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Presentation on theme: "DIARRHEA and DEHYDRATION"— Presentation transcript:


2 Sources: Excerpts from:
“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

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

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

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 absorbed in the small intestines even during copious diarrhea

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

History Physical Examination Select a plan to prevent or treat dehydration Management of acute diarrhea Management of acute bloody diarrhea Management of persistent diarrhea Prevention of diarrhea

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

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

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

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 Some Dehydration – follow Treatment Plan B to treat dehydration Severe Dehydration – follow Treatment Plan C to treat dehydration urgently

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

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

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: 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 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 Adults can consume up to 750mL/hr while still dehydrated Children can consume up to 20mL/kg BW/hr

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

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

21 PREVENTION & CONTROL Breastfeeding Improved weaning practices
Use of safe water Proper hand-washing / hand hygiene Use of latrine and safe disposal of stools Measles immunization


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