Dr. Anitha Rani M.

D
Dept of Community Medicine
SRMC&RI
 Overview
• Definition

• Epidemiological determinants

• Clinical features

• Oral dehydration therapy

• Assessment of Dehydration

• Treatment plans A, B and C

• Prevention and Control

 DEFINITION

• Passage of loose, liquid or watery stools > 3

times a day.
 Clinical Types of Diarrhoea
• Acute Watery diarrhoea – V.Cholera, E.coli, Rota
virus.

• Acute bloody diarrhoea - Shigella

• Persistent diarrhoea – 14 days or more.

• Diarrhoea with severe malnutrition.

 TYPES OF DIARRHEA

Diarrhea

Watery diarrhea Dysentery Persistent diarrhea

Rota virus diarrhea Shigellosis Causes are mostly unknown

E. coli diarrhea Amebiasis
Cholera
 Problem statement
• Globally - Children < 5 years, a median of 3
episodes of diarrhoea occurred per child year : 1.4
billion episodes of diarrhoea per year.

• India – ADD account for about 8% of deaths in

under 5 years age group.
 Etiology
Viral causes

1. Rotavirus (up to 50% of the cases),

2. Norwalk group viruses

3. Adeno virus

4. Astro virus.

5. Calci virus.

6. Entero virus
 Etiology (contd)
Bacterial causes
1. Campylobacter jejuni
2. Salmonella species,
3. Shigella
4. Escherichia coli.
5. Vibrio cholera
6. Bacillus cereus
 Etiology (contd)

Parasites
Giardia intestinalis

E.histolytica

Cryptosporidium species
 COMMON CAUSES OF DIARRHEA-OTHERS
• Metabolic disease

▪Hyperthyroidism

▪Diabetes mellitus

▪Pancreatic insufficiency

▪Food allergy

▪Lactose intolerance

▪Antibiotics

▪Irritable bowel syndrome

• RESERVOIR : Man & Animals.
• HOST FACTORS : 6 months to 2 years.
Malnutrition Infection

Diarrhoea

Incubation period :
Few hours to five days - Bacterial diarrhoea.
One to two days - Viral diarrhoea.
 Mode of transmission
• Faeco oral transmission
• Water borne
• Food borne
• Direct transmission
 CLINICAL FEATURE: CHOLERA
• Rice-watery stool

• Marked dehydration

• Projectile vomiting

• No fever or abdominal pain

• Muscle cramps
• Hypovolemic shock
• Scanty urine
 CLINICAL FEATURE: E. COLI DIARRHEA

• Watery stools

• Vomiting is common

• Dehydration moderate to severe

• Fever– often of moderate grade

• Mild abdominal pain

 CLINICAL FEATURE: ROTAVIRUS DIARRHEA

• Insidious onset
• Prodromal symptoms, including fever, cough, and
vomiting precede diarrhea
• Stools are watery or semi-liquid; the color is greenish or
yellowish– typically looks like yoghurt mixed in water
• Mild to moderate dehydration
• Fever– moderate grade
 CLINICAL FEATURE: SHIGELLOSIS
• Frequent passage of scanty amount of stools, mostly
mixed with blood and mucus

• Moderate to high grade fever

• Severe abdominal cramps

• Tenesmus– pain around anus during defecation

• Usually no dehydration
 CLINICAL FEATURE: AMEBIASIS
• Offensive and bulky stools containing mostly mucus
and sometimes blood

• Lower abdominal cramp

• Mild grade fever

• No dehydration
 Oral rehydration therapy

• Increased Fluid And Electrolyte Intake And

Continued Feeding When A Child Has
Diarrhoea.
 Appropriate clinical management
Oral rehydration solution
2.6 gms sodium chloride

2.9 gms trisodium citrate dihydrate

1.5 gms potassium chloride

13.5 gms glucose (anhydrous)

The above ingredients are dissolved in one litre of clean water

and used within 24 hrs.
 What should be done if the child
vomits?

• They should give regular, small sips

of fluid.
• Giving ORT reduces nausea and
vomiting and restores the appetite
through correction of acidosis and
potassium losses.
 Should feeding continue at the same
time as ORT?

• Feeding, especially breastfeeding, should be

continued once dehydration has been corrected.

• Even if the diarrhoea continues or the child is

vomiting, some of the nutrients are being
absorbed.
 Home drinks
• Mothers can use household
liquids, preferably those that have
been boiled, such as rice water or
carrot soup.
• A simple salt/sugar solution, if
these ingredients are available, is
also suitable for early oral
rehydration therapy.
Diarrhoea assessment
• DECISION :

NO signs of dehydration : TREATMENT PLAN ‘A’.

SOME signs of dehydration : TREATMENT PLAN ‘B’.

SEVERE signs of dehydration : TREATMENT PLAN ‘C’.

Treatment plan
 Plan A: for No Dehydration
The mother should be given enough ORS packets for
two days.

After Each Loose Stool:

• 50-100 ml (¼ - ½ cup) of ORS solution for a child less
than 2 years old.
• 100-200 ml for older children(2-10 years).
• Adults can take as much as they want.
• Picture 1 moderate to severe dehydration (skin pinch +).
• Picture 2 - ORS solution given.
• Picture 3 - well hydrated and, still receiving ORS and some food.
 Plan B: for Some Dehydration
•
 Plan B: for Some Dehydration

➢If weight of the child is known- 75 ml/kg in 4 hrs.

➢If the patient wants more ORS solution, Give more.

➢After 4-6 hours reassess the child. Then choose

the suitable treatment plan.
 Plan C : for Severe Dehydration

• IV FLUIDS GIVEN IMMEDIATELY.

Give 100 ml / kg RL divided as

• Infants – 30 ml /kg in 1 hr. Then 70 ml/kg in 5 hrs.
• Older - 30 ml /kg in 30 min. Then 70 ml/kg in 2 1/2 hrs.
• REASSESS THE PATIENT EVERY 1-2 HRS.
 Control of diarrhoeal diseases
SHORT TERM STRATEGIES :
a. Appropriate clinical management.

LONG TERM STRATEGIES :

a. Better MCH care practices.
b.Preventive Strategies.
c.Preventing diarrhoeal epidemics.
 Better MCH practices
1.Maternal nutrition.

2.Child nutrition.

a.Promotion of BF.

b.Appropriate weaning practices.

c.Supplementary feeding.

d.Vit A supplementation
 Preventive strategies
1. Sanitation.
2. Health education.
3. Immunization – Measles and Rota virus vaccine
4. Fly control.

PREVENTION OF DIARRHOEAL EPIDEMIC: Primary health

care.
 The integrated Global Action Plan
for Pneumonia and Diarrhoea (GAPPD)

PROTECT

• Children by establishing good health practices

• Exclusive breastfeeding for 6 months

• Adequate complementary feeding

• Vitamin A supplementation