Gastroenteritis
Dehydration
Prof.dr. Sarah.M.Warouw,SpA(K)
dr.J.I.Christie.Manoppo,SpA
Gastrohepatology Division
Child Health Department
Faculty of Medicine,
University of Sam Ratulangi
Introduction
Diarrhea ia a major health problem
Global Problem
Morbidity &Mortality
Definition : Frequency &Consistency
Frequency : 3 times or more/day
Consistency : watery stool, without blood or
mocous (WHO )
Acute diarrhea,Chronic diarrhea,Dysentry
Osmotic diarrhea, Secretory diarrhea
Etiology of Diarrhea
Direct
Infection : Virus, bacteria, Parasite
Food: Malabsorbsition,toxin,alergy
Indirect
Malnutrition
Hygiene & Sanitation
Risk Factor for diarrhea
Host Factor
Malnutrition
Immune defect
Decreased Gastric HCl
Gut hypomotility
Genetic factor
Relationship between 3 factors :
Host, Environment and agent
Host
Environment
Agent
Hygiene& Sanitation Bacteria,virus,parasit
Etiology of Infectious Diarrhea
Virus
Bacteria
Parasite
Rotavirus
E.coli,Shigella, Salmonella,V Cholerae,
Campylobacter
Cryptopyridium,
Entamoeba,Plasmodia,
Giardia lamblia
Diarrhea causing organism divided
according to their mechanism of action
invasive
partially
toxigenic&
invasive
noninvasive
Shigella sp
Rotavirus
V Cholera
Salmonella sp
Norwalk agent
ETEC
Y enterocilitica
Giardia lamblia
A hydrophilis
C Jejuni
Cryptosporidium
V parahaenolitycus
E Histolytica
adherent
EPEC
Relative degree of invasiveness of
the organism causing diarrhea
Salmonella Shigella Rotavirus Cholera
Lumen
Mucosa
Submucosa
Osmotic diarrhea
nutrient
unabsorbed
Bacterial fermentation
organic acids
increased osmotic pressurre
water flush to lumen
Diarhea
Secretory diarrhea
Bacteria
Toxin
Stimulation of c-AMP,c-GMP
Stimulation of water/electrolyte secretion
Diarrhea
Pathophysiology
Diarrhea
Water
potasium
Sodium
Bicarbonate
Glukose
Dehydration
hypokalemia
hyponatremia
acidosis
hypoglycemia
Sign &Symptoms of some
dehydration
Restless, irritable
Sunken eye
No tears when he cries vigorously
Thristy
drink eagerly
Slowly skin pinch ( skin turgor)
Sign &Symptoms of severe
dehydration
Floppy (restlessness), lethargic or
unconsciousness
Very sunken & dry eyes
No tears when he cries
Is unable to drink/ drink poorly
Skin pinch : very slowly ( take > 2 second)
Diarrhea Management
Acessing a child for dehydration
Ask ,look and feel for signs of dehydration
Condition &behaviour,eyes,tears, mouth& tongue
thirst, skin pinch
Anterior fontanella ,arms& legs, pulse,breathing
Determine the degree of dehydration
Select a treatment plan :
C : severe dehydration ( loss of > 10% of BW)
B : mild to moderate dehydration (loss of 5-10% of BW)
A :no signs of dehydration( loss of < 5% of BW)
Weight the child
Treatment of diarrhea
At home (plan A)
Prepare & give appropriate fluids for ORT
Feed a child with diarrhea correctly
Recognize when a child should be taken to
health worker
When to take the child to a health
worker
There is no improvement in 3 days
The passage of many watery stools
Repeated vomiting
Increased thirst
Failure to eat or drink normaly
Fever
Bloody stool
Treatment of Diarrhea
Plan B : Manage in ORS corner
Continue breast feeding
Give ORS 75ml/kgBW/3hours
Monitor Tx&reasess the child periodically until
rehydration is complete
send home (plan
A)
Give ORS 10ml/kgBW for each diarrhea
Resume giving foods other after 4 hours
Suplement Zinc < 6 months 10mg
Suplement Zinc > 6 months 20mg
Failure of ORT
The passage of many watery stools
Repeated vomiting
Increased thrist
Failure to eat or drink normally
Severe dehydration
Meteorism
Preparing &giving ORS not correctly
Indication of IV Fluid
Severe dehydration or with hypovolemia
Unable to drink (unconscious)
Persisted vomiting
Prolonged oligouria or anuria
Other complication that influenced ORS
Treatment for severe
Dehydration(Plan C)
Give Ringer laktate 100 ml/kgBW ;
AGE
30ml/kgBW
70ml/kgBW
<12 months
>12 months
1hours
30min-1hours
5hours
2-21/2 hours
can be repeated if the pulse is still weak or
unpalpable
Indication for antibiotic treatment
Suspected cases of cholera
Tetracycline or doxycycline ( if resistant :
furazolidone,cotrimoxsasole or
chloramphenicol may be used)
Suspected cases of dysentery ( bloody
diarrhea) Cotrimoxsasole, ampicilin,
Nalidixic acid
Indication for antibiotic treatment
Laboratory-proven, symptomatic infection
with entamoeba histolytica : Metronidazole
Laboratory-proven, symptomatic infection
with Giardia lamblia : Metronidazole
Medication NOT INDICATED
for diarrhea
Sulphonamide
Neomycin and streptomycin
Clinoquinol or Oxyquinolone
Antiperistaltic drug
Antivomiting drug
Kaolin
Steroid
Purgative
Prevention
Breast milk for the first 6 months of live
Avoiding the use of infant feeding bottles
Improving practices
Preparation
&Storage of weaning foods
Using clean water for drinking
Washing hand
Safely disposing of stool
Prevention
Measless vaccination
Improving nutritional status weaning food
Rotavirus vaccination
