Diarrhea resident survival guide (pediatrics): Difference between revisions
Sara Mohsin (talk | contribs) |
Sara Mohsin (talk | contribs) |
||
Line 79: | Line 79: | ||
==Complete Diagnostic Approach== | ==Complete Diagnostic Approach== | ||
Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children according the the WHO guidelines:<ref>https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1</ref><ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref> | *Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children according the the WHO guidelines:<ref>https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1</ref><ref name="Radlovic Lekovic Vuletic Radlovic 2015 pp. 755–762">{{cite journal | last=Radlovic | first=Nedeljko | last2=Lekovic | first2=Zoran | last3=Vuletic | first3=Biljana | last4=Radlovic | first4=Vladimir | last5=Simic | first5=Dusica | title=Acute diarrhea in children | journal=Srpski arhiv za celokupno lekarstvo | publisher=National Library of Serbia | volume=143 | issue=11-12 | year=2015 | issn=0370-8179 | doi=10.2298/sarh1512755r | pages=755–762}}</ref> | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }} | {{familytree | | | | | | | | | A01 | | | A01= Patient with history of [[diarrhea]] }} |
Revision as of 21:07, 21 December 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]
Synonyms and keywords: Approach to diarrhea in pediatric patients, Approach to infectious causes of diarrhea, Oral Rehydration therapy in children
Diarrhea resident survival guide (pediatrics) Microchapters |
---|
Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
Diarrhea remains one of the leading causes of preventable death in developing countries, especially among children under 5 years of age. Diarrhea is defined as an increase in the number of stools such as more than three bowel movements each day or the presence of loose stools comparative to normal stool consistency. Acute diarrhea is when diarrhea occurs for less than 3 weeks in total and it is chronic when it lasts longer than three weeks. Hydration status plays an important role in the management of pediatric diarrheal illness. The risk of dehydration due to fluid and electrolyte losses is inversely proportional to the child's age hence, the younger the child, the greater is the risk of dehydration. The type of dehydration whether it is isotonic, hypotonic, or hypertonic is usually independent of the responsible agent. Fluid loss due to diarrhea and vomiting can be life-threatening if it is as high as three times the circulating blood volume (80–125–250 mL per kg body weight per day). To keep the blood volume constant, the body usually extracts fluid from the intracellular space which can predispose it to dehydration. Complications and hospitalization due to dehydration can usually be prevented by the early and adequate oral administration of a rehydration solution (glucose-electrolyte solution) and normal food for the child’s age.
Causes
Life Threatening Causes | Common Causes | Miscellaneous |
---|---|---|
|
FIRE: Focused Initial Rapid Evaluation
- A Focused Initial Rapid Evaluation (FIRE) should be performed to identify the patients in need of immediate intervention].[2]
Patient presents with acute diarrhea in Emergency | |||||||||||||||||||||||||||||||||||||||||||||||
Mild Dehydration | Moderate Dehydration | Severe Dehydration | |||||||||||||||||||||||||||||||||||||||||||||
Home treatment with ORS, patient prescription, and dietary recommendations | Is there any evidence of dehydration or > 8 watery stools in 24 hours or > 4 episodes of vomiting in 24 hours or < 6 months old | Dehydration > 9 % Shock or Impaired consciousness | |||||||||||||||||||||||||||||||||||||||||||||
Give ORS by spoon or syringe according to age and weight
| Intensive Care | ||||||||||||||||||||||||||||||||||||||||||||||
Complete Diagnostic Approach
- Shown below is an algorithm summarizing the diagnosis of acute diarrhea in children according the the WHO guidelines:[3][4]
Patient with history of diarrhea | |||||||||||||||||||||||||||||||||
Assessment
| |||||||||||||||||||||||||||||||||
History
| |||||||||||||||||||||||||||||||||
Physical Examination
| |||||||||||||||||||||||||||||||||
Mild Dehydration There are no specific signs and symptoms | Moderate Dehydration Initially, the signs and symptoms that develop include: | Severe Dehydration [5] these effects become more pronounced and the patient may develop evidence of hypovolaemic shock including: | |||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of acute diarrhea in pediatric patients according the the WHO guidelines.[6]
Patient presents with acute diarrhea in Emergency | |||||||||||||||||||||||||||||||||||||
Mild Dehydration | Moderate Dehydration | Severe Dehydration | |||||||||||||||||||||||||||||||||||
Children with no signs of dehydration are given extra fluids and salts to replace losses due to diarrhea.[7]
Following Fluids can be given in such cases
| Oral rehydration therapy for children with moderate dehydration:
| *Start IV fluids immediately. | |||||||||||||||||||||||||||||||||||
Do's
- Hydrate the child well. Hydration plays a vital role in early recovery and reversal of symptoms of diarrhea.[8]
- Eating properly: Make the child eat properly such as eating a diet consisting of bananas, rice, applesauce, and toast.
- The use of probiotics can help shorten the duration of illness.
- Use antibiotics only when indicated in the case of pediatric diarrheal illness.
Don'ts
- Don't try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.[9]
- Don't prevent the child from eating if the child is hungry.[10]
- Don't use antibiotics unless prescribed by your pediatrician.
- Don't ignore the symptoms and record temperature and hydration status.
References
- ↑ "Diarrhoeal disease". WHO (in Afrikaans). Retrieved 2020-12-15.
- ↑ Koletzko, Sibylle; Osterrieder, Stephanie (2009-09-25). "Acute Infectious Diarrhea in Children". Deutsches Ärzteblatt International. 106 (33). doi:10.3238/arztebl.2009.0539. PMID 19738921. Retrieved 2020-12-15.
- ↑ https://apps.who.int/iris/bitstream/handle/10665/43209/9241593180.pdf;jsessionid=E1E068378A53790D37702AB3086551B4?sequence=1
- ↑ Radlovic, Nedeljko; Lekovic, Zoran; Vuletic, Biljana; Radlovic, Vladimir; Simic, Dusica (2015). "Acute diarrhea in children". Srpski arhiv za celokupno lekarstvo. National Library of Serbia. 143 (11–12): 755–762. doi:10.2298/sarh1512755r. ISSN 0370-8179.
- ↑ Parker, Michelle W.; Unaka, Ndidi (2018-08-01). "Diagnosis and Management of Infectious Diarrhea". JAMA pediatrics. American Medical Association (AMA). 172 (8): 775. doi:10.1001/jamapediatrics.2018.1172. ISSN 2168-6203. PMID 29889925.
- ↑ "The treatment of diarrhoea". WHO. 2011-12-15. Retrieved 2020-12-15.
- ↑ Vega, Roy M.; Avva, Usha (2020-08-08). "Pediatric Dehydration". NCBI Bookshelf. PMID 28613793. Retrieved 2020-12-15.
- ↑ "Diarrhoea and Vomiting – Dos and Don'ts – Whinpark Medical Centre". Whinpark Medical Centre – Medical Doctors in Edinburgh. Retrieved 2020-12-15.
- ↑ "The Dos and Don'ts of Treating Diarrhea for Quick Relief". GI Associates. 2019-09-04. Retrieved 2020-12-15.
- ↑ "Dos and Don'ts of Diarrhoea". Positive Parenting. 2016-03-28. Retrieved 2020-12-15.