ACUTE DIARRHEA

1. What is diarrhea?
It is the passage of liquid or watery stools more than 3 times a day.
A recent change in character of stool is more important.

2.What is dysentery?
Gross blood in the stool is the hallmark of dysentery and may be
accompanied by abdominal cramps and fever.

3. What is not diarrhea?
. Passage of frequently formed stools.
. Passage of pasty stools in breast fed infants
. Passage of stool during or immediately after feeding due to gastrocolic reflex.
. Passage of frequent loose greenish yellow stools on the 3rd and 4th day of life called as transitional stools.

4.What are the consequences of diarrhea?
Dehydration and Malnutrition leading to Death.

5.Why does diarrhea cause malnutrition?
. Impaired intestinal absorption causes loss of nutrients in diarrhea.
. Increased catabolism(waste of energy) due to infection.
. A child with diarrhea is often not hungry.
. Mothers withhold food during diarrhea.
. Doctors do not emphasize proper feeding during diarrhea.

6.What are the common causes of diarrhea?
. Rotavirus is the commonest cause of dehydrating diarrhea in children.
. Cholera is seen in epidemics.
. Shigella is the most common cause of dysentery.
. Giardia and Amoebiasis are uncommon causes of acute diarrhea.

7.How do you assess a child with diarrhea?

8 . What is the treatment for diarrhea?
ORAL REHYDRATION THERAPY(ORT): It is the cornerstone of management of diarrhea. The term ORT includes
. WHO ORS solution
. Home made salt sugar solution
. Food based solutions
. Culturally acceptable fluids in presence of continued feeding.

9.How do you give fluid therapy in diarrhea?
. Provide normal daily fluid requirements.
. Continue Breast milk or full strength animal or formula milk.
. Semisolid food if eaten by child should be continued.
. Replace ongoing losses.
. Home available fluids- plain water, lemon water, curd water, coconut water, rice kanji, dal without salt .These fluids along with food provide ORT.
. Avoid aerated drinks, tea or plain glucose water without salt as it may cause osmotic diarrhea.

Salt Sugar Solution

A finger pinch of salt plus 1 teaspoon of sugar in a glass of water.WHO ORS

How much to give?
. Less than 24 mths of age:- 50-100 ml per loose stool
. 2-10 years of age:- 100-200 ml per loose stool
. More than 10 years of age:- as much as required

How to give
One teaspoon every 1-2 mins for child less than 2 years and frequent sips from cup for older children. If the child vomits, wait for 10 mins and give slowly.

10. What are the DANGER SIGNS?
. Many water stools
. Repeated vomiting
. Marked thirst
. Eating or drinking poorly
. Fever- high grade
. Blood in the stool
. Drowsy child
. Marked decreased urine output

11.What are the indications for antibiotics?
. Malnourished or premature infants
. Gross blood in stool
. Associated non GI infections e.g. pneumonia

12 .What should not be used in treatment of acute diarrhea?
. Adsorbents-kaolin, pectin
. Motility suppressants-opiates
. Steroids

13.What is the dietary management in diarrhea?
. Children should continue to be fed during acute diarrhea because feeding is physiologically sound and prevents or minimizes the deterioration of nutritional status.
. In acute diarrhea breast-feeding should be continued with ORS uninterrupted even during dehydration.
. Optimally energy dense foods with the least bulk are recommended for routine feeding and those available in the household should be offered during diarrhea in small quantities but frequently.
. Staple foods that do not provide optimal calories per unit weight should be enriched with fats, oil or sugar e.g. khichri with oil rice with milk or curd and sugar, mashed potatoes, mashed oil and lentil.
. Foods with high fibre content e.g. coarse fruits and vegetables to be avoided.
. In non-breast fed infants, cow or buffalo milk can be given undiluted after correction of dehydration together with semisolid foods. Milk should not be diluted with water. Alternatively milk cereal mixtures can be used.
. Routine lactose free feeding is not required in acute diarrhea even when reducing substances are detected in the stools. Lactose malabsorption meriting dietary modification is very uncommon in acute diarrhea.
. During recovery, an intake of at least 125% of normal should be attempted with energy dense foods till nutritional status is normal as measured for age.

 

Last created on 13-12-2002
Last updated on 18-11-2006