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1 DIARRHEA and DEHYDRATION. 2 Sources: Excerpts from: “Integrated Approach to the Management of Childhood Illnesses” from the WHO - Integrated Management.

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Presentation on theme: "1 DIARRHEA and DEHYDRATION. 2 Sources: Excerpts from: “Integrated Approach to the Management of Childhood Illnesses” from the WHO - Integrated Management."— Presentation transcript:

1 1 DIARRHEA and DEHYDRATION

2 2 Sources: Excerpts from: “Integrated Approach to the Management of Childhood Illnesses” from the WHO - Integrated Management of Childhood Illness (IMCI) Manuals and Courses “Integrated Approach to the Management of Childhood Illnesses” from the WHO - Integrated Management of Childhood Illness (IMCI) Manuals and Courses “Management Protocols of Infectious and Tropical Diseases” of the Research Institute for Tropical Medicine, DOH “Management Protocols of Infectious and Tropical Diseases” of the Research Institute for Tropical Medicine, DOH

3 3 DIARRHEA Defined by WHO as change in consistency of stools Del Mundo, 4 th ed, p.698 Acute Diarrhea loose bowel movement loose bowel movement lasting <14 days lasting <14 days

4 4 DIARRHEA 2 ND leading cause of death globally (WHO, Tropical Disease, 1990 ASM News) In the Philippines (1998 data) #1 cause of morbidity for all ages #1 cause of morbidity for all ages 2 nd leading cause of child mortality 2 nd leading cause of child mortality An important cause of malnutrition An important cause of malnutrition

5 5 DEHYDRATION Causes many diarrheal deaths If not severe, can be safely & effectively treated using oral rehydration Oral Rehydration Salts combination of glucose & several salts combination of glucose & several salts absorbed in the small intestines even during copious diarrhea absorbed in the small intestines even during copious diarrhea

6 6 PRINCIPLES OF MANAGEMENT 1.Prompt replacement of fluids & electrolytes 2.Maintenance of nutrition 3.Use of anti-microbials only for those with bloody diarrhea, suspected cholera or serious non- intestinal infections & avoidance of anti-diarrheal agent 4.Patients or caretakers should be taught about feeding & hygiene practices that reduce diarrhea morbidity. Emphasize prevention & follow-up.

7 7 ASSESS & CLASSIFY DIARRHEA 1.History 2.Physical Examination 3.Select a plan to prevent or treat dehydration 4.Management of acute diarrhea 5.Management of acute bloody diarrhea 6.Management of persistent diarrhea 7.Prevention of diarrhea

8 8 HISTORY 1.presence of blood in stool 2.duration of diarrhea 3.presence of fever, cough, convulsions, recent measles 4.pre-illness feeding practices 5.type & amount of fluids (including breast milk) & food taken during the illness 6.drugs or other remedies taken (herbal) 7.immunization history

9 9 Physical Examination 1.Check for signs & symptoms of dehydration 1.1. LOOK for: - general condition - general condition - eyes and tears - eyes and tears - mouth and tongue - mouth and tongue - thirst - thirst 1.2. FEEL the child: - skin turgor - skin turgor

10 10 Physical Examination 2.Check for signs of other important problems: -does the stool contain red blood? -take the temperature

11 11 Prevent of Treat Dehydration Choose the treatment plan that corresponds with the patient’s degree of dehydration No Signs of Dehydration – follow Treatment Plan A at home to prevent dehydration & malnutrition No Signs of Dehydration – follow Treatment Plan A at home to prevent dehydration & malnutrition Some Dehydration – follow Treatment Plan B to treat dehydration Some Dehydration – follow Treatment Plan B to treat dehydration Severe Dehydration – follow Treatment Plan C to treat dehydration urgently Severe Dehydration – follow Treatment Plan C to treat dehydration urgently

