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ACUTE DIARRHEA

image 

 

 

get a good history (daycare, travel, drugs, foods, other symptoms)


Etiology 

 

  1. viral infection
    • most common in Canada, e.g. Rotavirus
    • associated with URTIs
    • slight fever, malaise, vomiting, vague abdominal pain
    • resolves in 3-7 days 
  2. bacterial infection
    • Salmonella, Campylobacter, Shigella, pathogenic E. coli, Yersinia
    • more severe abdominal pain, high fever, bloody diarrhea
  3. parasitic infection : Giardia lamblia, E. histolytica 
  4. toxin-induced: staphylococcal food poisoning, C. difficile toxin
  5. allergic: food intolerance
  6. antibiotic-induced
  7. non-specific: associated with any non-GI infection, generalized sepsis  or shock

Complications 

 

  1. dehydration
  2. electrolyte disturbances: hyper or hyponatremia, hypokalemia, metabolic acidosis 
  3. secondary disaccharidase deficiency (transient, due to villous damage)

 

Investigations

 

  • stool for C&S and O&P, blood and WBC, C. difficile toxin, Rotazyme assay


Management

 

  1. rehydration: most children managed with oral fluids e.g. Oral Rehydration Solution (Pedialyte, Gastrolyte)
  2. fluid replacement: consider deficit (% of body weight),maintenance and ongoing losses

Maintenance fluid requirements

  1. newborn: 120-160 ml/kg/day (may vary with weight)
  2. 100 ml/kg/24 hours for first 10 kg
  3. 50 ml/kg/24 hours for second 10 kg
  4. 20 ml/kg/24 hours thereafter
  • for example ,the maintenance fluid requirement of 24 kg child are :(100×10)+(50×10)+(20×4) = 1580 ml/24h
  • IV fluid rate per hour = total per day divided by 24

 

OR use 4:2:1 rule :

 

  1. For first 10 kg : 4 mL/kg/hr
  2. For second 10 kg : + 2 mL/kg/hr
  3. Thereafter: + 1 mL/kg/hr
  • for example ,the maintenance fluid requirement of 24 kg child are :(4×10)+(2×10)+(1×4) = 64 ml/h

 

Commonly used IV fluids

  1. first week of life: Dextrose 5%(D5W) + 0.2 NS
  2. 2/3 D5W 1/3 NS
  3. NS: as bolus to restore circulation in very dehydrated child
  • continue breast feeding when possible

DRUGS

 

NOT INDICATED: kaolin, pectin, anticholinergics,antispasmotics, opiate derivatives

 

Antibiotics used in:

  1. Salmonella sepsis
  2. Shigella/Yersinia/enterotoxic E. coli (Septra)
  3. C. difficile (oral Flagyl/Vancomycin)
  4. Campylobacter (Erythromycin)

    Correction of Fluid and Electrolyte Deficits

     

    Dehydration

    5% (mild )

    10% ( severe)

    Rate

     Isotonic

    Na 4-5 mmol/kgNa

    Na 8-10 mmol/kg

    K  4-5   mmol/kg

    1/2 deficit over 1st 8 hours,

    then 1/2 over 16 hours
    Hypotonic

    Na < 130 mmol/LK

    Na 5-6 mmol/kg

    K 3  mmol/kg  

    Na 10-12 mmol/kg

    K 5       mmol/kg

    If Na = 105, correct as above

    If Na < 105, correct by 20 mmol/L maximum

    over 0.5-4 hour with hypertonic saline
    Hypertonic

    Na > 150 mmol/L

    Na 2-4 mmol/kg

    K   2-4 mmol/kg

    Na 2-4 mmol/kg 

    K    2-4 mmol/kg

    Correct over 48-72 hours

    Do not allow serum Na to drop faster than 10-15 mmol/L/day


     

    Note:

     

    • For all types dehydration, H20 for 5% dehydration = 50ml/kg; for 10% dehydration = 100 ml/kg
    • To calculate exact deficit:

    [Na] deficit = ([Na]target - [Na]actual) x body weight (kg) x total body H20 (L/kg)

    • To lower serum Na by a predictable amount, remember: 4 ml/kg of free H20 lowers serum Na by 1 mmol/L
    ACUTE DIARRHEA ACUTE DIARRHEA Reviewed by Radiology Madeeasy on August 27, 2010 Rating: 5
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