Diarrhoea Flashcards
What is the differential for acute diarrhoea?
Infective gastroenteritis
What are the possible causative viruses of IE?
- Rotavirus
- Adenovirus
- Norovirus
- Calcivirus
- Coronavirus
- Astrovirus
What are the possible causative bacteria of IE?
- Campylobacter jejuni
- Shigella
- Cholera
- E.coli
What is the most common responsible agent for IE in developed countries?
60% of cases in <2y/o = rotavirus
What children are at increased risk of dehydration?
- Infants <6/12 or of LBW
- Passed >/= 6 diarrhoeal stools in 24hrs
- Vomited >/= 3x in 24hrs
- Unable to tolerate extra fluids
- Those that are malnourished
When is a stool culture required in IE?
- If the child look septic
- Blood in stool
- The child is immunocompromised
Consider if:
1) The child has been abroad recently
2) Diarrhoea has not improved by day 7
3) Doubt about the Dx
When should a blood culture be taken in IE?
Only if Abx’s are started (Abx’s being v. rarely indicated)
When should blood work be taken in IE?
U&Es and glucose should be taken if IV fluids are necessary
What are the red flags for a child at risk of developing shock?
- Appears unwell/deteriorating
- Altered responsiveness - e.g. irritable/lethargic
- Sunken eyes
- Tachycardia
- Tachypnoea
- Reduced skin turgor
What should be included in the assessment of dehydration of a child?
- Conscious level
- Fontanelles - ?sunken
- Mucous membranes - ?dry
- Eyes - ?sunken
- Cap refill - ?prolonged
- Skin - ?pale/mottled
- Nappies - ?reduced urine output
- Skin turgor - ?reduced
- Extremities - ?cool
- Vitals - ?tachycardia, ?tachypnoea, ?hypotensive
If a child were dehydrated without shock, what % of dehydration would they have as a % of their normal body weight?
5%
If a child were shocked/shock was imminent, what % of dehydration would they have as a % of their normal body weight?
10-15%
What is the management if the child is not clinically dehydrated?
- Continue usual feeds, including breast milk. Solid food okay
- Encourage other fluids, but not fruit juice/carbonated
What is the management if the child is clinically dehydrated?
- Continue breast feeds, NOT solid food
- Give 50mg/kg ORS for fluid replacement + maintenance fluid over 4 hour period. ORS little and freq. Give via NG if not tolerated orally
- Do not give additional oral fluids
What is the management if the child is shocked?
Replacement and maintenance fluid via IV
What is the replacement fluid requirement for a child that is clinically dehydrated?
50ml/kg
What is the replacement fluid requirement for a child that is shocked?
100ml/kg
What are the maintenance fluid requirements for a child
100ml/kg for the first 10kg + 50ml/kg for the next 10kg + 25ml/kg after that
What should parents be advised re: how long to expect the D&V?
Diarrhoea usually lasts 5-7 days, most stop within 2 weeks
Vomiting usually lasts 1-2 days, most stop within 3 days
How long before children can return to nursery/school?
48 hours after the last diarrhoea episode
How long before children can go swimming?
2 weeks after the last diarrhoea episode
What are the differentials for chronic diarrhoea in children?
- Toddler diarrhoea
- Cows milk protein intolerance
- Coeliac disease
- Inflammatory bowel disease
What is the commenest cause of persistent loose stools in pre-school children?
Toddler diarrhoea
How does toddler diarrhoea effect growth?
It doesn’t - children continue to thrive
