diarrhea final

7/31/2019 Diarrhea Final

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DIARRHEA


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DIARRHEA

Diarrhea is defined as the passage ofloose,

liquid or watery stools for more than 3 times

a day.

However, it is the recent change in

consistency and character of stools rather

than number of stool that is more important.


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CLINICAL TYPES OF DIARRHEA

ACUTE WATYERY DIARRHEA

ACUTE BLOODY DIARRHEA

PERSISTENT DIARRHEA

DIARRHEA WITH SEVERE

MALNUTRITION


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ACUTE WATERY DIARRHEA

Lasts several hours to days.

The main danger is dehydration, weight loss alsooccurs if feeding is not continued.

The pathogens that usually cause acute waterydiarrhea are:

V.chlorae

E.coli

Rota virus


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ACUTE BLOODY DIARRHEA

Also known as Dysentery

The main dangers are the damage of the

intestinal mucosa, sepsis, and malnutrition.

Other complications including dehydration

may also occur

It is marked by visible blood in the stools.

Most common cause of bloody diarrhea is

Shigella.


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PERSISTENT DIARRHEA

Diarrhea which lasts for 14 days or longer.

The main danger is Malnutrition and serious

non-intestinal, infection, dehydration may also

occur.

Persons with other illness such as AIDS, are

more likely to develop persistent diarrhea.


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DIARRHEA WITH SEVERE

MALNUTRION

The main dangers are:

1. Severe systemic infection

2. Dehydration3. Heart failure

4. Vitamin & mineral deficiency.


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Chronic diarrhoea Generally lasts > 3 weeks

Common causes: IBS,AIDS, bacterial outgrowthof small int., Colon cancer,Chrons disease

Acute diarrhoea lasts a few days or up to

a week


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PROBLEM STATEMENT

The current estimate in Under 5 children

suggest that there are about 1.4 billion

episodes of diarrhea per year with 123 million

clinic visits annually and 9 million

hospitalizations worldwide.

About 15% under 5 mortality is diarrheal

related.


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In India, acute diarrheal disease accounts for

about 13% of deaths in under 5 years age

group.

During the year 2009 about 11.2 Million cases

with 1762 deaths were reported in India.


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Leading Causes of Mortality and Burden of Disease

world, 2004

%

1. Ischaemic heart disease 12.2

2. Cerebrovascular disease 9.7

3. Lower respiratory infections 7.1

4. COPD 5.1

5. Diarrhoeal diseases3.7

6. HIV/AIDS 3.5

7. Tuberculosis 2.5

8. Trachea, bronchus, lung cancers 2.39. Road traffic accidents 2.2

10. Prematurity, low birth weight 2.0

%

1. Lower respiratory infections 6.2

2. Diarrhoeal diseases 4.83. Depression 4.3

4. Ischaemic heart disease 4.1

5. HIV/AIDS 3.8

6. Cerebrovascular disease 3.1

7. Prematurity, low birth weight 2.9

8. Birth asphyxia, birth trauma 2.7

9. Road traffic accidents 2.710. Neonatal infections and other 2.7

Mortality DALYs


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AGENT FACTORS

In the developing countries - INFECTIOUS in origin

VIRAL BACTERIAL

OTHERS


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INFECTIOUS CAUSES OF DIARRHEA

1. VIRUSES:

Rotaviruses

Astroviruses

Adenoviruses

Calciviruses

Norwalk group of viruses Enteroviruses


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2. BACTERIA:

Campylobacter jejuni

E.coli

Shigella

Salmonella

V. cholrae Bacillus cereus


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3. OTHERS:

E.histolytica

Giardia intestinalis

Trichuriasis

Cryptosporidium

Intestinal worms


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DIARRHEA-MALNUTRITION VISCIOUS

CYCLE


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Interactions between malnutrition and infection.

