DIAGNOSIS

AND TREATMENT
OF DIARRHEA
IN SCHOOL
CHILDREN
Let us define
Diarrhea based on
WHO
Passage of three or
more loose or liquid
stools per day
or more frequent passage than is
normal for the individual
And according to
WHO
 2 nd
leading cause of death in children
under five years old
 Malaria
19% Measles
7%

Others
32% Diarrhoea
Malnutritio 19%
n
54%
Acute
Perinatal Respiratory
18% Infection
19%
DISTRIBUTION OF 11.6 MILLION DEATHS AMONG CHILDREN LESS THAN 5
YEARS OLD IN ALL DEVELOPING COUNTRIES
Each year diarrhea kills around 760,000
children under five

Globally, there are nearly 1.7 billion

cases of diarrheal disease every year
CLINICAL TYPES
Acute Watery Diarrhea
Acute Bloody Diarrhea
Persistent Diarrhea
A 7 year old was brought to the clinic with
several episodes of watery-based stools for 1 day
with low grade fever. No vomiting was noted. He
was conscious, coherent, ambulatory with stable
vital signs. Pertinent PE revealed eyeballs not
sunken, with hyperactive bowel sounds. Skin
pinch goes back quickly. What is the degree of
dehydration?

A. No dehydration
B. Some dehydration
C. Severe dehydration
The above patient was sent home after giving ORS
in the clinic. However, diarrhea persisted at home
this time with more episodes of watery-based
stools. He was brought back to the clinic. On
physical examination, he was noted to be thirsty
with sunken eyeballs, hyperactive bowel sounds.
Skin pinch goes back quickly. His weight was 15
kg. What is the degree of dehydration now?

A. No dehydration
B. Some dehydration
C. Severe dehydration
You decided to give ORS to the patient at
the clinic and observed him. What
Treatment Plan are you going to give this
patient?

A. Treatment Plan A
B. Treatment Plan B
C. Treatment Plan C
Aside from ORS, what else can you give
this patient?

A. zinc
B. probiotics
C. food
D. all of the above
Tears (absence) &
Dryness of mouth
are no longer used as
parameters
for dehydration
What is the
treatment for
Diarrhea?
FLUIDS
water
breastmilk
ORS
 Use of low/reduced
osmolarity
Oral Rehydration Solution
(ORS)
 OLD WHO-ORS REFORMULATED ORS
(meq or mmol/l) (meq or mmol/l)

GLUCOSE 111 75

SODIUM 90 75

CHLORIDE 80 65

POTASSIUM 20 20

CITRATE 10 10

OSMOLARITY 311 245

Composition of the old and reformulated ORS

TREATMENT PLAN
A
Dissolve 1 sachet of ORS
(commercially-available) in 200 ml water and
give as follows (per bout of loose stool):
50 – 100 ml in children less than 2 years old
100 – 200 ml in children 2 to 10 years old
As much as wanted for older than 10 years old
TREATMENT PLAN
B
Give ORS in 4 hours

Weight in kg X 75 = _______ ml to be given in

4 hours

* 1 sachet of any commercially available ORS sachet

Example
weight = 15 kg
15 kg X 75 ml = 1,125 ml of ORS to be given in
4 hrs
3 sachets in 300 ml – 1st hour
3 sachets in 300 ml – 2nd hour
3 sachets in 300 ml – 3rd hour
3 sachets in 300 ml – 4th hour
12 sachets in 1200 ml in 4 hours;

if tolerated by the patient, send the patient home

with TREATMENT PLAN A
TREATMENT PLAN
C
IV Fluid: plain LRS
Age Initial Phase Subsequent Phase
(30 ml/kg) (70 ml/kg)
Infants (<12 months) 1 hour* 5 hours
Older children 30 minutes* 2 ½ hours
*Repeat once if radial pulse is still very weak or imperceptible
If trained to use a
nasogastric tube
for rehydration?
Start hydration by tube (or mouth) with ORS
solution.
Give (20 ml/kg/hr) for 6 hours (Total of 120 ml/kg)
Reassess the child every 2 hours
- If there is repeated vomiting or increasing
abdominal distention, give fluid more slowly
- If hydration status is not improving after 3
hours, send the child for IV therapy
After 6 hours, reassess the child. Classify
dehydration
 ZINC
Give for 14 days
Children < 6 months = 10 mg/day
Children > 6 months = 20 mg/day
ESSENTIAL for:
- maintenance of immune system
- important in leukocyte function and cytokine

expression
- Skin integrity and wound healing
- Activities of the thymus, growth, and sex

hormones
Serves as co-factor of superoxide enzymes
Supports normal growth and development
especially in childhood and adolescence
Plus…
Continued feeding
(including breastfeeding)
Food
Anti-secretory
Probiotics
 PRIMARY
PREVENTION
rotavirus and measles immunization
hand washing
improved drinking water supply
good sanitary practices
SECONDARY
PREVENTION
breastfeeding
vitamin A
zinc
Antibiotics are only given for
diarrhea secondary to:
SHIGELLA
CHOLERA
GIARDIASIS
AMEBIASIS
A 7 year old was brought to the clinic with
several episodes of watery-based stools for 1 day
with low grade fever. No vomiting was noted. He
was conscious, coherent, ambulatory with stable
vital signs. Pertinent PE revealed eyeballs not
sunken, with hyperactive bowel sounds. Skin
pinch goes back quickly. What is the degree of
dehydration?

A. No dehydration
B. Some dehydration
C. Severe dehydration
The above patient was sent home after giving ORS
in the clinic. However, diarrhea persisted at home
this time with more episodes of watery-based
stools. He was brought back to the clinic. On
physical examination, he was noted to be thirsty
with sunken eyeballs, hyperactive bowel sounds.
Skin pinch goes back quickly. His weight was 15
kg. What is the degree of dehydration now?

A. No dehydration
B. Some dehydration
C. Severe dehydration
You decided to give ORS to the patient at
the clinic and observed him. What
Treatment Plan are you going to give this
patient?

A. Treatment Plan A
B. Treatment Plan B
C. Treatment Plan C
Aside from ORS, what else can you give
this patient?

A. zinc
B. probiotics
C. food
D. all of the above
THANK YOU
GOOD DAY