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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.
WHO-UNICEF recommended policies
• Caregivers/ mothers should start treatment with new low osmolarity ORS solution immediately upon onset of diarrhea in a child. • Zinc supplementation with 20 mg per day of zinc supplementation for 14 days (10 mg per day for infants under six months old). • Emphasize continued feeding or increased breastfeeding during, and increased feeding after, the diarrheal episode. • Emphasize handwashing.
Water + Electrolytes Loss Zinc Loss
Lessen absorption capacity Decreases Immunity
Zinc Tablets Faster Recovery of Intestine Mucosa Increase in absorption capacity Increase in immunity
Management of Diarrhea and Dehydration
How long? How many? Is the child passing urine? 3-7 days Yes, freely 7-14 days Yes, but in decreased quantity Some Dehydration Restless , Irritable Sunken Thirsty, drinks eagerly Goes back slowly bit in less than 2 seconds 5-10% of body wt or 50-100 ml / kg body wt More than 14 days Blood in stool Greatly reduced urine output Severe Dehydration Lethargic, unconscious Sunken Drinks poorly or not able to drink Goes back very slowly, in more than 2 seconds >10% of body wt or 100 ml / kg body wt
Condition Eyes Thirst Skin pinch
Well , Alert Normal Drinks normally, Not thirsty Goes back quickly <5 % of body wt or 50 ml./ kg body wt
Assessment of a child with Diarrhea
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.
How much to give?
Give as much fluid as the child wants until diarrhea stops. Children < 2 years of age : 50-100 ml of fluid. Children 2 years - 10 years : 100-200 ml. Older children and adults : As much as they want.
Give 10 / 20 mg (depending on age of the child) every day for 14 days.
What feeds to give?
Breastfeeding should always be continued. The infant's usual diet should be continued during diarrhea and increased afterwards. .Emphasize
washing of Hands
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.
11-15.9 kg 16-29.9 kg
30 kg or more 2400-4000 ml
CUPS (200 ml)
Signs of Dehydration
For children with severe dehydration
• Refer the patient. • Preferred treatment is rapid intravenous rehydration.
Skin pinch test for dehydration
Why are drugs prescribed in Diarrhea?
• Lack of Knowledge • Lack of confidence in ORS and Zinc • Families demand drugs and Injections • Consultation/ Dispensing fees
Irrational use of drugs
• Increases the cost of therapy • Diverts attention from main therapy- ORS, feeding and Zinc • Side-effects - antibiotic induced diarrhea • Complications- Simple infection converted into a lifethreatening infection due to - Abdominal distension, - Paralytic ileus - Respiratory depression - Septicemia - Pseudomembranous entero-colitis • Drug resistance
Antibiotics, Adsorbents and Anti-motility drugs are NOT indicated in the routine treatment of acute childhood diarrhea.
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
• Safe drinking water
• Environmental sanitation and safe disposal of excreta • Measles vaccination
• 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.
THERE IS NO BETTER TIME THAN NOW