Katona P , Katona-Apte J Clin Infect Dis. 2008;46:1582-1588

2008 Infectious Diseases Society of America


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ASSESSMENT OF DEHYDRATION


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PARAMETERS NO DEHYDRATION SOME DEHYDRATION SEVERE

DEHYDRATION

OVERALL CONDITION WELL, ALERT RESTLESS, IRRITABLE LETHARGIC/UNCONS

CIOUS : FLOPPY

EYES NORMAL SUNKEN VERY SUNKEN & DRY

TEARS PRESENT ABSENT ABSENT

MOUTH & TONGUE MOIST DRY VERY DRY

THIRST DRINKS NORMALLY,

NOT THIRSTY

THIRSTY DRINKS

EAGERLY

DRINKS POORLY OR

NOT ABLE TO DRINK

FEEL: SKIN PINCH GOES BACK QUICKLY GOES BACK SLOWLY GOES BACK VERY

SLOWLY

DECIDE: PT. HAS NO SIGNS OF

DEHYDRATION

IF THE PATIENT HAS

TWO OR MORE

SIGNS INCLUDING AT

LEAST ONE

SIGN,THERE IS SOME

DEHYDRATION

IF THE PATIENT HAS

TWO OR MORE

SIGNS ,INCLUDING

ATLEAST ONE SIGN,

THERE IS SEVERE

DEHYDRATION


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Signs of Dehydration


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ORAL REHYDRATION THERAPY

Replacement of fluid & electrolytes losses is

the essential part of the treatment of

diarrhea.

This can be achieved by administration of

adequate & proper fluid either in the form of

ORS or IV therapy depending on the

circumstances.


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Diarrhea treatment should be started at home

at the time of onset of diarrhea by themothers using Oral Rehydration Salt(ORS).

It is recommended that all the diarrhea

episodes should be treated with ORS. If ORS is not available then home available

fluids (HAF) like salt sugar solution, lassi,

kanji, pop-rice water etc may be given.


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ORS SOLUTION RECOMMENDED

BY WHO


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REDUCED OSMOLARITY ORS

CONSTITUENTS:

Sodium- 75 mmol/Litre

Chloride- 65 mmol/Litre

Glucose anhydrous- 75 mmol/Litre

Potassium- 20 mmol/Litre

Citrate- 10 mmol/LitreTOTAL OSMOLARITY- 245 mmol/Litre


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Continued. Nacl- 2.6gm

KCL- 1.5gm

Trisodium citrate- 2.9gm

Glucose- 13.5gm Water -1 L

TOTAL WEIGHT: 20.5gm

TOTAL OSMOLARITY: 245 mmol/litre


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New Who ORS is very effective & safe.

It reduces the stool output, duration, and

frequency of diarrhea.

It also reduces the vomiting and the need of

unscheduled use of IV fluid.


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BASIS OF ORAL FLUID THERAPY IN

DIARRHEA

In most diarrheas the absorptive capacity of

gut is retained and nutrients such as Glucose,

Amino acids and dipeptides tends to be

absorbed in most cases.

As glucose is absorbed in the gut sodium is

carried along and also gets absorbed.

ORS helps in absorption of glucose and

sodium.


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One Na ion is transported along with each

molecule of the glucose is absorbed.

This mechanism remains active even in severecases of diarrhea.

In other words oral fluid therapy is based on

the observation that glucose given orallyenhances the intestinal absorption of salt and

water,and is capable of correcting the

electrolyte and water deficit


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ROLE OF ZINC

When zinc supplement is given during anepisode of acute diarrhea, it reduces theepisodes duration and severity.

In addition, zinc supplements given for 10 to

14 days lowers the incidence of diarrheas inthe following 2-3 months.

WHO & UNICEF therefore recommends daily

10 mg of zinc for infants under 6 months ofage and 20 mg for children older than 6months for 10-14 days.


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Interactions among events related to zinc deficiency, malnutrition and diarrheal disease.
http://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpg


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Interactions among events related to zinc deficiency, malnutrition and diarrheal disease.

Wapnir R A J. Nutr. 2000;130:1388S-1392S
http://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpghttp://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpghttp://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpg

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