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World Health Report 2005, U5MR estimates from UNICEF2004, State or the worlds children 2006
82.6% 60.3%
National Data
M.P. Data
2005-2006, National Family Health Survey (NFHS-3)
1.
r : Urb
. A r
i i
r: r
r l r
Acute Gastroenteritis Infantile Diarrhea Toddlers Diarrhea Winter Diarrhea Travelers Diarrhea
ECF 14 litres
50%
CHILD 7 Kg ADULT 70 Kg
Bacteri a
Parasites
Parenteral
NonNon-infective
Psychogenic
Hepatic
Malabsoption
q Absorption
o Secretion
Trasport Defect
Maldigestion Solute
Examples
Lactase
Features
fecal leucocytes Stops with fasting, o breath H2
No
Examples
Salmonella Shigella
Features
leucocytes Blood/Mucus in stools
Fecal
Examples
IBS Thyrotoxicosis
Features
Infection
L O S S
Orthostatic Hypotension
q Urine flow
q Intraocular O Pressure
q Organ Perfusion
Dried oral mucosa, Absent tears, Lethargy, Unconsciousness Deep & Rapid breathing Abdominal distension, ileus, hypotonia
E Acidosis C F Hypokalemia
Risk Factors:
Age < 2 years Malnutrition/Immune deficiency Intercurrent infections e.g. measles Low socioeconomic status, environmental sanitation & personal hygiene
Character of Stools
Large volume, watery. No pus/blood (Naked eye / microscopy) Frequent, small volume. Pus &/ blood present. Initially large volume watery stools changing to small volume stools. (Macro- or (MacroMicroMicro-scopic pus/blood present)
Likely Organism
Viruses, V. Cholerae, E. Coli (EPEC, ETEC, EAEC), toxins, cryptosporidium Shigella, E. histolytica, E. Coli (EHEC, EIEC), Cl. Difficile Salmonella, Shegella sonnei, Campylobacter
Increased thirst, irritability q Skin turgor, depressed fontanelle, dry mucous membranes, sunken eyes Drowsy, apathetic, refusal to feed/drink, anuria, acidosis, shock
Severe
WHO 1995; ESP GHA N 2001
>10%
CDC; 1992, AAP 1996
Signs useful:
Thirst Pulses Urine output
Hypertonic
(Na+ >150) 5-10%
Hypotonic
(Na+ <130) 15-20% 15-
Cold Poor Dry Dry Sunken & soft Depressed Drowsy Rapid Low
Cold/Hot Fair Doughy Parched Sunken Levelled/D Irritable Mod. rapid Mod. Low
Cold Very Poor Clammy Slightly moist Sunken & soft Depressed Comatose Rapid Very Low
ICF ECF
Fluid moves from ECF to ICF comprtment In hyponatremic dehydation accentuating fluid depletion in ECF
ICF ECF
Fluid moves from ICF to ECF compartment in hypernatremic (hypertonic) dehydration, thus partially compensating for fluid depletion of ECF compartment
Fluid of choice: Ringer lactate with 5% dextrose Ringer lactate Normal Saline
Discontinue IV treatment
Shift to Plan B
No dehydration
Discontinue IV treatment
Shift to Plan A
*Repeat if necessary
Fluid of choice: Half strength Darrows solution with 5% dextrose Ringer lactate with 5% dextrose 0.45% (half normal) saline with 5% dextrose
Inadequate Fluids:
oVery rapid weight loss with increasing Na+ or o Persistent tachycardia
Cl(mEq/L)
K+
(mEq/L)
Lactate Osmolarity
(mEq/L) (mOsm/L)
154 77 30 130 61
154 77 30 109 52
4 17
28 27