12 12 Management of Acute Diarrhea Treatment Plan A Rule 1: Give the child more fluids than usual to prevent dehydration Rule 1: Give the child more fluids than usual to prevent dehydration What fluids to give Any fluid that normally contains salt Any fluid that normally contains salt Plain clean water Plain clean water Other fluids Other fluids How much fluids to give General Rule: General Rule: As much fluid as patient wants until diarrhea stops

13 13 Management of Acute Diarrhea Treatment Plan A Home ORS: Mix the ff in a liter of water: Home ORS: Mix the ff in a liter of water: - 1 level tsp of table salt + 8 level tsp of table sugar - Give at least 2 bananas How much fluids to give after each loose stool: How much fluids to give after each loose stool: Children < 2 yrs: 50 – 100 mL of fluid Children 2 – 10 yrs: 100 – 200 mL Older children & adults: as much fluid as they want

14 14 Management of Acute Diarrhea Treatment Plan A Rule 2: Continue to feed the child to prevent malnutrition Rule 2: Continue to feed the child to prevent malnutrition Continue feeding during diarrhea Increase feeding afterwards Do not withhold food Do not dilute usual food Continue breastfeeding AIM: GIVE AS MUCH NUTRIENT-RICH FOOD AS THE CHILD WILL ACCEPT

15 15 Management of Acute Diarrhea Treatment Plan A What foods to give What foods to giveMilk Breast milk – as often & as long as child wants Breast milk – as often & as long as child wants Milk formula – every 3 hrs, if possible by cup Milk formula – every 3 hrs, if possible by cup Infants < 4 months: on mixed feeding should receive increased breastfeeding. If possible, breastfeed exclusively Infants < 4 months: on mixed feeding should receive increased breastfeeding. If possible, breastfeed exclusively Other foods Those recommended for child’s age Those recommended for child’s age Locally appropriate energy & nutrient rich food Locally appropriate energy & nutrient rich food

16 16 Management of Acute Diarrhea Treatment Plan A Rule 3: Take the child to a health worker if there are signs of dehydration or other problems: Rule 3: Take the child to a health worker if there are signs of dehydration or other problems: Starts to pass many watery stools Has repeated vomiting Becomes very thirsty Is eating or drinking poorly Develops a fever Has blood in the stools or Child does not get better in 3 days

17 17 Management of Acute Diarrhea Treatment Plan B Patients with Some Dehydration should receive oral rehydration therapy (ORT) with ORS solution in a health facility following treatment plan B Patients with Some Dehydration should receive oral rehydration therapy (ORT) with ORS solution in a health facility following treatment plan B Adults can consume up to 750mL/hr while still dehydrated Adults can consume up to 750mL/hr while still dehydrated Children can consume up to 20mL/kg BW/hr Children can consume up to 20mL/kg BW/hr

18 18 Management of Acute Diarrhea Treatment Plan C For patients with SEVERE dehydration For patients with SEVERE dehydration Patients should be brought to the hospital so that IV fluids can be started immediately Patients should be brought to the hospital so that IV fluids can be started immediately Usual fluid given is Lactated Ringer’s solution Usual fluid given is Lactated Ringer’s solution If not available, Normal Saline solution may be used If not available, Normal Saline solution may be used

19 19 Management of Acute Bloody Diarrhea Patient should be referred immediately to the hospital Especially if also with severe malnutrition If not, assess patient, give appropriate fluids to prevent or treat dehydration and give food

20 20 Management of Persistent Diarrhea Objective of treatment: Restore weight gain Restore weight gain Restore normal intestinal function Restore normal intestinal function Treatment consists of: Appropriate fluids to prevent or treat dehydration Appropriate fluids to prevent or treat dehydration Antimicrobials to treat diagnosed infections Antimicrobials to treat diagnosed infections A nutritious diet that does not worsen the diarrhea A nutritious diet that does not worsen the diarrhea Supplementary vitamins and minerals Supplementary vitamins and minerals

21 21 PREVENTION & CONTROL 1.Breastfeeding 2.Improved weaning practices 3.Use of safe water 4.Proper hand-washing / hand hygiene 5.Use of latrine and safe disposal of stools 6.Measles immunization


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