Approach to Diarrhea Dr.Honar Pediatric Gastroenterohepatologist

Definition Diarrhea -frequency -consistency -weight

Definition Normal pattern of defecation Non pathologic diarrhea Self limited pathologic diarrhea

Classification Acute diarrhea -prolonged episode of acute diarrhea Non acute diarrhea -chronic diarrhea -persistent diarrhea

Acute Diarrhea Less than 2 weeks Cause of diarrhea Self limited

Acute Diarrhea Treatment -Hydration mild moderate severe

Acute Diarrhea Mild dehydration -hydration at home - 50 ml/kg ORS Moderate dehydration -hydration with supervision-75ml/kg ORS Severe dehydration -admit the patient,IV hydration-100ml/kg

ORS Efficacy of ORS -standard or WHO ORS -hypoosmolar ORS Cooperation of mother Preparation of ORS The most efficacy in moderate dehydration

Acute Diarrhea -Breast feeding -Feeding -Supplement -Complication(medical ,surgical) Electrolyte imbalance Ileus Intussusception HUS -Antibiotic

Persistent Diarrhea More than 2 weeks Acute onset Persistent(recovery less than 48 hours) Mechanism of Persistent diarrhea

Persistent Diarrhea One of the most common cause of mortality of diarrhea -prophylaxy -indication of NPO -breast feeding -appropriate feeding -supplements

Persistent Diarrhea In formula fed -Lactose free formula -continue for at least 1 month,tapering -Second line :extensive pr.hydrolysate :soy based formula

Chronic Diarrhea -More than 2 weeks -Insidious onset -On and off

Chronic Diarrhea Food allergy -usually self limited IBD Celiac CF Others