1. infantile diarrhea

2. Etiology Pathogenesis Clinical manifestations Diagnosis Treatment Differential diagnosis diarrhea

6. morbidity constituent ratio < 1y 38.65% 1- 2y 32.29% Etiology

7. Low gastric acidity the ability killing pathogens Low activity of digestive enzymes digestive ability Rapid growth nutrient requirements overburden in gastrointestinal tract Predisposing factors Immature digestive function and rapid growth

14. rotavirus

16. Enterohemorrhagic E. coli O157:H7 Blood stool Abdominal cramps fever Transmission electron micrograph

17. Shigella sonnei

18. Salmonella

20. Entamoeba histolytica

21. Candida albicans

22. Extraintestinal infections Otitis media Upper respiratory infection Meningitis Pneumonia Urinary infection Cutaneous infection etc . diarrhea vomiting Infectious Factors

31. Carbohydrate decomposition & absorption disorder Shedding of epithelial cells on intestine mucous membrane, intestinal villus shortening Intestinal lactic acid ↑ Intestinal Na + & glucose ↑ Disaccharidase activity ↓ Watery diarrhea Na + , glucose coupling transporter disorder Na + , glucose absorption disorder Reabsorbed water-electrolyte ↓ Pathogenesis of Viral Enteritis Virus particles Microvillares epithelial cells on Small intestine mucous membrane Intestines osmotic pressure↑

32. Pathogenesis of Noninfectious Diarrhea Improper diet Gastric gathered food ， less gastric acid, lower intestinal bacteria up-moving & propagation Decomposition producing Amines ↑ Bacteria & toxicity products short chain organic acid Intestinal osmotic Portal vein system pressure↑ Enterokinesia↑ entering blood circulation Osmotic diarrhea Toxicosis symptom (endogenous infection)

34. Clinical manifestations GI symptoms Systemic toxic symptoms Disturbances in water, electrolyte, and/or acid-base balances Acute Diarrhea

36. Clinical manifestations Systemic toxic symptoms Abnormal temperature Irritability, lethargy, coma Acute Diarrhea

43. muguet (mycotic stomatitis)

49. Higher metabolic rates Increased body surface area to mass index Higher body water contents (water comprises approximately 70% of body weight in infants, 65% in children, 60% in adults) Young pediatric patients tend to be more susceptible to fluid losses a quick turnover of fluids and solute

50. Normal routes of fluid excretion in infants and children. Lungs Skin Urine & feces insensible water losses

52. Clinical features of dehydration in an infant prolonged

53. Loss of Skin Elasticity

55. Degrees According to the severity of the symptoms and signs The key point to distinguish severe cases from mild and moderate ones is poor peripheral circulation and even shock. Dehydration

56. Dehydration 5-10% Slight sunken

57. Types of dehydration Hypertonic Isotonic Hypotonic The type is defined according to the change of serum osmolality (serum Na+ concentration) Dehydration

60. Hypertonic dehydration Loss of more water than sodium with high serum Na concentration (>150mmol/L) 1. Less obvious signs of dehydration 2. Particularly dangerous : Water is drawn out of the brain and cerebral shrinkage within a rigid skull may lead to multiple, small cerebral haemorrhages and convulsions. A shift of water from ICF to ECF The least common, usually results from high insensible water losses or from profuse, low-sodium diarrhea Types of dehydration Definition:

61. Hypertonic dehydration Isotonic dehydration Hypotonic dehydration humour distribute Interstitial fluid plasma ICF

62. Property of dehydration ICF: severely decrease, Milder dehydrant sign than the other two kinds >150 mmol / L High grade fever, Infection Hypertonic ECF: severely decrease, Easily shock ， Severer dehydrant sign than the other two kinds <130 mmol / L Chronic gastrointestinal fluid lose Hypotonic ECF: decrease, Osmotic pressure (intracellular = extracellular) Dehydrant volume accord with dehydrant physical sign 130 ～ 150 mmol / L Acute gastrointe-stinal fluid lose Isotonic Pathophysiology & clinical characteristic Serum sodium Pathogeny Type of dehydration

69. Hypokalemia: K+ < 3.5 meq/L

73. Features before and after rehydration

79. Treatment Fasting severe vomiting Regulating and limiting the diet Antibiotic : bacterial infection Microecological drug : lactobacilli GI tract mucosa protector : smecta Drug therapy Fluid therapy Mainstay of treatment Dietary therapy

86. Fluid therapy Electrolyte solutions Sodium chloride solution (NaCl) Isotonic (0.9%, Normal saline, NS): Replenish volume. Maintain plasma osmolality Hypertonic(3%) Correct hyponatremia Sodium bicarbonate (SB)(NaHCO 3 ) Isotonic(1.4%) Maintain plasma osmolality, correct acidosis Hypertonic(5% , 3.6 tonic) Correct acidosis Potassium chloride (KCl) Isotonic(1.2%) Hypertonic(10% ,8.9 tonic ) Replenish K+

88. Oral fluid therapy Mild or moderate dehydration. No severe vomiting or abdominal distention Indications ORS may be used with unlimited water intake. The fluid is best given in small amounts frequently . Fluid therapy

89. Ingredient amount (grams) NaCl 3.5 NaHCO 3 2.5 KCl 1.5 Glucose 20 Water 1000ml Oral rehydration salt (ORS) It has been advocated by the WHO Formula of rehydration salt: 2/3 tonicity and the potassium concentration is 0.15%

90. 40℃ warm water or cooled boiled water Oral rehydration salt (ORS)

96. The amount of fluid 60-80 ml/kg /day Maintenance requirements 10-30ml/kg/day Ongoing abnormal losses 100-120 50-100 50 Preexisting losses (ml/kg) 150-180 120-150 90-120 Total amount (ml/kg) Severe Moderate Mild Degrees of dehydration

97. losing continuing 1/2 ～ 1/3 tonic Sodic solution physiological need 1/3 ～ 1/5 tonic Sodic solution The Quality of fluid 1/3 ～ 1 / 5 Tonic Sodic solution Hypertonic dehydration 2:3:1 Isotonic dehydration 4:3:2 Hypotonic dehydration Cumulated losing volume Dehydrant category

99. Speed 5ml / kg / h 8 ～ 10ml / kg / h 12 ～ 16h 8 ～ 12h 24h Keep transfusing period （ physiological need, losing continuing ） Cumulated losing volume Total volume

107. Definition: Dehydration Isotonic dehydration Hypotonic dehydration Hypertonic dehydration Hypokalemia Key Points

108. Etiology of infantile diarrhea To evaluate the severity of dehydration caused by infantile diarrhea, you should pay attention to some signs For fluid therapy, the commonly used non-electrolyte solution and the electrolyte solutions 2:1 isotonic solution ,2:3:1 solution component and usage key points about K + replacement the main distinction between severe and mild infantile diarrhea Key Points

110. Thanks ！