1. Dr. Muhammad Razzaq malik

2. DIARRHOEA  It is the passage of liquid and watery stool more than three times a day.  It is the recent change in consistency of stools rather than the number of stools.

3. Dr. Muhammad Razzaq malik PERSISTANT DIARRHOEA  Diarrhoea of presumed infectious origin that begins acutely and lasts for 14 days or more.

4. Dr. Muhammad Razzaq malik DYSENTERY  Presence of blood and pus in the stools, abdominal cramps and fever. Gross blood in the stools is the most reliable sign.

5. Dr. Muhammad Razzaq malik DD  Biggest single killer of children  Causing nutritional loss, Growth retardation  Dehydration and death ( >10% loss of fluid)`  4 B cases of diarrhoea in the world  2.2 M deaths out of which 2 M deaths / yr <5  50 % deaths due to dehydration  14 % Persistant diarrhoea  15 % dysentery  DD are impt. Contributors of pool of malnutrition

6. Dr. Muhammad Razzaq malik FACTORS  Contaminated water supply  Contaminated food  Unsanitary disposal of human waste  Poor personal and domestic hygiene

7. Dr. Muhammad Razzaq malik PAKISTAN  Very high mortality in Pakistan  700,000 children deaths during one year  228,000 deaths due to diarrhoea  Diarrhoea leading to malnutrition  Reduced resistance leading to repeated infections  Wrong management of diarrhoea is a major cause of malnutrition & death  No health education / counseling

8. Dr. Muhammad Razzaq malik CAUSES OF DIARRHOEA  Rota virus  E Coli  Shigella  Compylobacter jejuni  Vibrio cholerae  Salmonellosis  Protozoa E. Hisyolytica Giardia lumblia Cryptosporidium

9. Dr. Muhammad Razzaq malik Death due to DD < 5 yearsDia.Rota Afghanistan293,0006153012306 Bangla Desh 3120006552013104 India2400,000504,000100,800 Pakistan599,00012579025158 UK40004014 USA30,000300102 World1,06,30,00021,12,020439,788

10. Dr. Muhammad Razzaq malik ASK  Duration of diarrhoea;  Consistency of stool;  Presence of blood in the stool;  Presence of fever, convulsions, or other problems (e.g., cough, recent measles);  Pre-illness feeding practices;  Type and quantity of fluids (including breast milk) and food consumed during the illness; and  Drugs or other remedies taken.

11. Dr. Muhammad Razzaq malik LOOK  General condition: alert; restless or irritable; floppy, lethargic or unconscious; severely undernourished?  Eyes: sunken, or very sunken and dry?  Are there tears when the child cries?  Mouth and tongue: moist, dry, or very dry?  When water is offered to drink : is it taken normally, eagerly, or is the patient unable to drink?  Respiration.

12. Dr. Muhammad Razzaq malik

16. PLAN-A-1  Give the child more fluids than usual to prevent dehydration Home food-based fluids like gruels, cooked rice, soups, potatoes and yoghurt-like drinks If this is not possible, give plain water Use ORS solution for the treatment and prevention of dehydration, Give as much as free fluids as child can take Continue fluids until diarrhoea stops

17. Dr. Muhammad Razzaq malik PLAN-A-2  Give the child plenty of food to prevent under nutrition Continue BF Give usual milk if not BF, If < 6 months, dilute milk can be added / given If > 6 months, give freshly prepared solid foods like cereals, pulses, vegetables along with oil Give fresh fruit juices, smashed banana for K‾ Encourage child to eat, offer food 6 times a day Give same food after dia. stops

18. Dr. Muhammad Razzaq malik PLAN-A-3  Take the child to health worker if child does not get better in 3 days or develop any of the following Many watery stools Repeated vomiting Marked thirst Eating or drinking poorly Fever Blood in stool

19. Dr. Muhammad Razzaq malik Composition of Oral Rehydration Salt (ORS) IngredientGrams Sodium chloride Sodium bicarbonate Potassium chloride Glucose, 3.5 2.5 1.5 20.0

20. Dr. Muhammad Razzaq malik Composition of Oral Rehydration Salt (ORS) IngredientGrams Sodium chloride Trisodium citrate, dihydrate Potassium chloride Glucose, 3.5 2.9 1.5 20.0

21. Dr. Muhammad Razzaq malik Composition of Oral Rehydration Salt Solution IngredientGrams Sodium chloride Trisodium citrate dihydrate Potassium chloride Glucose, Water 3.5 2.9 1.5 20.0 1 Liter

22. Dr. Muhammad Razzaq malik O R Sol  Sodium90 m.mol / L  Potassium 20  Chloride80  Citrate10  Glucose111  ORS should preferably be given with a teaspoon or in small sips from a cup or tumbler.

