A Child with Diarrhea M Rawashdeh, MD, MSc, FRCP, FRCPCH Professor of Pediatrics & Gastroenterology

Diarrhea in the 21st Century Second most common cause of morbidity and mortality worldwide WHO estimation (2002), diarrhoeal disease results in: 2.5 million people die annually, mostly children 1.6 million children <5yrs old (in developing countries)

What is Diarrhea? An increase in the frequency, fluidity or size of bowel movements. The passage of 3 or more stools beyond infancy.

Acute diarrhea X Chronic diarrhea lasts a few days or up to a week Generally lasts > 2 weeks Common causes: infections, bacterial, IBD, celiac disease, CF, CMPA Acute diarrhea lasts a few days or up to a week X IMPORTANT !!! distinguish between acute and chronic diarrhea >>>different diagnostic tests, different treatments

What worries you about gastroenteritis?

Complications of Diarrhea Dehydration Excessive loss of fluids and minerals (electrolytes) from the body Common in infants and young children with viral gastroenteritis or bacterial infection Kidney failure and shock Electrolyte imbalance Acidosis

Assessment of Dehydration Studies that have evaluated the correlation of clinical signs of dehydration with post-treatment weight gain indicate that the first signs of dehydration might not be evident until 5%, with more numerous clinical signs evident at 5 -9% and signs indicating severe dehydration not evident until fluid loss reaches10%. Duggan C, Refat M, Hashem M, Wolff M, Fayad I, Santosham M. How valid are clinical signs of dehydration in infants? J Pediatr Gastroenterol Nutr 1996;22:56--61.

Degree of Dehydration?

Degree of Dehydration No clinical signs = Mild dehydration 2 signs with stable circulation = Moderate 2 signs and signs of shock = Severe

Laboratory tests? Supplementary laboratory studies, including serum electrolytes, urea and creatinine to assess patients with acute diarrhea are usually unnecessary. Stool analysis and culture are indicated in cases of dysentery (bloody diarrhea) but are not usually indicated in acute, watery diarrhea for the immunocompetent patient.

Therapy of AGE

Bicarbonate 30 M

How Much ORS? 75ml/kg in 3-4 hours Regular food 100 ml after each loose stool

Dietary Therapy of AGE Breastfed infants should continue nursing on demand Feedings with diluted (e.g., half- or quarter-strength) formula? Formula-fed infants should continue their usual formula immediately upon rehydration no advantage of lactose-free formulas over lactose-containing formulas

Prevention Wash hands thoroughly before and after eating or when preparing the meals. Make sure that the tools used for eating and preparing the meals are clean. Cover our food or put them in the fridge to prevent any contamination.