4. Management
Dx-
Clinical & stool examination
Assess hydration status
Treatment-
No specific dietary restrictions or recommendations
Continue breast-feeding
ORS- nimbu-paani, rice water, commercial preparations
IV fluids- Ringer’s lactate- vomiting, ileus, altered sensorium
Antiemetics- metoclopramide, domperidone
Antibiotics- dysentery, pseudomembranous colitis, immunosuppressed
Antimotility agents- Loperamide, not in children
Prevention-
Sanitation & hygiene
Vaccine- rotavirus, typhoid, cholera
5. ORS constituents- per liter water
NaCl- 3.5 gm
NaHCO3- 2.5 gm
KCl- 1.5 gm
Glucose-20 gm
6. Food poisoning
Due to preformed enterotoxin
Abrupt onset
S.aureus-
1-6 hours, intense vomiting with diarrhea
C.perfringens-
6-12 hours, profuse diarrhea with cramps & nausea
B.cereus-
Reheated rice- 1-6 hours, severe vomiting with diarrhea
Meat/gravy- 6-12 hours, severe diarrhea with nausea/vomiting
Rx- supportive- antiemetics & ORS
7. Escherichia coli
Gram –ve bacillus
Normal commensal in human gut
Virulent types-
Enterotoxigenic- leading cause of watery diarrhea,
most common cause of travellers’ diarrhea
Enteropathogenic- diarrhea with mucus
Enteroinvasive- profuse diarrhea with fever
Enterohemorrhagic- dysentery, can cause HUS
Enteroaggregative- watery diarrhea
Rx- supportive,
fluoroquinolones shorten duration
8. Cholera
Caused by bacteria V.cholerae
Primarily affects small-intestine
People with O blood group more affected,
carriers of cystic fibrosis are protected
Toxin leads to cAMP activation causing
secretion of water, Na, K, Cl & HCO3
Causes profuse diarrhea (rice water),
with abdominal pain, ± vomiting