ( >10% loss of fluid)` 4 B cases of diarrhoea in the world 2.2 M deaths out of which 2 M deaths / yr <5 50 % deaths due to dehydration 14 % Persistant diarrhoea 15 % dysentery DD are impt. Contributors of pool of

malnutrition


FACTORS

Contaminated water supply Contaminated food Unsanitary disposal of human waste Poor personal and domestic hygiene


PAKISTAN

Very high mortality in Pakistan 700,000 children deaths during one year 228,000 deaths due to diarrhoea Diarrhoea leading to malnutrition Reduced resistance leading to repeated

infections Wrong management of diarrhoea is a

major cause of malnutrition & death No health education / counseling


CAUSES OF DIARRHOEA

Rota virus E Coli Shigella Compylobacter jejuni Vibrio cholerae Salmonellosis Protozoa

E. Hisyolytica Giardia lumblia Cryptosporidium


Death due to DD< 5 years Dia. Rota

Afghanistan 293,000 61530 12306

Bangla Desh

312000 65520 13104

India 2400,000 504,000 100,800

Pakistan 599,000 125790 25158

UK 4000 40 14

USA 30,000 300 102

World 1,06,30,000 21,12,020 439,788


ASK

Duration of diarrhoea; Consistency of stool; Presence of blood in the stool; Presence of fever, convulsions, or other

problems (e.g., cough, recent measles);

Pre-illness feeding practices; Type and quantity of fluids (including

breast milk) and food consumed during the illness; and

Drugs or other remedies taken.


LOOK

General condition: alert; restless or irritable; floppy, lethargic or unconscious; severely undernourished?

Eyes: sunken, or very sunken and dry? Are there tears when the child cries? Mouth and tongue: moist, dry, or very

dry? When water is offered to drink : is it

taken normally, eagerly, or is the patient unable to drink?

Respiration.


Eyes1 Normal

Tears Present

Assessment of Diarrhoea Patients for DehydrationA

1. Look At: condition Well, alert

Goes back quickly

Use Treatment Ploan A

MOUTH and TONGUE Moist

THIRST 2 Drinks normally, not thirsty

2. FEEL SKIN PINCH3

3. DECIDE:

4. TREAT:

The patient has NO SIGNS OF DEHYDRATION

Dr. Muhammad Razzaq malik TREAT: Weigh the patient, if possible,

and use Treatment Plan B

feel skin pinch

DECIDE: If the patient has two or more signs, including at least one *signs*, there is SOME DEHYDRATION

*Goes back slowly*

mouth 7 tongue Dry

thirst * Thirsty, drinks eagerly*

Eyes Sunken

Tears Absent

Assessment of Diarrhoea Patients for DehydrationB

Look At: condition *Restless, Irritable*


THIRST 2 * Drinks poorly or not able to drink*

Assessment of Diarrhoea Patients for DehydrationC

2. FEEL SKIN PINCH3

3. DECIDE: If the patient has two or more signs, including at least one *signs*, there is SERVER DEHYDRATION

*Goes back slowly*

4. TREAT: Weigh the patient, and use Treatment Plan C URGENTLY

1. Look At: condition *Lethargic or unconscious; floppy*

Eyes1 Very sunken and dry

Tears Absent

MOUTH and TONGUE very dry


PLAN-A-1

Give the child more fluids than usual to prevent dehydration Home food-based fluids like gruels, cooked

rice, soups, potatoes and yoghurt-like drinks

If this is not possible , give plain water Use ORS solution for the treatment and

prevention of dehydration, Give as much as free fluids as child can

take Continue fluids until diarrhoea stops


PLAN-A-2

Give the child plenty of food to prevent under nutrition Continue BF Give usual milk if not BF, If < 6 months, dilute milk can be added / given If > 6 months, give freshly prepared solid foods

like cereals, pulses, vegetables along with oil Give fresh fruit juices, smashed banana for K‾ Encourage child to eat, offer food 6 times a

day Give same food after dia. stops


PLAN-A-3

Take the child to health worker if child does not get better in 3 days or develop any of the following Many watery stools Repeated vomiting Marked thirst Eating or drinking poorly Fever Blood in stool


Composition of Oral Rehydration Salt (ORS)

