Management of diarrhoea in child & pregnant women
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This document discusses the management of diarrhea in children and pregnant women. It provides information on common pathogens that cause diarrhea, rehydration strategies like oral rehydration solution and intravenous fluids, maintaining nutrition during diarrhea, and choices of drug treatment based on the identified pathogen. The key points are: more than 5 million children under 5 die from diarrhea annually in India; oral rehydration with WHO's new lower sodium and glucose formula is preferred if fluid loss is mild; intravenous fluids like Ringer's lactate are given for more severe dehydration; maintaining nutrition with foods like milk and bananas during diarrhea; and targeted antibiotic treatment depending on the identified diarrhea-causing bacteria or parasite.
Management of diarrhoea in child & pregnant women
- 1. Management of diarrhoea in child & pregnant women :- Dr Nikhil Bansal J.N.M.C. Wardha
- 2. Introduction in brief :- More than 5 million children under the age of 5 years die every year due to diarrhoea. In India, more than 1 million children every year die due to this disease.
- 3. Pathogen % of cases Viruses Rotavirus 15 to 25% Bacteria Enterotoxigenic Escherichia coli 10 to 20% shigella 5 to 15% Campylobacter jeijuni 10 to 15% Vibrio cholerae 5 to 10% salmonella 1 to 5% Protozoans Cryptosporidium 5 to 15% No pathogen - 20 to 30% found Pathogens frequently identified in treatment centres in children
- 4. Rehydration :- i) Intravenous rehydration – Given when fluid loss > 10% of the body weight OR 10 ml/kg/hr Dhaka fluid :- NaCl : 85 mM = 5g In 1 litre of water or glucose KCl : 13mM = 1g solution NaHCO3 : 48mM = 4g
- 5. Ringer lactate by WHO :- Na : 130 mM Cl : 109 mM K : 4 mM Lactate : 28 mM Volume equivalent to 10% of the body weight should be infused over 2 to 4 hrs
- 6. ii) Oral rehydration:- Given if the fluid loss is just mild (7.5 to 10% of the body weight)
- 7. Rationale of ORS composition:- Oral rehydration possible only if glucose is added with salt helping glucose coupled sodium absorption General principles:- 1. Isotonic or somewhat hypotonic(200 to 310 mOsm/L) 2. The molar ratio should not exceed 110mM 3. Enough potassium(15-25mM) & bicarbonates(8-12mM) must be provided
- 8. WHO recommends (old):- Na 90mM K 20mM Cl 80mM Citrate 10mM Glucose 110mM (Total osmolarity of 310mOsm/L)
- 9. New formula of WHO–ORS:- Introduced in 2002 with low sodium & low glucose formulated by WHO Both sodium & glucose tend to increase the stool volume in higher concentrations & hence they must be reduced Ideally the total osmolarity should be 245mOsm/L
- 10. New formula WHO-ORS Content Concentration NaCl : 2.6 g Na : 75mM KCl : 1.5 g K : 20mM Trisod. Citrate : 2.9 g Cl : 65mM Glucose : 13.5 g Citrat : 10mM Water : 1L Glucose : 75mM (total osmolarity is 245mOsm/L)
- 11. Administration of ORS:- At ½ - 1 hr intervals Initially body weight equivalent is given in 2-4 hours(5ml/kg/hr) Intragastric drip is used in case of childrens. Super ORS:- Main aim is to reduce the stool volume other than the rehydration task Amino acids helping in sodium co-transport are included viz. alanine & glycine
- 12. Maintenance of Nutrition :- Fasting decreases brush border disaccharide enzymes & reduce absorption of salt,water & nutrients Nutrients like buffalo milk,boiled potato,rice,chicken soup,banana should be given to patient.
- 13. Drug therapy:- Choice of drug for pregnant women in dehydration – anti diarrhoeals like diphenoxylate-atropine,loperamide. Oral rehydration salts is used as an alternative
- 14. Choice of drug for children in dehydration - Pathogen Drug given Nalidixic acid Enterotoxigenic Escherichia , cotrimoxazole, ampicillin,inj. coli gentamicin shigella Nalidixic acid,cotrimoxazole,ampicillin Campylobacter jeijuni Erythromycin, furazolidin,chlorampheni col,gentamycin Furazolidin,cotrimoxazole,tetracycline, Vibrio cholerae erythromycin salmonella Ampicillin,chloramphenicol Entamoeba histolytica Metronidazole,tinidazole,secnidazole Metronidazole,tinidazole,secnidazole L.giardia