DIARRHOEA & DEHYDRATION : Paediatric : Summary

                               DIARRHOEA & DEHYDRATION

EVALUATION

• H/O diarrhea : duration, frequency, consistency, blood in stools
• Vomiting: duration, frequency, color, contents
• Associated symptoms: fever, cough, fits, rash, meningeal signs, urine amount, frequency, colour
• Feeding Practices: type of milk, complementary feeds, change made after onset of diarrhea/vomiting
• Vaccination status, H/O measles in last 3 months
• Wt, midarm circumference, length / height.
• Degree of PCM

	No Dehydration	Some Dehydration	Severe Dehydration
1.General Condition	Normal	Irritable	Floppy, unconscious
2.Eyes	Normal	Sunken	Very Sunken
3.Thirst	Normal	Eager	Unable to Drink
4.Skin Elasticity	Immediate recoil	Slowly	Very Slowly
Treatment Plan	A	B	C

Treatment Plan C

• Maintain IV Line
• Give Ringer’s lactate or normal saline (100ml/kg)
• Infant (<1 Yr):

30 ml/kg in one hour, then 70 ml/kg in next 5 hour                     

• Children (1-5 years)

30 ml/kg in one hour, then 70 ml/kg in next 2 ½ hour.

If IV not accessed, then pass NG tube and give ORS 75 ml/kg over 4 hours. One may use intra-osseous route in emergency.

• Give ORS slowly with spoon (as soon as baby can drink)
• Continue feeding if possible (offer breast feeding)
• Reassess after rehydration.

 Treatment Plan B

                                                                                               

·         Admit in emergency or ORT corner.  

·         Give ORS 75ml / kg in 4 hours slowly with spoon.                                                               Reassess after each  hour

·         Shift to plan C, if vomiting worsens, child is unable to drink or fails to rehydrate

·         Discharge on plan A if re-hydration accomplished    

Treatment Plan A

                       

Continue feeding (breast feeding, yogurt, khichree, banana, dalya, banana shake, 

 or rice cereal)

Give ORS ½ - 1 cup after each loose stool (according to age)

Return for followup clinic after two days & earlier if one of the following conditions occur:

o   Diarrhea worsen

o   Vomiting worsens

o   Scanty urine,

o   Unable to drink

o   High grade fever

o   Blood in stools,

o   Fits,

o   Abdominal distention

Investigations

Not required in a simple diarrhea cases, only when indicated.

Hb, TLC, DLC,

Stool C/E, microscopy, pH, reducing sugar. & for isolation of Rota virus. 

s/Na, K.,

Give zinc sulfate 10 mg OD orally for 10 days.

Indications of Antibiotics

Dysentry, Cholera, Amebiasis, Giardiasis, clinical sepsis or neonatal diarrhea.