Gastroenteritis

Dehydration
Prof.dr. Sarah.M.Warouw,SpA(K)
dr.J.I.Christie.Manoppo,SpA
Gastrohepatology Division
Child Health Department
Faculty of Medicine,
University of Sam Ratulangi

Introduction

Diarrhea ia a major health problem

Global Problem
Morbidity &Mortality
Definition : Frequency &Consistency
Frequency : 3 times or more/day
Consistency : watery stool, without blood or
mocous (WHO )
Acute diarrhea,Chronic diarrhea,Dysentry
Osmotic diarrhea, Secretory diarrhea

Etiology of Diarrhea
Direct
Infection : Virus, bacteria, Parasite
Food: Malabsorbsition,toxin,alergy
Indirect
Malnutrition
Hygiene & Sanitation

Risk Factor for diarrhea

Host Factor

Malnutrition
Immune defect
Decreased Gastric HCl
Gut hypomotility
Genetic factor

Relationship between 3 factors :

Host, Environment and agent
Host

Environment
Agent
Hygiene& Sanitation Bacteria,virus,parasit

Etiology of Infectious Diarrhea

Virus
Bacteria

Parasite

Rotavirus
E.coli,Shigella, Salmonella,V Cholerae,
Campylobacter
Cryptopyridium,
Entamoeba,Plasmodia,
Giardia lamblia

Diarrhea causing organism divided

according to their mechanism of action
invasive

partially

toxigenic&

invasive

noninvasive

Shigella sp

Rotavirus

V Cholera

Salmonella sp

Norwalk agent

ETEC

Y enterocilitica

Giardia lamblia

A hydrophilis

C Jejuni

Cryptosporidium

V parahaenolitycus
E Histolytica

adherent

EPEC

Relative degree of invasiveness of

the organism causing diarrhea
Salmonella Shigella Rotavirus Cholera
Lumen
Mucosa
Submucosa

Osmotic diarrhea
nutrient
unabsorbed
Bacterial fermentation
organic acids
increased osmotic pressurre
water flush to lumen
Diarhea

Secretory diarrhea
Bacteria
Toxin
Stimulation of c-AMP,c-GMP
Stimulation of water/electrolyte secretion
Diarrhea

Pathophysiology
Diarrhea

Water
potasium
Sodium
Bicarbonate
Glukose

Dehydration
hypokalemia
hyponatremia
acidosis
hypoglycemia

Sign &Symptoms of some

dehydration

Restless, irritable
Sunken eye
No tears when he cries vigorously
Thristy
drink eagerly
Slowly skin pinch ( skin turgor)

Sign &Symptoms of severe

dehydration
Floppy (restlessness), lethargic or
unconsciousness
Very sunken & dry eyes
No tears when he cries
Is unable to drink/ drink poorly
Skin pinch : very slowly ( take > 2 second)

Diarrhea Management
Acessing a child for dehydration
Ask ,look and feel for signs of dehydration
Condition &behaviour,eyes,tears, mouth& tongue
thirst, skin pinch
Anterior fontanella ,arms& legs, pulse,breathing

Determine the degree of dehydration

Select a treatment plan :
C : severe dehydration ( loss of > 10% of BW)
B : mild to moderate dehydration (loss of 5-10% of BW)
A :no signs of dehydration( loss of < 5% of BW)

Weight the child

Treatment of diarrhea
At home (plan A)
Prepare & give appropriate fluids for ORT
Feed a child with diarrhea correctly
Recognize when a child should be taken to
health worker

When to take the child to a health

worker

There is no improvement in 3 days

The passage of many watery stools
Repeated vomiting
Increased thirst
Failure to eat or drink normaly
Fever
Bloody stool

Treatment of Diarrhea
Plan B : Manage in ORS corner
Continue breast feeding
Give ORS 75ml/kgBW/3hours
Monitor Tx&reasess the child periodically until
rehydration is complete
send home (plan
A)
Give ORS 10ml/kgBW for each diarrhea
Resume giving foods other after 4 hours
Suplement Zinc < 6 months 10mg
Suplement Zinc > 6 months 20mg

Failure of ORT

The passage of many watery stools

Repeated vomiting
Increased thrist
Failure to eat or drink normally
Severe dehydration
Meteorism
Preparing &giving ORS not correctly

Indication of IV Fluid

Severe dehydration or with hypovolemia

Unable to drink (unconscious)
Persisted vomiting
Prolonged oligouria or anuria
Other complication that influenced ORS

Treatment for severe

Dehydration(Plan C)
Give Ringer laktate 100 ml/kgBW ;
AGE

30ml/kgBW

70ml/kgBW

<12 months
>12 months

1hours
30min-1hours

5hours
2-21/2 hours

can be repeated if the pulse is still weak or

unpalpable

Indication for antibiotic treatment

Suspected cases of cholera
Tetracycline or doxycycline ( if resistant :
furazolidone,cotrimoxsasole or
chloramphenicol may be used)
Suspected cases of dysentery ( bloody
diarrhea) Cotrimoxsasole, ampicilin,
Nalidixic acid

Indication for antibiotic treatment

Laboratory-proven, symptomatic infection
with entamoeba histolytica : Metronidazole
Laboratory-proven, symptomatic infection
with Giardia lamblia : Metronidazole

Medication NOT INDICATED

for diarrhea

Sulphonamide
Neomycin and streptomycin
Clinoquinol or Oxyquinolone
Antiperistaltic drug
Antivomiting drug
Kaolin
Steroid
Purgative

Prevention
Breast milk for the first 6 months of live
Avoiding the use of infant feeding bottles
Improving practices
Preparation
&Storage of weaning foods
Using clean water for drinking
Washing hand
Safely disposing of stool

Prevention
Measless vaccination
Improving nutritional status weaning food
Rotavirus vaccination