DIARRHEA
DIARRHEA
Diarrhea is defined as the passage of loose, liquid or watery stools for more than 3 times a day. However, it is the recent change in consistency and character of stools rather than number of stool that is more important.
CLINICAL TYPES OF DIARRHEA
ACUTE WATYERY DIARRHEA ACUTE BLOODY DIARRHEA PERSISTENT DIARRHEA DIARRHEA WITH SEVERE MALNUTRITION
ACUTE WATERY DIARRHEA
Lasts several hours to days. The main danger is dehydration, weight loss also occurs if feeding is not continued. The pathogens that usually cause acute watery diarrhea are: V.chlorae E.coli Rota virus
ACUTE BLOODY DIARRHEA
Also known as Dysentery The main dangers are the damage of the intestinal mucosa, sepsis, and malnutrition. Other complications including dehydration may also occur It is marked by visible blood in the stools. Most common cause of bloody diarrhea is Shigella.
PERSISTENT DIARRHEA
Diarrhea which lasts for 14 days or longer. The main danger is Malnutrition and serious non-intestinal, infection, dehydration may also occur. Persons with other illness such as AIDS, are more likely to develop persistent diarrhea.
DIARRHEA WITH SEVERE MALNUTRION
The main dangers are: 1. Severe systemic infection 2. Dehydration 3. Heart failure 4. Vitamin & mineral deficiency.
Chronic diarrhoea
Generally lasts > 3 weeks Common causes: IBS, AIDS, bacterial outgrowth of small int., Colon cancer, Chrons disease
Acute diarrhoea
lasts a few days or up to a week
PROBLEM STATEMENT
The current estimate in Under 5 children suggest that there are about 1.4 billion episodes of diarrhea per year with 123 million clinic visits annually and 9 million hospitalizations worldwide. About 15% under 5 mortality is diarrheal related.
In India, acute diarrheal disease accounts for about 13% of deaths in under 5 years age group. During the year 2009 about 11.2 Million cases with 1762 deaths were reported in India.
Leading Causes of Mortality and Burden of Disease world, 2004
Mortality
%
DALYs
%
1. 2. 3. 4.
Ischaemic heart disease Cerebrovascular disease Lower respiratory infections COPD
12.2 9.7 7.1 5.1
1.
Lower respiratory infections
6.2
2. Diarrhoeal diseases 4.8
3. 4. 5. 6. 7. 8. 9. 10. Depression Ischaemic heart disease HIV/AIDS Cerebrovascular disease Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma Road traffic accidents Neonatal infections and other 4.3 4.1 3.8 3.1 2.7 2.7 2.7
5. Diarrhoeal diseases
6. 7. 8. 9. 10. HIV/AIDS Tuberculosis Trachea, bronchus, lung cancers Road traffic accidents Prematurity, low birth weight
3.7
3.5 2.5 2.3 2.2 2.0
AGENT FACTORS
In the developing countries - INFECTIOUS in origin
VIRAL
BACTERIAL
OTHERS
INFECTIOUS CAUSES OF DIARRHEA
1. VIRUSES: Rotaviruses Astroviruses Adenoviruses Calciviruses Norwalk group of viruses Enteroviruses
2. BACTERIA: Campylobacter jejuni E.coli Shigella Salmonella V. cholrae Bacillus cereus
3. OTHERS: E.histolytica Giardia intestinalis Trichuriasis Cryptosporidium Intestinal worms
DIARRHEA-MALNUTRITION VISCIOUS CYCLE
Interactions between malnutrition and infection.
Katona P , Katona-Apte J Clin Infect Dis. 2008;46:15821588
2008 Infectious Diseases Society of America
ASSESSMENT OF DEHYDRATION
PARAMETERS
NO DEHYDRATION
SOME DEHYDRATION RESTLESS, IRRITABLE
SEVERE DEHYDRATION LETHARGIC/UNCONS CIOUS : FLOPPY VERY SUNKEN & DRY ABSENT
OVERALL CONDITION WELL, ALERT
EYES TEARS
NORMAL PRESENT
SUNKEN ABSENT
MOUTH & TONGUE
THIRST FEEL: SKIN PINCH DECIDE:
MOIST
DRINKS NORMALLY, NOT THIRSTY GOES BACK QUICKLY PT. HAS NO SIGNS OF DEHYDRATION
DRY
THIRSTY DRINKS EAGERLY GOES BACK SLOWLY IF THE PATIENT HAS TWO OR MORE SIGNS INCLUDING AT LEAST ONE SIGN,THERE IS SOME DEHYDRATION
VERY DRY
DRINKS POORLY OR NOT ABLE TO DRINK GOES BACK VERY SLOWLY IF THE PATIENT HAS TWO OR MORE SIGNS ,INCLUDING ATLEAST ONE SIGN, THERE IS SEVERE DEHYDRATION
Signs of Dehydration
ORAL REHYDRATION THERAPY
Replacement of fluid & electrolytes losses is the essential part of the treatment of diarrhea. This can be achieved by administration of adequate & proper fluid either in the form of ORS or IV therapy depending on the circumstances.
Diarrhea treatment should be started at home at the time of onset of diarrhea by the mothers using Oral Rehydration Salt(ORS). It is recommended that all the diarrhea episodes should be treated with ORS. If ORS is not available then home available fluids (HAF) like salt sugar solution, lassi, kanji, pop-rice water etc may be given.
ORS SOLUTION RECOMMENDED BY WHO
REDUCED OSMOLARITY ORS
CONSTITUENTS: Sodium75 mmol/Litre Chloride65 mmol/Litre Glucose anhydrous- 75 mmol/Litre Potassium20 mmol/Litre Citrate10 mmol/Litre TOTAL OSMOLARITY- 245 mmol/Litre
Continued.
Nacl- 2.6gm KCL- 1.5gm Trisodium citrate- 2.9gm Glucose- 13.5gm Water -1 L TOTAL WEIGHT: 20.5gm TOTAL OSMOLARITY: 245 mmol/litre
New Who ORS is very effective & safe. It reduces the stool output, duration, and frequency of diarrhea. It also reduces the vomiting and the need of unscheduled use of IV fluid.
BASIS OF ORAL FLUID THERAPY IN DIARRHEA
In most diarrheas the absorptive capacity of gut is retained and nutrients such as Glucose, Amino acids and dipeptides tends to be absorbed in most cases. As glucose is absorbed in the gut sodium is carried along and also gets absorbed. ORS helps in absorption of glucose and sodium.
One Na ion is transported along with each molecule of the glucose is absorbed. This mechanism remains active even in severe cases of diarrhea. In other words oral fluid therapy is based on the observation that glucose given orally enhances the intestinal absorption of salt and water,and is capable of correcting the electrolyte and water deficit
ROLE OF ZINC
When zinc supplement is given during an episode of acute diarrhea, it reduces the episodes duration and severity. In addition, zinc supplements given for 10 to 14 days lowers the incidence of diarrheas in the following 2-3 months. WHO & UNICEF therefore recommends daily 10 mg of zinc for infants under 6 months of age and 20 mg for children older than 6 months for 10-14 days.
Interactions among events related to zinc deficiency, malnutrition and diarrheal disease.
Interactions among events related to zinc deficiency, malnutrition and diarrheal disease.
Thank You for Being Patient Till the End
Wapnir R A J. Nutr. 2000;130:1388S-1392S
2000 by American Society for Nutrition
