Š Š Diarrhea results in large losses of water and electrolytes sodium and potassium frequently is complicated by severe systemic acidosis .

thready. irritable Drinks normally. might refuse liquids Normal SEVERE DEHYDRATION (>9% LOSS OF BODY WEIGHT) Apathetic. fatigued or restless.cyanotic Minimal Quality of pulses Breathing Eyes Tears Mouth and tongue Skinfold Capillary refill Extremities Urine output Normal Normal Normal Present Moist Instant recoil Normal Warm Normal to decreased Normal to decreased Normal. unconscious Thirsty. or impalpable Deep Deeply sunken Absent Parched Recoil in >2 sec Prolonged.fast Slightly sunken Decreased Dry Recoil in <2 sec Prolonged Cool Decreased .alert Normal. unable to drink Normal to increased Tachycardia.SYMPTOM Mental status Thirst Heart rate MILD TO MODERATE MINIMAL OR NO DEHYDRATION (3² DEHYDRATION (<3% LOSS OF BODY 9% LOSS OF BODY WEIGHT) WEIGHT) Well.minimal Cold.eager to drink Drinks poorly.mottled. with bradycardia in most severe cases Weak. lethargic.

Š Š Š Š Hyponatremia Hypernatremia Hypokalemia Hyperkalemia .

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50²100 mL/kg body Same weight over 3²4 hr Lactated Ringer solution or normal saline in 20 mL/kg body weight intravenous amounts until perfusion and mental status improve.if unable to drink. then administer 100 mL/kg body weight ORS over 4 hr or 5% de trose ½ normal saline intravenously at twice maintenance fluid rates Same Same. >10 kg body weight: 120²240 mL ORS for each diarrheal stool or vomiting episode NUTRITION Continue breast-feeding.DEGREE OF DEHYDRATION Minimal or no dehydration REHYDRATION THERAPY Not applicable REPLACEMENT OF LOSSES <10 kg body weight: 60² 120 mL oral rehydration solution (ORS) for each diarrheal stool or vomiting episode. Same administer through nasogastric tube or administer 5% de trose ¼ normal saline with 20 mEq/L potassium chloride intravenously     . or resume ageappropriate normal diet after initial hydration. including adequate caloric intake for maintenance[*] Mild to moderate dehydration Severe dehydration ORS.

Š Restore intravascular volume ƒ ƒ Normal saline: 20 mL/kg over 20 min Repeat as needed Š Š Š Š Š Rapid volume repletion: 20 mL/kg normal saline or Ringer Lactate (ma imum = 1 L) over 2 hr Calculate 24-hr fluid needs: maintenance + deficit volume Subtract isotonic fluid already administered from 24 hr fluid needs Administer remaining volume over 24 hr using D5 ½ normal saline + 20 mEq/L KCl Replace ongoing losses as they occur .

Š Š Š Š VITAL SIGNS ƒ Pulse ƒ Blood pressure INTAKE AND OUTPUT ƒ Fluid balance ƒ Urine output and specific gravity PHYSICAL EXAMINATION ƒ Weight ƒ Clinical signs of depletion or overload ELECTROLYTES .

5 times maintenance .Š RESTORE INTRAVASCULAR VOLUME Normal saline: 20 mL/kg over 20 min (Repeat until intravascular volume restored) ƒ Š DETERMINE TIME FOR CORRECTION BASED ON INITIAL SODIUM CONCENTRATION ƒ ƒ ƒ ƒ [Na]:145²157 mEq/L:24 hr [Na]:158²170 mEq/L:48 hr [Na]:171²183 mEq/L:72 hr [Na]:184²196 mEq/L:84 hr Š ADMINISTER FLUID AT CONSTANT RATE OVER TIME FOR CORRECTION ƒ ƒ Typical fluid: D5 ½ normal saline (with 20 mEq/L KCl unless contraindicated) Typical rate: 1.25²1.

or Decrease rate of intravenous fluid 2. Sodium decreases too slowly Decrease sodium concentration of intravenous fluid.Š Š Š Š FOLLOW SERUM SODIUM CONCENTRATION ADJUST FLUID BASED ON CLINICAL STATUS AND SERUM SODIUM CONCENTRATION Signs of volume depletion: administer normal saline (20 mL/kg) 1. Sodium decreases too rapidly Increase sodium concentration of intravenous fluid. or Increase rate of intravenous fluid REPLACE ONGOING LOSSES AS THEY OCCUR .

Š Š Continued enteral feeding in diarrhea aids in recovery from the episode and a continued age-appropriate diet after rehydration is the norm. aiming to provide an energy intake of a minimum of 100 kcal/kg/day and a protein intake of between 2 and 3 g/kg/day . The usual energy density of any diet used for the therapy of diarrhea should be around 1 kcal/g.

vomiting. watery diarrhea Hypertension and bradycardia if significant increases in intracranial pressure Lacrimation. confusion. coma. nausea.or hypoactive deep tendon refle es. seizures. fatigue. increased intracranial pressure Weakness. salivation Oliguria Musculoskeletal Gastrointestinal Cardiovascular Tissue Renal . hyper.Body System Central nervous system Hyponatremia Headache. muscle cramps/twitching Anore ia.

Improved case management of diarrhea. .Š Š Š Š Š Promotion of exclusive breast-feeding. Improved complementary feeding practices Rotavirus immunization Improved water and sanitary facilities and promotion of personal and domestic hygiene.