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approach to the patient of Acute Diarrhoea

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approach to the patient of Acute Diarrhoea

  1. 1. Approach to the patient of acute diarrhea
  2. 2. DEFINATION  Passage of 3—4 stools of consistency softer than normal per day,lasting less than 2 weaks.
  3. 3. CAUSES  INFECTIONS(90%)  FOOD INTOLERANCE  DRUGS  STRESS
  4. 4. INFECTIOUS DIARRHEA        INFLAMMATORY Shigella Salmonella Campylobacter Clostridium difficle Entamoeba histolytica Cytomegalovirus
  5. 5. NON-INFLAMMATORY Rota Virus  Norwalk  E.Coli  V.Cholera  Staphaureus  Bacillus Cereus 
  6. 6. Giardia
  7. 7. Shigella
  8. 8. salmonella
  9. 9. Vibrio Cholera
  10. 10. HISTORY Ask about the onset,duration and frequency of loose stools  Any recent travelling  Exposure to unpurified water  Any unusual food intake  Any history of drug intake  Similar illness in family 
  11. 11. EXAMINATION General appearance  Mental status  VITALS Blood pressure Pulse Rate Temprature Resp.Rate 
  12. 12. LOOK FOR DEHYDRATION Confused  Dry mouth  Inelastic Skin  Lethargy  Sunken Eyes  Decrease Urination 
  13. 13. Symptom s Mental status Thirst Minimal Moderate Severe Alert Restless Lethargic Pulse Normal drinking Eager to drink Normal Decrease Eyes Normal Tongue Skin Fold Moist Instant recoil Extremitie Warm Unable to drink Weak ,Thready Slightly Deeply sunken sunken Dry Parched Less than More than 2 sec. 2 sec Cool Cold,cyan
  14. 14. CLUE TO THE ORGANISM    WATER V.Cholera,Giardia,Norwalk POULTRY Salmonella,Shigella EGGS Salmonella
  15. 15.    SHELFISH V.Cholera,Salmonella FOREIGN TRAVEL E.Coli,Salmonella,Shigella,Giardia ANTIBIOTICS Clostridium difficle
  16. 16. MANAGEMENT  Maintain IV line or pass CVP line  Monitor vitals  Monitor urine output  Rehydrate the patient
  17. 17. Degree of Rehydration Replacement dehydration Mild Moderate Severe Nutrition Not Applicable 120—240ml Ors Normal soft for each loose diet with stool adequate calories ORS 50— SAME SAME 100ml body wt over 4 hours R.Lactate or SAME. By NG if SAME N/S,@ unable to drink 20ml/kg bolus until perfusion improves,then 100ml/kg ORS over 4 hrs.
  18. 18.  In Emergency rehydrate by giving Normal saline or Ringer Lactate @ 50….200ml/kg/24hrs  Fluids should be given according to hydration status  Look for basal crepts…or cvp pressure .r 
  19. 19. Anti diarrheal Can be used in mild – moderate diarrhea  Should not be used in inflammatory diarrhea  Loperamide 4mg initially,then 2mg after each loose stool 
  20. 20. ANTIBIOTICS     In most of the cases not required Empirical therapy given in inflammatory cases Ciprofloxacin 500mg BD Metronidazole 500 mg Tds if Giardia suspected
  21. 21. ADVISE FOR HOME Plenty of fluids  Specially ORS…1 sachet in 1 litre boiled water(100..200ml after each stool ) OR  Add 1tsp salt,8 tsp sugar.1tsp baking powder in 1 litre boiled water.  Take 1 or 2 banana alongwith it. 
  22. 22. DIET Soft diet  BANANA  RICE  APPLE MASH  TOAST  Avoid fats,milk,caffiene,alcohal
  23. 23. PREVENTION Always wash hands after trip to the toilet  Make sure ,dairy products you use are pasteurized  Avoid unnecessary antibiotics use  Eat freshly cooked meal  Use boiled water 
  24. 24. MCQ’S 
  25. 25.  Salmonella and shigella cause.. 1.Inflammatory diarrhea  2.Non.Inflammatory diarrhea  3.Both  4.Non of the above 
  26. 26.  Anti.diarrheals may be given in.. 1.Salmonella  2.Shigella  3.Staphaureus  4.Non of the above 
  27. 27.  Antimicrobials are indicated in… 1.Inflamatory diarrhea  2.Non Inflammatory diarrhea  3.Both 
  28. 28.  Water contains… 1.V.Cholera  2.Giardia  3.Norwalk  4.All  5.None 
  29. 29.  Diarrhea by C.difficle is due to. 1.Unpurified water  2.Use of antibiotics  3.Poultry  4.Shell fish 
  30. 30. Identify the Organism. 1.Salmonella  2.Shigella  3.E.coli  4.Non of the above 
  31. 31.  In Dehydration Heart rate .. 1.Increases  2.Remains normal  3.May be decreased  4.Both 1&3 true. 
  32. 32. THANKS 

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