DIARRHOEA Flashcards
What is Diarhea
Diarrhea is the passage of frequent loos watery stool 3 or more times a day
Commonest cause of diarrhea in children
Virus
Diseases associated with diarrhea
Malaria
Pneumonia
Ear infections
Urinary tract infections
Should enemas and laxatives be given in diarrhea
No
What is acute diarrhea
Less than 2 weeks
Infections associated with chronic diarrhea
Tuberculosis
Opportunistic infections with HIV/AIDS
Amoebiasis
Cuases of chronic diarrhea
Chronic infections
Functional
Inflammatory disease
Malabsorption syndromes
Malignancy
Endocrine disorders
Drug-induced causes
What iss chronic diarrhea
More than 2 weeks
Causes of acute diarrhea
Viruses: norovirus, rotavirus
Bacteria: E. coli, Campylobacter, Shigella, Salmonella, Vibrio cholerae
Protozoal: E. histolytica
Drugs: penicillins
Drug-induced causes of chronic diarrhea
Laxatives
NSAIDs
Functional causes of chronic diarrhea
Irritable bowel syndrome
Inflammatory causes of chronic diarrhea
Ulcerative colitis
Crohn’s disease
Signs of diarrhea
Anemia
Weight loss
Anorexia
Oral lesions
Skin lesions
Signs of dehydration
Enlarged thyroid
Abdominal mass
Rectal mass
Endocrine causes of chronic diarrhea
Hyperthyroidism
Diabetic autonomic neuropathy
Symptoms of diarrhea
Frequent watery stools
Blood or mucus in stool
Associated vomiting
Reduced urine output
Presence of fever
Diagnostic clues seen in viral diarrhea
Diarrhea with vomiting, low grade fever with no mucus in stools
Diagnostic clues seen in bacterial diarrhea
Diarrhea with vomiting, fever, blood or mucus in stools abdominal cramps
Diagnostic clues seen in amoebiasis
Diarrhea with blood and mucus in stool without fever
Diagnostic clues seen in cholera
Profuse diarrhea with rice water stools and vomiting
Diagnostic clues seen in food poisoning
Diarrhea with excessive vomiting (especially if in more than one member of the household or group)
Diarrhea presenting with oral and or skin lesions, weight loss over a long period is seen in ………..
HIV
Diarrhea alternating with constipation is seen in …….
Bowel malignancy
Assess dehydration based on condition of child
Nil (<5%)
Well, alert
Mild-moderate (5-10%)
Irritable, restless
Severe (>10%)
Unconscious, floppy or lethargic
Assess dehydration based on eyes of child
Nil (<5%)
Normal
Mild-moderate (5-10%)
Sunken
Severe (>10%)
Very dry and very sunken
Assess dehydration based on mouth and tongue of child
Nil (<5%)
Moist
Mild-moderate (5-10%)
Dry
Severe (>10%)
Very dry
Assess dehydration based on level of thirst of child
Nil (<5%)
Drinks normally, not thirsty
Mild-moderate (5-10%)
Thirsty, drinks eagerly
Severe (>10%)
Drinks poorly
Assess dehydration based on how the child’s skin fells after pinching
Nil (<5%)
Goes back immediately after pinching
Mild-moderate (5-10%)
Goes back slowly after pinching
Severe (>10%)
Goes back very slowly after pinching
Treatment plans for different degrees of dehydration
Nil
Treatment plan A
Mild-moderate
Traetment plan B
Severe
Treatment plan C
Investigations in diarrhea
FBC
BUE/Cr
Stool C/S
Stool routine examination
Blood film for malaria parasites
Treatment objectives in diarrhea
To prevent dehydration
To replace lost fluid
To maintain nutrition by ensuring adequate dietary intake during illness
To maintain personal hygiene
To eliminate infecting organism
Non-pharmacological management of diarrhea
Keep surroundings clean
Improve personal hygiene
Adequate fluid intake
Maintain adequate nutrition
First line treatment for bacterial gastroenteritis
Oral Ciprofloxacin
500mg 12 hourly for 5 days in adults
15mg/kg for 5 days in children
Second line treatment for bacterial gastroenteritis
IV Cefuroxime
750mg 8 hourly for adults
25mg/kg 12 hourly for Children
25mg/kg 12 hourly for neonates > 7 days
25mg/kg 8 hourly for neonates < 7 days
then
Oral Cefuroxime for 5-7 days
250mg 12 hourly in adults and children > 12 years
15mg/kg (max 250mg 12 hourly) for 2-12 years
10mg/kg (max 125mg 12 hourly) 3months to 2 years
Can cefuroxime suspension be given to neonates
No, it can only be used in children above 3 months
