Download as PDF, PPTX
Uploaded byNgunyi Yannick
Diarrheal diseases and dehydration
Diarrheal diseases are a major public health concern worldwide, especially among children under 5 years old. Diarrhea is defined as having 3 or more loose stools per day and can be caused by bacterial, viral, parasitic, or fungal infections. The main risk factors are poor hygiene, inadequate food safety, and low socioeconomic status. Diarrhea is classified based on duration and etiology. The main signs and symptoms include loose stools and dehydration. Treatment focuses on oral rehydration and management of dehydration severity from no dehydration managed at home to severe dehydration treated intravenously in a hospital. Prevention emphasizes handwashing, food safety, breastfeeding, and vaccination.
More Related Content
Similar to Diarrheal diseases and dehydration
Diarrheal diseases and dehydration
- 1. Diarrheal Diseases & Dehydration Presentedby : Ngunyi Yannick L. MD, Faculty of Health Sciences University of Buea, Cameroon
- 2. Plan • Definition • Epidemiology •Risk factors • Types of diarrhea • Etiology • Signs/Symptoms • Workup • Complications • Prevention • Management • Dehydration
- 3. WHAT IS DIARRHEA? •Diarrhea is defined by the World Health Organization as having 3 or more loose or liquid stools per day, or as having more stools than is normal for that person. • Increase in daily stool weight above 200gm • Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral, fungi and parasitic organisms.
- 4. Epidemiology • People ofall ages can get diarrhea, but it is more common in children below five years of age. • Diarrhea is a Public Health Concern, & its the second leading cause of mortality and morbidity in the world after pneumonia among children under five globally. • Globally, there are about two billion cases of diarrheal disease every year.
- 5. Epidemiology • Today only39 per cent of children with diarrhea in developing countries receive the recommended treatment, and limited trend data suggest that there has been little progress since 2000 • Nearly one in five child deaths (about 1.5 million each year) is due to diarrhea. • 3rd main cause of death in Cameroon after HIV and Lower Respiratory Infections.
- 6. Risk factors • prematurity •immunodeficiency conditions • lack of personal hygiene • inadequate food hygiene • Poor infant feeding practices • illiteracy • poor socio-economic status
- 7. Types of Diarrhea Basedon duration 1. Acute diarrhea : Acute watery or bloody diarrhea (dysentery) lasting less than 14 days 2. Persistent/chronic diarrhea. >14 days
- 8. Based on etiology 1.Osmotic diarrhea Too much water is drawn into the bowels. This can be the result of maldigestion in which the nutrients are left in the lumen to pull in water (e.g., pancreatic disease) Caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels)
- 9. Based on etiology 2)Motility-related diarrhea Due to rapid movement of food through the intestines If the food moves too quickly through the GIT, there is not enough time for sufficient nutrients and water to be absorbed. Due to over stimulation of the parasympathetic system 3) Secretory diarrhea increase in the active secretion, or there is an inhibition of absorption. The most common cause is a cholera toxin that stimulates the secretion of anions, mostly chloride ions.
- 10. Based on etiology 4)Inflammatory diarrhea Occurs when there is damage to the mucosal lining, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. caused by bacterial infections, viral infections, fungal infections, parasitic infestations, or autoimmune conditions
- 11. Etiology / Causes A.Infectious causes Viral Infections • Rota virus (40% of cases in children <5ys ) • Norovirus (Adults) • Adenovirus types 40 and 41 • Astroviruses Parasitic Infections • Giardia lamblia • Entamoeba histolytica Bacterial Infections • Escherichia coli • Salmonellae • Shigella • Campylobacter • Vibrio cholera • Clostridium difficile Fungi • Candida albicans
- 12. Etiology / Causes B)Non infectious causes Malabsorption Cystic fibrosis, Coeliac disease Food Intolerance or Allergy Lactose Intolerance, Cow's milk Protein Allergy Drug induced- Antibiotics Surgical Conditions Appendicitis Intussusception Partial bowel obstruction Other rare conditions Haemolytic-uraemic syndrome Pseudomembranous colitis Toddler diarrhoea
- 13. Signs & symptomsof Diarrheal diseases • Mostly signs and symptoms of dehydration such as Weight loss, poor skin turgor, dry mucus membranes, dry lips, pallor, sunken eyes, depressed fontanelles • Abdominal pain • Fever • Frequent loose stools with/without Blood or mucus • Vomiting, headache • Behavioral changes like irritability, restlessness, weakness, lethargy, sleepiness, delirium, stupor and flaccidity • Rice water stools in case of cholera
- 14. Signs & symptoms •Convulsions and loss of consciousness may also be present in some children with diarrheal diseases, due to loss of electrolytes. • Hypotension, tachycardia, tachypnea, cold clammy extremities • Decreased or absent urinary output
- 15. Workup / Investigations a.Stool cultures for bacterial and viral pathogens, b. Full Blood Count c. Stool analysis: direct inspection for ova and parasites d. immunoassays for certain bacterial toxins (C. difficile) e. Serum electrolytes f. Kidney function test (urea + creatinine) g. Other tests to rule out specific etiologies e.g. Widal for salmonella infection
- 16. Complications of Diarrhealdiseases • Dehydration: Main complication of diarrheal diseases Leading cause of mortality in diarrheal diseases Causes end organ failure • Electrolyte imbalance: From excessive loss of electrolytes can lead to seizures and muscle spasms
- 17. Prevention • Keep yourhands clean • Wash fruits and vegetables • Refrigerate and cover food • Eat well-cooked foods • Rotavirus Vaccination (Rotarex at 6th & 10th week) • Promotion of early and exclusive breastfeeding and vitamin A supplementation • Community-wide sanitation promotion
- 18. Management Mainly fluidreplacement (with ORS or IV crystalloids) to prevent or correct dehydration & correction electrolyte imbalance Reassess hydration state and hydrate accordingly with respect to severity of dehydration no dehydration- WHO plan A some dehydration- WHO plan B severe dehydration- WHO plan C Zinc supplement Antibiotherapy for bacterial causes Antidiarrheal agents (loperamide, racicadotril(1-1-1))
- 19. Dehydration Dehydration is adeficit of total body water, with or without electrolytic and acid-base disturbances. It occurs when free water loss exceeds free water intake Main complication in patients with diarrheal diseases and leading cause of mortality in these patients.
