GI - Toddlers Diarrhoea Flashcards
Defintion
Non-specific diarrhoea seen in small children, between about one and four years
Clinical features
Frequent, poorly formed brown and slightly offensive stools
Food material easily recognisable in the stool is a hallmark feature.
Dehydration symptoms
Passing little urine
Dry mouth
Dry tongue and lips
Fewer tears when crying
Sunken eyes
Weakness
Being irritable or lacking in energy (lethargic)
Symptoms of severe dehydration
Drowsiness
Pale or mottled skin
Cold hands or feet
Very few wet nappies
Fast (but often shallow) breathing
Management
Repeated parental reassurance and avoidance of full-strength fruit juices are very sufficient
Reducing intake of peas, corn, and carrots, which are not adequately chewed and appear in the stool, may serve to reduce parental anxiety about poor digestion
The faeces should become firm by age 3 or when child is toilet trained
IV fluid pathway
Fluid resuscitation
- For Px with no pre-existing condition (CKD or cardiac conditions)
- use glucose-free crystalloids that contain sodium in the range 131-154 mol/litre,
- with a bolus of 10ml/kg over less than 10 minutes for children and young people
- bolus of 10-20 ml/kg over less than 10 minutes for term neonates (0.9% NaCl)
Routine maintenance
- Measure plasma electrolyte concentrations and blood glucose when starting IV fluids (except before most elective surgery) and at least every 24 hours thereafter
- Neonates
= from birth to day 1: 50-60ml/kg/day
= day 2: 70-80 ml/kg/day
= day 3: 80-100 ml/kg/day
= day 4: 100-200 ml/kg/day
= day 5-28: 120 - 150 ml/kg/day
With 5-10% glucose
- Child or young person = use body weight
= 100 ml/kg/day for the first 10 kg of weight
= 50 ml/kg/day for the second 10 kg of weight
= 20 ml/kg/day for the weight over 20 kg.
= Be aware that over a 24-hour period, males rarely need more than 2500 ml and females rarely need more than 2000ml.
