Diarrhea is defined as having more than 3 loose or watery stools in a 24-hour period. The seminar discussed the types, causes, risk factors, signs of dehydration, and treatment plans for diarrhea in children. Treatment involves oral rehydration with WHO recommended oral rehydration solution and continued feeding. Antibiotics only have a limited role and zinc supplementation can decrease diarrhea duration and severity.

1. Seminar
On
“APPROACH TO DIARRHEOA IN
CHILDREN”
Presented by
Vijay kr. Singh
DNB PGT (Pediatrics)
Under guidance of
Dr T K MAITY
MD(PEDIATRICS)
Consultant pediatrician M R Bangur Hospital
Date 18 june 2013
Venue
DNB Seminar hall M R Bangur hospital Kolkata-33

2. DIARRHEOA
Diarrhea is best defined as
excessive stool loss of fluid and
electrolyte more than three
within 24hrs period. Recent
change of consistency is more
important than frequency

3. Types of diarrhea
Acute watery diarrhoea-start suddenly
and last for hours or days.
Dysentery- it is similar to acute
diarrhea but associated blood loss in
stool.
Persistent diarrhea- if diarrhea persist
more than 14days

4. WHO and UNICEF estimate that
almost 2.5billion episode of
diarrhea in children less than 5
years of age in developing
countries. More than 80%occring
in Africa and south Asia. Globally
mortality dicrease significantly but
incidence remain unchanged.

5. Epidemiology of diarrhea
Diarrhoeal disorder in childhood
account for a large proportion 18%
of childhood death about 1.5 million
deaths per year globally and making
second most common cause of
childhood mortality

6. Diarrhea can cause undernutrition
and worsen the milder form of
malnutrition because
Impaired intestinal absorption of macro
and micronutrient.
Urinary loss of specific nutrient Vit A.
Increase catabolism due to infection.
A child with diarrhea is often not hungry.
Mother often make the mistake of not to
feed during diarrhea.

7. Etiology of diarrhea
Organism causes non
inflammatory(enterotoxin or adherence /
superficial invasion)
 Location- Proximal small intestine
 Causes watery diarrhea
These are
 E.coli(ETEC,LT,ST)
 Clostiridum perfringens
 Bacillus cereus
 Staph. Aureus, giadia lambia, Rota virus, Norwaklike
virus,Crytosporidium,Microsporidia,

8. Enteropathogens elicit noninflamatory
diarrheoa through entrotoxine
production by some bacteria,
destruction of villous surface by
viruses, adherence by parasite and
adherence and translocation by
bacteria. Bacterial enterotoxin can
selectively activate enterocyte
intracellular signal transduction and
cause alteration in the water and
electrolyte fluxes across enterocyte.

9.  Location- colon
 Dysentery
Organisms
 Shigella E.coli(EIEC,EHEC)
 Salmonella enteridis
 Vibrio parahemolyticus
 Clostiridum difficilue, campylobacter jejuni,
Entaemaeba hitolytica.
 Inflammatory diarrhea is usually caused by bacteria and
directly invade the intestine or produce cytotoxin with
consequent fluid, protein, and cells. That inter the
intestine
Inflammtory(invasive, cytotoxin)

10. Penetrating
Location- Distal small intestine
Salmonella typhi
Yersinia enteropathica
Campylobacter fetus

11. Risk factors of gastroenteritis
Envinmental contamination and
increased exposure to pathogens
Malnutrition
Lack of exclusive breast feeding or
prolong and predominant
breastfeeding
Measles
Immunodeficiency

12. Clinical evaluation of diarrhea
Child dehydration can be classified
according to WHO criteria
No dehydration Treatment planA
Some dehydration Treatment Plan B
Severe dehydration Treatment Plan C

13. Signs of dehydration:
 Decreased urination (fewer than 4 wet diapers in
24 h),
 Increased thirst,
 No tears,
 Dry skin, mouth and tongue,
 Faster heart beat,
 Sunken eyes,
 Grayish skin,
 Sunken soft spot (Anteriar fontanelle) on baby’s
head