- 20. Classification Of Dehydration 1)Severe Dehydration Two or more of the following signs: • lethargy or unconsciousness • sunken eyes • unable to drink or drinks poorly • skin pinch goes back very slowly (>2 s) • Manage with WHO plan C
- 21. Classification Of Dehydration 2)Some Dehydration Two or more of the following signs: • restlessness, • irritability • sunken eyes • drinks eagerly, thirsty • skin pinch goes back slowly • Manage with WHO plan B 3) No Dehydration • Not enough signs to classify as some or severe dehydration • Manage with WHO plan A
- 22. WHO Management ofDehydration PLAN A (NO DEHYDRATION – TREAT AT HOME) Teach mother or family member how to give Oral rehydration solution (ORS) at home. FOR EACH LOOSE STOOL UNTIL DIARRHOEA RESOLVES; • Children < 2yrs give 50-100mls of ORS • Children 2-10yrs give 100-200mls of ORS • Children > 10yrs or older and adults should take as much as they want (AD LIBIDUM). • If child vomits, wait 10mins and then continue slowly 5mls every 2-3mins.
- 23. Management of Dehydration •Give Zinc supplements. children <= 6months ½ tab/day x 14days children > 6months 1 tab/day x 14days • Continue breast feeding without interruption • For children < 6 months on formula or cow’s milk, give half strength for 2days. After 2 days give usual formula or cow’s milk • For older children give usual cow’s milk • Children > 6 months give soft or semi solid weaning foods. Give as much food as they want but every 3-4hrs (6x/day), small frequent feeds are better tolerated.
- 24. Management of Dehydration PLANB (SOME DEHYDRATION – ADMIT PATIENT) • Give ORS, 75mls/kg in 4-6hrs • If patient asks for more ORS, give pure water 100-200mls in the first 4hours. • If child vomits, wait 10mins and then continue slowly 5mls every 2- 3mins. • Continue feeding as in Plan A
- 25. Management of Dehydration •PLAN C (SEVERE DEHYDRATION – ADMIT PATIENT) • Patients with severe dehydration can die from hypovolemic shock, so treat as hypovolemic shock. Treatment of choice is intravenous rehydration with crystalloids. • REQUIRED FLUIDS: Ringer’s lactate, Normal saline, Half- strength DARROW’S solution with 2.5% or 5% dextrose, or Half normal saline in 5% dextrose. • INFANTS: 30mls/kg first hr 70mls/kg for the next 5hrs = 100mls/kg in 6hrs • OLDER CHILDREN AND ADULTS: 30mls/kg within 30mins 70mls/kg over 2.5hrs = 100mls/kg in 3hrs.
- 26. Management of Dehydration •NB; if after the first 30mins the radial pulse is still weak and rapid, repeat a second infusion of 30mls/kg. • If IV therapy is not possible NG replacement – maximum 20mls/kg/hr. If there is increasing abdominal distension and frequent vomiting Give slowly ORAL REPLACEMENT • Children <2yrs give, ORS by spoon 5mls/min. In older children from a cup, as soon as the patient is able to drink. Avoid NG and oral replacement in case of paralytic ileus.
- 27. Management of Dehydration TRANSITIONTO PLANS B AND A • Usually rehydration period for plan C is 3-6hrs. Reassess the patient’s hydration status and either continue plan C or change to plans B or A. • Patients with severe dehydration should be hospitalized until diarrhea stops.
- 28. References 1. World HealthOrganization (WHO) 2. "Diarrhea in non travelers: risk and etiology“ 3. "Astrovirus gastroenteritis". The Pediatric Infectious Disease Journal 21 4. Williams, George; Nesse, Randolph M. (1996). Why we get sick: the new science of Darwinian medicine. New York: Vintage Books. pp. 36–3 5. Wikipedia.com
- 29. THANK YOU FORYOUR KIND ATTENTION