1. Dr.Soma Sekhara Reddy

2. OBJECTIVES
 INTRODUCTION
 CAUSES
 ETIOPATHOGENESIS
 CLINICAL FEATURES AND COMPLICATIONS
 DIAGNOSIS
 EVALUATION OF DEHYDRATION
 TREATMENT
 PREVENTION

3. Introduction
 common cause of death in developing countries
 second most common cause of infant deaths
worldwide.

4. DIARRHOEA
 DEFINITION – Passage of watery stools atleast 3 times
in a 24h period.
 Recent change in consistency is more important.

6. ETIO-PATHOGENESIS
VIRAL – MC – ROTA, ADENO
OSMOTIC DIARRHOEA
LOSS OF MATURE ABSORPTIVE CELLS
INVADE S.I. MUCOSA
VIRAL - MC
ROTA ADENO

7. SECRETORY DIARRHOEA
ULCERATION – SYNTHESIS OF SECRETAGOGUES
ACUTE INFLAMMATION
INVADE LARGE INTESTINE
BACTERIAL - INVASIVE
SHIGELLA, SALMONELLA, YERSINIA, V.PARAHEMOLYTICUS

8. DECREASE ABSORPTIVE SURFACE
CELL INFLAMMATION, CELL DEATH
ELABORATION OF CYTOTOXIN
BACTERIA - CYTOTOXIC
SHIGELLA,EPEC,V.HEMOLYTICUS,C.DIFFICILE

9. ALTERED SALT AND WATER TRANSPORT
ENTEROTOXIN-INCREASE THE CONC. OF INTRACELLULAR
MEDIATORS
COLONISE SMALL INTESTINE
BACTERIA - TOXIGENIC
SHIGELLA,ETEC,VIBRIO

10. DECREASE INTESTINAL ABSORPTIVE SURFACE
FLATTENING OF MICROVILLI
COLONISE & ADHERE SMALL INTESTINE
BACTERIAL ADHERENTS
EPEC,EHEC

11. CAUSES OF DIARRHOEA WITH
MORBIDITY

12. CLINICAL FEATURES
 BLOODY STOOLS – BACTERIAL ETIOLOGY
HUS
 ABDOMINAL PAIN – GE
 PERITONEAL SIGNS - APPENDICITIS

15. DIAGNOSIS
 ATLEAST 3 STOOLS PER 24H
 ASSESSING DEHYDRATION
-H/O NORMAL FLUID INTAKE AND OUT PUT
- PHYSICAL EXAMINATION
- PERCENTAGE OF BODY WT LOSS

16. EVALUATING DEHYDRATION
 GENERAL CONDITION-MENTAL STATUS*
 THIRST*
 EXTREMITIES
 CAPILLARY REFILL TIME
 SKIN TURGOR
 BREATHING
 HEART RATE
 B.P
 PULSE QUALITY
 EYES*
 TEARS*
 MUCOUS MEMBRANES*
 ANTERIOR FONTANELLE
 URINARY OUTPUT

17. SIGNS NONE /MINIMAL
DEHYDRATION(<3%
LOSS OF BODY WT)
SOME/ MILD TO
MODERATE(3 -9%
LOSS OF B.WT)
SEVERE ( >9%
LOSS OF B.WT)

18. CLINICAL DEHYDRATION SCORE

19. LAB.EVALUATION AND IMAGING
 STOOL CULTURE- salmonella
shigella
yersinia
campylobacter
pathogenic E.coli-serotyping
 RAPID STOOL TEST: for inflammatory markers
 Hematological tests: white blood cell band count >100/mm3.
C-reactive protein cut point of >12
milligrams/dl
 Biochemical tests: BUN
Ser.bicarbonate <17 mEq/L
GRBS
 USG

20. TREATMENT
 ORT [ ORS: CH-75mmol/l; Na-75; k-20; Cl-65;
base-10; osmolarity-245m osm/l]
 ZINC FORTIFIED-ORS
 NO SUBSTITUTES
 IV REHYDRATION-only for severe dehydration
 REHYDRATION PHASE -Give 50 to 100 mL of
ORS/kg plus additional 10 mL/kg per stool and 2
mL/kg per emesis
 BREAST FEEDING

22. I.V. REHYDRATION
 START I.V.F IMMEDIATELY IF CHILD IS SEVERELY
DEHYDRATED.
 CONSIDER ORS IF CHILD CAN DRINK.
 I.V.F :
R.L + 5 % DEXTROSE***
R.L**
N.S.* - can be used
ONLY 5 % DEXTROSE – not effective

23. I.V. REHYDRATION
 TARGET : 100 ml /kg
 < 1 yr :
30 ml/kg in 1 hour
repeat 30 ml/kg in 1 hour
70 ml/kg in 5 hours
 >1 yr :
30 ml/kg in 30 min
repeat 30 ml/kg in 30 min
70 ml/kg in 2 and ½ hrs

24.  Start giving ORS if child starts drinking: 5 ml/kg/hr
< 1 year : within 3 to 4 hours
>1 year : within 1 to 2 hours

25.  IF UNABLE TO GIVE I.V.FLUIDS:
N.G.TUBE
20 ml/kg/hour
reassess after 1 to 2 hours repeated vomitting/
abdominal distension
no improvement after 3 hours
give the fluids more
Start i.v.fluids as soon as possible slowly

26. TREATMENT
 ANTIEMETIC-Ondansetron 0.5mg/kg/dose
 NO ANTIMOTILITY MEDICATION :
Diarrhea may function as an evolved expulsion
defense mechanism
Can cause HUS in EHEC infection.
 ADSORBANTS AND ANTISECRETORY AGENTS:
Bismuth – inc.salicylate levels
 PROBIOTICS - Lactobacillus GG and
Saccharomyces boulardii
 ANTIBIOTICS FOR A/C GE

27. PREVENTION
 Good Hygiene
 Vaccines
 Prevent global warming
Global warming α food borne infections
α contamination of water
ENRICH – ( December 2011 Bulletin from IAP )

28. Thank you