14. Treatment PLAN A
•Age less than 24 months
•50-100ml per each loose stool
•Age between 2yrs to 10yrs
•100 to 200 ml after each stool
•Age more than 10 yrs
•As much as wants

15. Treatment Plan B
The fluid therapy has three component.
Correction of the existing water and
electrolyte deficient.
Replacement of ongoing loss due to
continuing diarrhea
 Deficient replacement

16. 75 ml/ kg of ORS In first 4 yrs
Maintenance therapy
 This begins when dehydration corrected over
4hrs
 ORS 10-20 ml/kg after each stool .
 Offer plan water in between

17.  High stool purge- 5ml/ kg/hr
 Persistent vomiting > 3episode per hr

 Incorrect preparation

 Abdominal distention

 Glucose malabsorption
When ORT therapy is ineffective

18. Treatment Plan C
Start IV fluid immdiately
Age <12months
30ml/kg in 60 minutes
Then 70ml/ kg in 5hrs
Age between 12months to 5 years
30ml/kg in 30 minutes
Then 70 ml/kg in2.5 hrs

19. Monitoring
Reassess the child every 15-30 minutes
until a strong radial pulse is present.
Repeat IV fluid is severe dehydration
still present.
If child is improving but still shows
sign of dehydration.
Discontinue IV fluid and give ORS for
4hrs

20. Secretory diarrhea
 Secretory diarrhea is often caused by a
secretagogue, such as cholera toxin, binding
to a receptor on the surface epithelium of
the bowel and thereby stimulating
intracellular accumulation of cyclic
adenosine monophosphate or cyclic
guanosine monophosphate. Some
intraluminal fatty acids and bile salts cause
the colonic mucosa to secrete through this
mechanism.

21. Secretory diarrhoea occurs after
ingestion of a poorly absorbed solute. The solute
may be one that is normally not well absorbed
(magnesium, phosphate, lactulose, or sorbitol) or
one that is not well absorbed because of a
disorder of the small bowel (lactose with lactase
deficiency or glucose with rotavirus diarrhea).
Malabsorbed carbohydrate is fermented in the
colon, and short-chain fatty acids (SCFAs) are
produced.

22. ROLE OF DRUGS IN DIARRHOEA
 ORS
 Antibiotics
 Zinc supplement
 Antimotility drugs
 Probiotics
 Enkephaline inhibitor

23. ORS
An oral rehydration solution (ORS)low
osmolility is an exact mixture of
water, salts and sugar. These solutions can
be absorbed even when your child is
vomiting. The key is to give small amounts
of ORS often (for example, 1 teaspoon
every 5 minutes), gradually increasing the
amount until your child can drink
normally.

24. Antibiotics
Antibiotics have very minor
roll in diarrhoea.
It is only in bacterial infective
diarrhoea and dysentry.

25. Zinc
It increase recovery rate
Decrese stool out put
Maintain mucusal layer
Increse immunity
Dose 20mg/ day in case of age less
than 6month 10mg once a day

26. Antimotility agents
It is contra indicated in
dysentry.
No role in management of
acute watery diarrhoea.

27. Probiotics
It restore the beneficial bacterial
intestinal flora and enhance host
protective immunity such as down
regulation of pro- inflammatory
cytokines and up- regulate anti –
inflammatory cytokines.

28. ENKEPHALINSE INHIBITOR
It consistently has been
shown to reduce stool out
put.
But experience with this drug
is limited.

29. Foods to avoid
Do not give your child sugary drinks
such as: fruit juice or sweetened fruit
drinks, carbonated drinks (pop/soda),
sweetened tea, broth or rice water.
These have the wrong amounts of
water, salts and sugar and can make
your child’s diarrhea worse.

30. Preventive measure for
diarrhoeal disease
Improve domestic & food hygiene.
Improve water supply.
Improve excreta disposal
Maintain good nutrition.
 Health education.
Immunization