Professional Documents
Culture Documents
by
Harold Rugnao
ESSENTIAL CONCEPTS OF DIARRHEA
DIARRHEA
passage of unusually loose or watery stools, at
least 3x in a 24 hr period
CLINICAL TYPES OF DIARRHEA
Acute watery diarrhea
Acute bloody diarrhea
Persistent diarrhea
Diarrhea with severe malnutrition
ESSENTIAL CONCEPTS OF DIARRHEA
Dehydration
Deficit of water and electrolyte
Malnutrition
Zinc Deficiency
Use of antimicrobials and anti-diarrheal drugs
Important Microbial Causes of Acute
Diarrhea in Infants and Children
Rotavirus Campylobacter jejuni
Escherichia Coli Vibrio cholerae 01
Enterotoxigenic
and 0139
Localized adherent
Salmonella
Diffuse Adherent
Giardia duodenalis
Enteroinvasive
Enterohemorrhagic
Entamoeba
histolytica
Shigella
Cryptosporidium
ASSESSMENT OF CHILD WITH
DIARRHEA
1. History
2. Physical Exam
3. Determine Degree of Dehydration and
select treatment plan
4. Diagnose other important problems
ASSESSMENT OF DIARRHEA PATIENTS
FOR DEHYDRATION
A B C
LOOK AT: CONDITION Well, alert Restless, irritable Lethargic or
unconscious
EYES Normal Sunken Sunken
THIRST Drinks Drinks eagerly, Drinks Poorly or not
normally, not thirsty able to drink
thirsty
FEEL: SKIN PINCH Goes back goes back slowly goes back very slowly
quickly
DECIDE NO SIGNS SOME SIGNS OF SEVERE SIGNS OF
OF DEHYDRATION DEHYDRATION
DEHYDRA-
TION
TREAT Use Weigh the patient, Weigh the patient, use
treatment use Treatment Treatment Plan C
plan A Plan B URGENTLY
ESTIMATED FLUID
DEFICIT
Assessment Fluid deficit as Fluid deficit in
%of body wt ml/kg body wt
No signs of <5% < 50ml/kg
dehydration
Some dehydration 5 – 10 % 50 – 100 ml/kg
2. CONTINUE FEEDING
- To prevent malnutrition
If the child wants more ORS than shown, give more
AFTER 4 HOURS
Reassess the child and classify the child for
dehydration
Select the appropriate plan
Begin feeding the child
GIVING ZINC
GIVING FOOD
Treatment Plan C – for patients with
severe dehydration
1. GUIDELINES FOR INTRAVENOUS
REHYDRATION
Give 100ml/kg Ringer’s Lactate Solutiona
divided as follows:
Age First give 30ml/kg in: Then give 70ml/kg in:
Infants (under 1 hourb 5 hours
12 months)
Older 30 minutesb 2 ½ hours
• Reassess the patient every 1 – 2 hrs. If hydration is not improving, give the IV drip
more rapidly
•After 6 hrs (infants) or 3 hrs (older patients), evaluate patient using the assessment
chart. Then choose the appropriate Treatment Plan
a
if Ringers Lactate Solution is not available, nomal saline may be used
b
Repeat once if radial pulse is still very weak or not detectable
2. MONITOR THE PROGRESS OF INTRAVENOUS
REHYDRATION
3. ELECTROLYTE DISTURBANCES
Hypernatremia
Serum Na > 150mmol/L
Can cause convulsions
Hyponatremia
Serum Na < 130mmol/L
Lethargy, less often, seizures
Hypokalemia
Serum K+ <3 mmol/L
Muscle weakness, paralytic ileus, impaired
kidney function and cardiac arrhythmia
Management of
Suspected Cholera
Cholera differs from acute diarrhea of other
causes in 3 ways:
It occurs in large epidemics that involve both
children and adults
Voluminous watery diarrhea may occur, leading
rapidly to sever dehydration with hypovolemic
shock
For cases with sever dehydration appropriate
antibiotics may shorten the duration of the
illness
Antimicrobial Therapy
Management of Acute Bloody
Diarrhea (Dysentery)
Shigella is the most common cause of bloody
diarrhea
Ciprofloxacin for 3 days
Out Patient Management of Bloody
Diarrhea
CHILD WITH LOOSE STOOLS
WITH BLOOD
REFER TO
SEVERELY MALNOURISHED?
HOSPITAL
Yes
No
COMPLETE 3
BETTER IN 2 DAYS? DAYS
Yes TREATMENT
No
INITIALLY DEHYDRATED REFER TO
AGE< 1Y/O OR MEASLES HOSPITAL
Yes
IN PAST 6 WEEKS
CHANGE TO SECOND
ANTIMICROBIAL FOR
SHIGELLA b
COMPLETE 3
BETTER IN 2 DAYS? DAYS
Yes TREATMENT
No
REFER TO HOSPITAL OR
TREAT FOR AMOEBIASIS
Management of
Persistent Diarrhea
Persistent Diarrhea
Diarrhea, with or without blood, that begins acutely
and lasts at leat 14 days.
Usually associated with weight loss, and often, with
serious non-intestinal infections