Treatment for amoebic dysentery
PO Metronidazole
800mg 8 hourly for 5 days in adults
400mg 8 hourly for for 5 days in 8-12 years
200mg 8 hourly for 5 days in 4-7 years
100mg 8 hourly for 5 days in 0-3 years
Treatment for cholera
Tetracycline for 3 days
500mg 6 hourly in adults
or
Doxycycline for 3 days
100mg 12 hourly in adults
or
Erythromycin for 5 days
500mg 8 hourly in adults and children >13 years
250-500mg 6 hourly for 6-12 years
250mg 6 hourly for 2- 6 years
125mg 6 hourly for 1 month to 2 years
12.5mg/kg 6 hourly for neonates
How long should ORS be given again if the child vomits
After 10 minutes
Zinc dosing in diarrhea
10mg for 10-14 days in children < 6months
20mg for 10-14 days in children > 6 months
Plan A treatment of diarrhea by fluid therapy in children 2-10 years
1000ml or more of ORS basic amount
100-200ml of ORS for every extra stool passed
Plan A treatment of diarrhea by fluid therapy in children <2 years of age
500ml or more of ORS basic amount
50-100ml of ORS for every extra stool passed
Plan A treatment of diarrhea by fluid therapy in children over 10 years
2000ml or more of ORS basic amount
100-200ml of ORS for every extra stool passed
For treatment plan B how long is ORS given for initially
4 hours
For treatment plan B, when is state of hydration reassessed
After 4 hours
Plan B treatment of diarrhea by fluid therapy in children <6kg or up to 4months
ORS 200-400ML
Plan B treatment of diarrhea by fluid therapy in children 6 to 10kg or 4-12 months
ORS 400 to 700ml
Plan B treatment of diarrhea by fluid therapy in children 10-12kg or 1 to 2 years
ORS 700 to 900ml
Plan B treatment of diarrhea by fluid therapy in children 12-19kg or 2 to 5 years
ORS 900 to 1400ml
Approximate way of calculating required ORS amount for treatment plan B
Weight times 75ml
Total IV fluid regimen in treatment plan C
100ml/Kg R/L
or
Normal saline
or
Cholera replacement fluid (5:4:1)
According to treatment plan C, when is ORS given and how much is given
5ml/kg/hour as soon as child can drink
3-4 hours in infants
1-2 hours in children
According to treatment plan C, when is reassessment for dehydration done
After 6 hours in infants
After 3 hours in children
When is IV fluids stopped according to treatment plan C
Do not stop the IV fluids until the child has been observed to retain the ORS for at least 1 hour and there is improvement in the clinical condition
Potassium abnormalities in diarrhoea
Hypokalemia due to marked fluid loss
or
HShyperkaliemia from impaired renal function leading
Acid base imbalance present in diarrhea
impaired renal function leading to acidosis
Should infants or children breastfeed or eat during diarrhea
Yes
Plan C diarrhea treatment plan by fluid therapy
Infants (<12 months)
30ml/kg in 1 hour then 70ml/kg in 5 hours
Children (12months to 5 years)
30ml/kg in 30mins then 70ml/kg in 2.5 hours
Anti-diarrheal medications not used in children
Loperamide
Codeine
Diphenoxylate/atropine
Mist kaolin
Antibiotic preparations with kaolin or pectin are beneficial in diarrhea
False
Most common cause of severe diarrhea in children less than 5 years
Rotavirus
Rotavirus diarrhea peaks between which months
Dry months (December-March)
Symptoms of rotavirus diarrhea
Fever
Vomiting
Profuse watery diarrhea
Thirst
Signs of rotavirus diarrhea
Sunken eyes
Diminisehd skin turgor
Altered consciousness
Investigations in rotavirus diarrhea
Enzyme immunoassay (EIA) to detect rotavirus antigen
Non-pharmacological treatment of rotavirus diarrhea
Home-based fluids
Adequate nutrition (give an extra meal per day for 2 weeks after the episode )
pharmacological treatment of rotavirus diarrhea
ORS
Zinc
Prevention of rotavirus diarrhea
Two (2) doses of Rotavirus vaccine, given at 6 - 10 weeks
The 2nd dose should be given by 16 weeks, and not later than 24 weeks
Referral criteria for rotavirus diarrhea
Poor response to rehydration process (passing more stools than
drinking)
Poor drinking
Blood in stool
Poor feeding
Altered consciousness/convulsions
Diarrhoea and vomiting continuing for > 3 days
