MANAGING--DIARRHOEA

Approximately 4 – 5 million deaths occur as a result of diarrhoeal diseases. 8 out of 10 deaths are in the first 2 years of life. Diarrhoeas account for about 20% of the hospitalized paediatric cases. A child suffers form around 12 episodes of diarrhoea, 4 during the first year of infancy itself.

DIARRHOEA means passage of 3 or more loose or watery motions per 24 hours, resulting in excessive loss of fluid and electrolytes.

Secretory, osmotic or motility abnormalities singularly or in combination form the basics of all diarrhoeal episodes.

Secretory diarrhoea has a tendency to be watery, voluminous and persistent even when no feed is given orally. It is caused by – cholera toxin and lactose deficiency.

Osmotic diarrhoea follows ingestion of a poorly absorbed solute- Magnesium phosphate or alcohol. It is watery and acidic with reducing substances.

Motility diarrhoea is associated with delayed motility or increased motility.

  • Irritable bowel syndrome.
  • Intestinal pseudo obstruction.

Acute diarrhoea begins acutely and terminates within a week or so, only small cases pass to the 2nd week.

Chronic diarrhoea refers to motions beyond 2 weeks. The cause for this is malabsorption or underlying organic disease.

Persistent diarrhoea denotes an acute attack that lasts for more than 2 weeks.

ACUTE  DIARRHOEA

It is often called gastroenteritis. 500 million children suffer every year – out of which 5 million die.

  1. Enteric infections:
    • Viral.
    • Parasital
    • Fungal.
    • Parenteral.
  1. Dietary / Nutritional.
  2. Drugs.
  3. Non – specific.

VIRAL

Rotavirus, also termed GEV ( gastroenteritis virus) is most frequently seen in diarrhoeal stools. Age 9 to 10 months show peak incidence and is usually seen in winter and dry months in India.

Transmission is feco – oral route.

The virus causes reversible patchy atrophy of villi and loss in the absorptive capacity of mucosa. Brush border enzymes are reduced usually function and morphology revert to normalcy within 2 – 3 weeks. Incubation period is less than 48 hours.

Symptoms:

  1. Usually vomiting precedes the onset of the watery motions.
  2. Slight fever.
  3. Mucus in stools.
  4. Occasional blood in the stools.

BACTERIAL:

Escherechia coli ( e. coli) constitute the major bacterial diarrhoea.

e.coli has 5 classes:

    • Enteropathogenic.
    • Enterotoxigenic.
    • Enterohaemorrhagic
    • Enteroadherant.
    • Enteroinvasive.

They are notorious for causing dehydrating diarrhoea.

  • Prolonged diarrhoea with mucus.
  • Abdominal pain with diarrhoea.
  • With blood at times.

Enteroinvasive E. coli may cause damage to mucosa of ileum and colon through toxins leading to ulcer formation.

Cholera vibrio causes watery diarrhoea and vomiting.

PARASITIC:

Giardia lambia is the most important cause of recurrent diarrhoea.

Clinical features: The clinical picture varies form

  1. Mild.
  2. Moderate.
  3. Severe.

MILD: Onset is insidious. 2 – 5 motions, green, loose, offensive. May contain mucus and milk curds. Attack subsides in a day or two.

MODERATE: Onset is insidious to acute. Number of motions – 10 or more Symptoms like fever, irritability, anorexia and Vomiting are present.

SEVERE:  Child passes ‘too many’ loose motions. Has severe vomiting to the extent that nothing is retained.Onset is usually sudden. Marked fever with irritability.

GRADES  OF  DEHYDRATION:

MILD:

  1. 3 – 5% weight loss.
  2. Irritability or drowsiness.
  3. Pallor.
  4. Sunken eyes.

MODERATE:

  1. 6- 10% weight loss.
  2. Irritability or drowsiness.
  3. Depressed fontanelles.
  4. Dry mucus membrane.
  5. Dry and inelastic skin.

SEVERE:

  1. More than 10% weight loss.
  2. Symptoms of superimposed shock –
    • Coma
    • Limpness.
    • Pallor.
    • Cold and clammy.
    • Thin, rapid pulse.
    • Metabolic acidosis.
    • Scanty urination.

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