23. Dr. Muhammad Razzaq malik ORS  Educate mother how much ORS is given after each stool & give 2 packets Age < 2 years---50-100 ml Age 2 -10 years---100-200 ml 10 years or more– as much as wanted  Show mother how to mix ORS  Show mother how to give ORS Give 1 TSF every 1-2 minutes If child vomits, give ORS slowly after waiting for 10 minutes

24. Dr. Muhammad Razzaq malik ORS (4 hrs)=(wtx75) Age<4 mon 4-11 mon 1-2 yrs 2-4 yrs 5-14 yrs 15 & abov e Wt (Kg) <55- 7.9 8- 10.9 11- 15.9 16- 29.9 30 & abov e ORS sol (ml) 200 - 400 400- 600 600- 800 800- 120 0 120 0- 220 0 220 0- 400 0

25. Dr. Muhammad Razzaq malik food  Give plenty of food to prevent under- nutrition  Continue breast feeding  Continue foods like milk,  Nutrient rich foods  Increase food intake after diarrhoea stops  Never restrict food during diarrhoea

26. Dr. Muhammad Razzaq malik Education of mother Explain to the mother that she should take her child to a health worker if the child does not get better in 3 days or;  Starts to pass may stools;  Has repeated vomiting;  Becomes very thirsty;  Is eating or drinking poorly;  Develops a fever;  Has blood in the stool.

27. Dr. Muhammad Razzaq malik Good weaning practices  Wash hands before preparing food and before feeding the child  Prepare food in a clean place.  Wash uncooked food in clean water before feeding it to child.  Cook or boil food well when preparing it.  Prepare weaning foods immediately before they will be eaten.  Cover foods that are left over.  Keep foods in a cool place  If cooked food is prepared more than 2 hours in advance of feeding, reheat it until it is thoroughly hot before giving it to the child.

28. Dr. Muhammad Razzaq malik Prevention of Deaths Due to D.D  Improved mother & child nutrition  Optimal BF practices  ORT  Zinc supplementation during diarrhoea.  Immunization of all children against measles  Appropriate drug therapy  Increased access to safe water supply  Proper sanitation facilities  Improved personal & domestic hygiene.

29. Dr. Muhammad Razzaq malik

37. Preparing ORS

38. Dr. Muhammad Razzaq malik

39. Home made ORS

40. Dr. Muhammad Razzaq malik MCQ  Glucose is added to rehydrating solution because it: Changes taste for easy drinking Increases absorption of salt and water Increases absorption of amino acids For sweet taste of the solution All of the above

41. Dr. Muhammad Razzaq malik MCQ  Following are present in ORS except: Sodium bicarbonate Sodium chloride Potassium chloride Calcium chloride Glucose

42. Dr. Muhammad Razzaq malik MCQ  The freshly ORS should not be used for more than: 2 hours 8 hours 12 hours 24 hours 30 hours

43. Dr. Muhammad Razzaq malik MCQ  Home made ORS is made of in one liter of water: -10 gm salt, 10 gm sugar 5 gm salt, 20 gm sugar 20 gm salt, 5 gm sugar 5 gm salt, 50 gm sugar All of the above

44. Dr. Muhammad Razzaq malik MCQ  Estimated fluid deficit in severe dehydration is: 40 ml / kg 65 ml / kg 75 ml / kg 100 ml / kg 150 ml / kg

45. Dr. Muhammad Razzaq malik MCQ  Which of the following is not true about oral rehydrating solution: Mild to moderate dehydration can be corrected by ORS at home The solution at home should be made daily In BF child, nursing should be delayed till dehydration is corrected Patients should be given as much ORS as they want ORS should not be given to a child who is unconscious.

46. Dr. Muhammad Razzaq malik MCQ  Ideal intravenous fluid for correction of dehydration due to diarrhoea is : Normal saline Ringer lactate Dextrose saline 5% dextrose Oral rehydrating solution

47. Dr. Muhammad Razzaq malik MCQ  All of the following viral infections produce diarrhoea except Enterovirus Adenovirus Rota virus Retrovirus Norwalk virus

48. Dr. Muhammad Razzaq malik MCQ  Diarrhoea is more common during weaning because of Declining level of maternally acquired antibodies Lack of active immunity in infants Introduction of contaminated food Eruption of teeth Cessation of breast feeding