Transcript 3._Diarrhea_III

Diarrhea
Dr. Adnan Hamawandi
Professor of Pediatrics
Treatment of diarrhea
Rehydration therapy
Goals
1. Correct existing fluid deficit.
2. Replace further fluid losses.
Treatment of diarrhea
Sever dehydration : The treatment of choice
is Intravenous fluid.
 Ringer’s lactate is the preferred solution.
Normal saline or half normal saline in
glucose may be used.
 Infants should receive IV fluid at a rate of
30ml./kg in the first hour followed by 70ml./kg
in the next 5 hours, thus providing 100ml./kg
in 6 hours.
Treatment of diarrhea
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Older children should be given 30ml./kg
within 30 minutes followed by 70ml./kg in the
next 2 and half hours, thus providing
100ml./kg in 3 hours.
After the first 30ml/kg has been given a
strong radial pulse should be readily palpable
If it is very weak and rapid a second infusion
of 30ml./kg should be given in the same rate;
however, this is rarely necessary.
Treatment of diarrhea
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Small amounts of ORS( 5ml/kg) should also
be given by mouth as soon as the patient is
able to drink to provide additional potassium
and bicarbonate. This is usually possible
after 3 – 4 hours for infants and 1 – 2 hours
for older children.
Treatment of diarrhea
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At the end of planned rehydration period
(usually 3 – 6 hours), the patient hydration
state should be reassessed carefully.
If signs of sever dehydration are still present
rehdration should be continued by IV route,
If there are signs of some dehydration shift
to treatment of some dehydration.
Treatment of diarrhea
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Some dehydration:
Can be treated in the ORT corner where
mothers can help with treatment and learn
how to continue it at home.
Oral rehydration solution 75 ml./kg has to be
given in the first four hours. It should be
given by a cup and spoon. A teaspoonful
every 1 – 2 minutes for infants and frequent
sips from a cup for an older child.
Treatment of diarrhea
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If the child vomits, wait 10 minutes and then
continue giving ORS but more slowly.
If the child eyelids become puffy stop ORS
and give plain water or breast milk until the
puffiness is gone.
After 4 hours carefully reassess the child’s
hydration status; If the child has No signs of
dehydration, the child can continue treatment
at home by ORS and feeding.
Treatment of diarrhea
If there are signs of some dehydration
continue giving the estimated volume of ORS
again until the signs of dehydration
disappear. If the child is passing watery
stools frequently and the signs of sever
dehydration appear ORT should be
temporarily stopped and the child rehydrated
intravenously.
Treatment of diarrhea
Treatment of diarrhea at home:
Is appropriate when the child have no signs
of dehydration. Three important rules has to
be explained to the mother:1. Give the child more fluid than usual to
prevent dehydration. The recommended
home fluids include ORS, food based fluids
( soups, rice water, and yoghurt), and water.
Treatment of diarrhea
Amount of ORS to be given after each loose
stool is 50 – 100 ml. in children less than 2
years of age and 100 – 200 ml. in older child.
Continue giving these fluids until diarrhea
stops.
Treatment of diarrhea
2. Give the child plenty of food to prevent
malnutrition.
 Continue to breast feed frequently and if the
child is not breast fed give the usual milk.
 If the child is 6 months or older
- give cereal or another starchy food mixed
with pulses, vegetables and meat or fish. Add
1-2 teaspoonful vegetable oil to each serving
Treatment of diarrhea
-Give fresh fruit juice or mashed banana to
provide potassium.
-Encourage the child to eat. Give food at least
6 times/day.
-Give the same foods after diarrhea stops and
give an extra meal each day for 2 weeks.
Treatment of diarrhea
3. Take the child to the health center if he does
not get better in three days or develops
- Many watery stools.
- Repeated vomiting.
- Marked thirst.
- Eating or drinking poorly.
- Blood in stools.
- Fever.
Treatment of diarrhea
Nutritional therapy
Feeding should be continued during all
types of diarrhea to the greatest extent
possible and should be increased during
convalescence so as to avoid malnutrition.
Treatment of diarrhea
Antimicrobial therapy
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Should not be used routinely . Most episodes
including sever diarrhea and diarrhea with
fever do not benefit from such treatment.
The exceptions are :1. Dysentery
2. suspected cholera.
Treatment of diarrhea
3. Persistent diarrhea when trophozoite or
cyst of Giardia or trophozoite of E. histolytica
are seen in the feces or intestinal fluids, or
when pathogenic enteric bacteria are
identified by stool culture.
Treatment of diarrhea
Antidiarrheal and antiemetic
Antimotility agents (Diphenoxylate, Codeine,
Loperamide) adsorbants(Charcoal, Pectin,
Kaolin) and antiemetics including
Chlorpromazine and Promethazine should
NOT be used in the treatment of diarrhea in
children less than 5 years of age as non of
these drugs has any proved practical
benefits and some may have serious side
effects.
Role of Zinc in treatment of acute
diarrhea in children.
Zinc treatment is a simple, inexpensive, and critical
new tool for treating diarrheal episodes among
children in the developing world. This important
micronutrient becomes depleted during diarrhea, but
recent studies suggest that replenishing zinc with
a10- to 14-day course of treatment can reduce the
duration and severity of diarrheal episodes and may
also prevent future episodes for up to three months.
WHO and UNICEF specifically recommend daily
20 mg zinc supplements for 10 days for children with
acute diarrhea and 10 mg per day for infants under
six months old.
Role of Probiotics in the management
of diarrhea in children
Specific probiotic strains can contribute to both the prophylaxis
and therapeutic management of acute infectious diarrhea in
children decreasing its incidence and duration. They favorably
affect the host by local and/or immune modulation pathways.
1. In the gut, the probiotic agents compete with pathogens for
nutrients and prevent their adherence to the mucosa.
2. They produce bacteriocins that acts as local antibiotic; and
they induce the synthesis of human B- defensin 2 an
antimicrobial peptide.
3. they produce lactic and acetic acid that can inhibit pathogen
growth by lowering luminal PH.
4. Probiotics may improve integrity of the mucosal barrier
function by stimulating mucin production.