Diarrhoea
Diarrhoea is when your bowel movement become loose or watery. the definition of diarrhoea is Passing of three or more loose or watery stools within 24 hours is called diarrhoea.
Types of Diarrhoea:
A. Acute watery diarrhoea :Acute watery diarrhoea may last up to one or two days and goes away on its own ,which is common condition that affects people of all age .
B.Persistent diarrhoea(chronic diarrhoea): diarrhoea lasting four or more is known as chronic diarrhoea or persistent diarrhoea.
Causes of Diarrhoea :
A. Acute watery diarrhoea:
a. Rota virus
b .Enterotoxigenic E.coli
c .Vibrio cholerae
d. Campylobacter jejuni
e .Salmonella
f. cryptosporidium
g. Enteropathogenic E.coli
B. Choronic diarrhoea :
a. Enteroadherent E.coli
b. shigella
c. cryptosporidium
d. Giardia lamblia
e. Entomoeba hystolytica
Clinical features (sign and symptoms):
The stool may also contain mucus ,pus ,blood ,or excessive amount of fat in addition to frequent watery bowel movement
Following symptoms may occur with diarrhoea:
a. Frequent watery stool in large volume .
b. Dehydration
c. vomiting
d. fever
e. Abdominal pain
f. Blood in the stool
g. Hypovolemia
h. Convulsion
i. Shock
Persistent diarrhoea may also lead to death.
Dehydration can be classified and managed as per IMCI guidelines as follow:
|
Points
|
No
Dehydration
|
Some
Dehydration
|
Severe
Dehydration
|
|
1. Look of Condition
|
Well alert
|
Restless,
Irritable
|
Lethargic
Unconscious
|
|
· Eyes
· Tears
· Mouth, tongue
· Thirst
|
Normal
Present
Moist
Drinks Normally
|
Sunken
Absent
Dry
Thirsty, Drinks Eagerly
|
Very Sunken with Dry
Absent
Very Dry
Drinks slowly or not able to drink
|
|
2. Skin Pinch
|
Goes back
Quickly
|
Goes back
Slowly
|
Goes back
Very Slowly
|
|
3. Decide
|
The patient has no signs of dehydration.
|
If two or more signs, patient has some dehydration.
|
If two or more signs, patient has severe dehydration.
|
|
4. Treatment
|
Plan ‘A’
|
Plan ‘B’
|
Plan ‘C’
|
We have included the Treatment Plan in the ending of this post.
Management: (in case of child )
A.fluid and electrolyte correction:
- Oral rehydration solution
- I/V fluid
B. Nutritional Therapy
- Breast feeding
- Yoghourt
- avoid soft drink
- Extra meal each day for at least one month
C. Anti-microbial agents
- Metronidazole for G.lamblia
- Ciprofloxacin
D. Use of antimotility drug eg.loperamide
E. Treatment of associated features
F. Persistent vomiting
eg. Metochlopramide 0.3 mg/kg/day
G. Abdominal distension
H. Treatment as per IMCI guidelines [ We have already classified Dehydration as per IMCI guidelines in our post.]
Now, let’s have a look towards Treatment Plans as per IMCI guidelines.
Treatment plan ‘A’:
A. Describe and show the amount to be given after each stool using a local measure show the mother how to mix ORS.
B.Show her how to give ORS. Give a teaspoonful every 1-2 minutes for a child under 2 years.
C.Give frequent sips from a cup for an older child.
D. If the child vomits wait for 10 minutes. Then give the solution more slowly for example, a spoonful every 2-3 minutes.
E. If diarrhea continues after the ORS packets are used up, tell the mother to give other fluids as described above or return for more ORS.
F.Continue breast feeding.
G. Give fresh fruit juice or mashed banana to provide potassium.
H. Encourage the child to eat, after food at least 6 times a day.
Treatment plan ‘B’:
All the cases with treatment plan ‘B’ need to be treated in health center or hospital observation.
- Give 75 ml/kg/BW of ORS in the first 4 hours
- If no signs of dehydration ,plan ‘A’
- If some of dehydration repeat plan ‘B’
- If severe plan’C’
Treatment Plan ‘C’:
Prevention of diarrhoea:
• Breast feeding.
• Prevention of malnutrition including improved
weaning practice.
• Use of safe water for drinking and washing purpose.
