Diarrhoea: Management

Always weigh the child and assess its general condition.

Assess whether the weight loss is <5%,>10%.

Is it dysentery or not? If yes, is it amoebic or bacillary?

With mild to moderate dehydration use ORS. The volume that should be given is 1-2 times the fluid deficit. ORS is best given by the mother and should be given over a 4 to 6 hour period. It is best if it is given with a small cup and spoon. With very small children a syringe can be used to drip the fluid into the mouth. If the child vomits a few times the treatment should be continued nevertheless. Administration using a nasogastric drip infusion is rarely necessary. The success of the treatment should be monitored by assessing the general condition of the child and its weight.

With severe dehydration (>10%) or if the treatment with ORS is not successful, IV rehydration should be used. If it is not possible to inject into a vein and a venous cut-down is not feasible and the situation is desperate, the intraosseous route can be used: the fluid enters the bone marrow of the tibia and is taken up in this way. The infusion can be rapid at first (70 to 100 ml/kg over 3 hours). If the pulse can be felt clearly again and the child has generally improved, the treatment can then be switched to oral therapy.

Newborn children with a low birth weight are very sensitive to hypernatremia. Rehydration is achieved best with 2/3 ORS and 1/3 extra salt-free water.

Food must continue to be given while the patient has diarrhoea. It used to be thought that a period of fasting (24 to 48 hours) was good for the child, but this is counterproductive. Breastfeeding should not be stopped. A balanced diet, best low in residue and semi-solid is indicated. A good diet is also important after the diarrhoea. During episodes of diarrhoea, patients are catabolic (they break down their own muscle proteins for energy).

Category: Medical Subject Notes , Medicine Notes