Ingredient Grams

Sodium chloride

Sodium bicarbonate

Potassium chloride

Glucose,

3.5

2.5

1.5

20.0


Composition of Oral Rehydration Salt (ORS)

Ingredient Grams

Sodium chloride

Trisodium citrate, dihydrate

Potassium chloride

Glucose,

3.5

2.9

1.5

20.0


Composition of Oral Rehydration Salt Solution

Ingredient Grams

Sodium chlorideTrisodium citrate dihydratePotassium chlorideGlucose, Water

3.52.9

1.520.01 Liter


O R Sol

Sodium 90 m.mol / L Potassium 20 Chloride 80 Citrate 10 Glucose 111 ORS should preferably be given with

a teaspoon or in small sips from a cup or tumbler.


ORS

Educate mother how much ORS is given after each stool & give 2 packets Age < 2 years---50-100 ml Age 2 -10 years---100-200 ml 10 years or more– as much as wanted

Show mother how to mix ORS Show mother how to give ORS

Give 1 TSF every 1-2 minutes If child vomits, give ORS slowly after waiting

for 10 minutes


ORS (4 hrs)=(wtx75)

Age <4 mon

4-11 mon

1-2 yrs

2-4 yrs

5-14 yrs

15 & above

Wt (Kg)

<5 5-7.9 8-10.9

11-15.9

16-29.9

30 & above

ORS sol (ml)

200-400

400-600

600-800

800-1200

1200-2200

2200-4000


food

Give plenty of food to prevent under- nutrition

Continue breast feeding Continue foods like milk, Nutrient rich foods Increase food intake after diarrhoea

stops Never restrict food during diarrhoea


Education of mother

Explain to the mother that she should take her child to a health worker if the child does not get better in 3 days or;

Starts to pass may stools; Has repeated vomiting; Becomes very thirsty; Is eating or drinking poorly; Develops a fever; Has blood in the stool.


Good weaning practices

Wash hands before preparing food and before feeding the child

Prepare food in a clean place. Wash uncooked food in clean water before

feeding it to child. Cook or boil food well when preparing it. Prepare weaning foods immediately before they

will be eaten. Cover foods that are left over. Keep foods in a cool place If cooked food is prepared more than 2 hours in

advance of feeding, reheat it until it is thoroughly hot before giving it to the child.


Prevention of Deaths Due to D.D

Improved mother & child nutrition Optimal BF practices ORT Zinc supplementation during diarrhoea. Immunization of all children against

measles Appropriate drug therapy Increased access to safe water supply Proper sanitation facilities Improved personal & domestic hygiene.


Preparing ORS


Home made ORS


MCQ

Glucose is added to rehydrating solution because it: Changes taste for easy drinking Increases absorption of salt and water Increases absorption of amino acids For sweet taste of the solution All of the above


MCQ

Following are present in ORS except: Sodium bicarbonate Sodium chloride Potassium chloride Calcium chloride Glucose


MCQ

The freshly ORS should not be used for more than: 2 hours 8 hours 12 hours 24 hours 30 hours


MCQ

Home made ORS is made of in one liter of water:

-10 gm salt, 10 gm sugar 5 gm salt, 20 gm sugar 20 gm salt, 5 gm sugar 5 gm salt, 50 gm sugar All of the above


MCQ

Estimated fluid deficit in severe dehydration is: 40 ml / kg 65 ml / kg 75 ml / kg 100 ml / kg 150 ml / kg


MCQ

Which of the following is not true about oral rehydrating solution: Mild to moderate dehydration can be corrected

by ORS at home The solution at home should be made daily In BF child, nursing should be delayed till

dehydration is corrected Patients should be given as much ORS as they

want ORS should not be given to a child who is

unconscious.


MCQ

Ideal intravenous fluid for correction of dehydration due to diarrhoea is : Normal saline Ringer lactate Dextrose saline 5% dextrose Oral rehydrating solution


MCQ

All of the following viral infections produce diarrhoea except Enterovirus Adenovirus Rota virus Retrovirus Norwalk virus


MCQ

Diarrhoea is more common during weaning because of Declining level of maternally acquired

antibodies Lack of active immunity in infants Introduction of contaminated food Eruption of teeth Cessation of breast feeding

Dr. Muhammad Razzaq malik. DIARRHOEA It is the passage of liquid and watery stool more than three...

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