Acute Watery Diarrhoea

Presented by - DOEL

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 CONTENTS
1. Definition
2. Statistics
3. Types
4. Etiology
5. Mode of transmission
6. Pathogenesis
7. Sign / Symptoms
8. Management
9. Complication
 Definition
According to WHO,

“Diarrhoea is defined as the passage of three or more loose or liquid

stools per day (or more frequent passage than is normal for the
individual)”

Even one big volume of loose motion can be defined as diarrhoea.

 Statistics
 Diarrhoeal disease is the second most common cause of death in
children under five years old, accounting about 9% of total
deaths.
 Each year Diarrhoea kills around 5,25,000 children under 5,
nearly 1.7 Billion children are affected worldwide.
 This translates about 1300 young children dying each day.
 Worldwide,1.53 Million people died due to diarrhoeal disease in
2019.

Source - UNICEF, 2019

 Statistics
 According to the latest WHO data published in 2020 Diarrhoeal diseases Deaths in
Bangladesh reached 36,111 or 5.05% of total deaths
 Classification
1. Acute-diarrhoea
which lasts for less than 14 days; usually
infective cause
• Watery
• Bloody(Dysentery)
2. Chronic/Persistent diarrhoea
which lasts for more than 14 days,
usually due to non-infective cause.
 Etiology
Infectious Non-Infectious
Toxin in food – Staphylococcus NSAID’s
aureus Cytotoxic Agents
Clostridium Drugs Antibiotics
Gastroenteritis

Laxative
PPI
Bacterial –
Escherichia coli, Vibrio
Cholerae, Salmonella Metabolic Diabetes
Viral – Cause Thyrotoxicosis
Rota virus (most common),
Astro virus, Adeno virus
Protozoal - Inflammatory
Giardiasis, Malaria GI cause Bowel Disease
 Mode Of Transmission
The main mode of transmission is faeco-oral route which can be
through 5F’s

1. Food
2. Fluid
3. Fly
4. Finger
5. Feces

Incubation Period –
Few hours to 48 hours
 Pathogenesis
1. Ingestion of Toxin or Agent

2. Adherence to mucous membrane of Intestine

3. Release of enterotoxin

4. Interfere with endothelial function

5. Interfere with Absorption or increased secretion

6. Watery Diarrhoea
 Sign / Symptoms

 Loose watery Stool

 Abdominal cramps or Pain
 Vomiting
 Nausea
 Bloating
 Fever
 Mucous in the stool
 Lethargy
 Dehydration
 Laboratory Diagnosis
1. In Acute Watery Diarrhoea, if there is no features of
dehydration, No investigation is usually given

If needed,
2. Microscopic examination of stool
3. Stool culture and sensitivity
4. CBC
5. Serum Electrolytes
 Treatment

• Treatment begins with the assessment of the patients conditions, esp.

dehydration status (no dehydration, some or severe dehydration) and
corresponding intervention.

• A. Non severe diarrhoea - No drug treatment

-- Oral Rehydration Therapy,
-- Home made fluid (green coconut water)
-- Diet (breastfeeding, khichuri, vegetables,
rice, pulse, fish, meat, banana)
 Treatment

B. Severe diarrhoea- Saline in I/V route (Cholera Saline, Hartman’s

Solution, Normal saline)
--Zinc supplements
-- Antimotility drugs
--Specific (in case of cholera) – Antibiotics
• Symptomatic
 Assessment of dehydration
No Dehydration Some Dehydration Severe Dehydration

General Well, alert Restless, irritable Lethargic or

appearance unconscious
Eyes Normal Sunken Sunken

Thirst Drinks normally, Thirsty, drink eagerly Drinks poorly or

not thirsty unable to drink
Skin pinch Goes back quickly Goes back slowly Goes back very
slowly
Heart rate Normal Increased Increased

Urine output Decreased Markedly Decreased Anuria

 Correction of Dehydration & Electrolyte Imbalance

No dehydration Some dehydration Severe dehydration

# Give ORS 50-100ml/kg ORS 100ml/kg I/V saline
# Proper diet
# Give Zinc
supplementation

(Zinc supplements reduce

the duration of a diarrhoea
episode by 25% and are
associated with a 30%
reduction in stool volume)
 Oral Rehydration therapy

Sodium – 3gm/L
chloride – 3.5gm/L.
Potassium - 0.5gm/L
Acetate – 2.8 gm/L
Water – 1L
 I/V saline (Cholera Saline)

Sodium – 3gm/L
chloride – 3.5gm/L.
Potassium - 0.5gm/L
Acetate – 2.8 gm/L
Water – 1L
 I/V therapy (Hartman’s Solution)

Sodium chloride – 4 gm.

Potassium chloride – 1 gm.
Sodium acetate lactate – 6.5 gm.
Water for injection – 1000 ml.
 Specific Treatment

# In Diarrhoea caused by Cholera –

In Adult: Tetracycline
In Children: Cotrimoxazole, Erythromycin

# Anti Motility Drug (act on enteric nervous system)

To reduce motility & act on mucosa to reduce secretions)
Loperamide, Bismuth Subsalicylate, Colestipol
 Irrational Use of Antibiotics
The vast majority of medications given for childhood
diarrhoea are not only ineffective, they can also be
dangerous (WHO, 1990)

 Anti motility drug in children, especially in babies or

in patients with IBD, there’s potential danger of
causing Paralytic ileus & respiratory distress.

 Irrational use of anti microbial drugs (Example -

Azithromycin, Ciprofloxacin) can lead to antibiotic
resistance, adverse effects & cost burden to the
patient.
 Irrational Use of Antibiotic

Many families buy antibiotics

without seeking medical advice.
Even when doctors are consulted,
they also recommend drugs more
often then ORT despite knowing
better.
Steps to make Homemade ORS
 Complication

1. Dehydration
2. Electrolyte imbalance
3. Shock
4. Convulsion
5. Coma
6. Death
Prevention Of Diarrhoeal Disease
 Avoid Contamination With Good Hand Hygiene

1. Hand hygiene
2. Personal hygiene
3. Home hygiene
4. Control of vector
 Maintenance of Proper Food Hygiene
1. To prevent these illnesses, the Pan American Health Organization/World Health Organization
(PAHO/WHO) recommends "five keys to food safety.“

2. These five simple keys to safe and healthy food are: keep clean, separate raw and cooked,
cook thoroughly, keep food at safe temperatures, and use safe water and raw materials.
Use of Improved Sanitation
 Exclusive Breastfeeding

It is protective and prevents diarrhoea from occurring in young children. Breastfeeding

also reduces the SEVERITY of diarrhoea.
Vaccination against Cholera & Rota Viral Diarrhoea
Health Education About How Infections Spread
 Presented By

Ibrahim Salim
Rabbil Alamin Sagor
Afsana Afrin Anthi
Sifat Dewan
Ishmam Nihal
Tamanna Rupa