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Prevent dehydration, if no signs of dehydration are present. Treat dehydration, if present. Reduce duration and severity of illness. Prevent nutritional damage. Reduce the occurrence of future episodes.
Diarrhea
Water + Electrolytes Loss Zinc Loss
Dehydration
ORS
Zinc Tablets Faster Recovery of Intestine Mucosa Increase in absorption capacity Increase in immunity
Rehydration
No Dehydration
SEE
Well , Alert Normal Drinks normally, Not thirsty Goes back quickly <5 % of body wt or 50 ml./ kg body wt
Fluid deficit
DO
PLAN A
PLAN B
PLAN C
PLAN A
Home therapy to prevent dehydration and malnutrition
Children with no signs of dehydration need extra fluid and salt to replace their losses of water and electrolytes due to diarrhea.
Fluids to be given
ORS Salted drinks e.g. salted rice water, salted yoghurt drink ,green coconut water. Home based ORS. Plain water should also be given. Commercial fizzy drinks, fruit juices, sweetened tea, coffee, medicinal tea should be avoided.
Zinc supplement
Give 10 / 20 mg (depending on age of the child) every day for 14 days.
washing of Hands
PLAN B
For children with some dehydration
Approximate amount of ORS required (in ml) can be calculated by multiplying the patient's weight in kg by 75. More can be given, if required. Breast feeding should be continued. No other foods are to be given during the initial period. After 4 hours, the child should be given some food every 3-4 hours. After 4 hours, reassess the child and decide what treatment to be given next as per level of dehydration. Referred for IV rehydration if dehydration persists.
AGE
WEIGH T
<4 months
<5 kg
4-11 months
5-7.9 kg
12-23 months
8-10.9 kg
2-4 years
5-15 years
>15 years
11-15.9 kg 16-29.9 kg
30 kg or more 2400-4000 ml
ML
CUPS (200 ml)
200-400 ml
400-600 ml
600-800 ml
800-1200 ml
1200-2400 ml
12
20
Signs of Dehydration
PLAN C
For children with severe dehydration
Refer the patient. Preferred treatment is rapid intravenous rehydration.
Antibiotics, Adsorbents and Anti-motility drugs are NOT indicated in the routine treatment of acute childhood diarrhea.
Danger Signs
Refer immediately if Does not improve within 3 days. Increase in the number of stools. Develops very watery or bloody stools. Severe vomiting. Marked reduction in urine output. Develops high grade fever. Decrease in alertness or consciousness.
Prevention of diarrhea
Exclusive breast feeding for 6 months Complementary feeding at 6 months Hand washing
CONCLUSION
A substantial reduction in the diarrhea burden will require greater emphasis on the following actions: Reinstate diarrhea prevention and treatment as a cornerstone of community-based primary health care. Reach every child with effective interventions. Ensure wide availability of low-osmolarity ORS. Ensure wide availability and use of zinc.
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