Gastroenteritis in

Children

PRESENTATION
BY: Dr. M. DITU
DEFINITIONS
• Acute Diarrhea is the passage of loose or watery stools, 3
times or more in 24 hour period for up to 14 days
• In the breastfed infant, the diagnosis is based on a change
in usual stool frequency and consistency as reported by the
mother
• Acute Diarrhea must be differentiated from “persistent
diarrhea which is of >14 days” and may begin acutely.
CAUSES AND RISK FACTORS FOR ACUTE
DIARRHOEA
• Microbial
• Host
• Environmental
factors interact to cause Acute Gastroenteritis
HOST FACTORS
• BIOLOGICAL FACTORS
• Malnutrition
• Age
• Failure to get immunized against rotavirus
• HIV
• BEHAVIORAL FACTORS
• Not breastfeeding exclusively for 6 months
• Using infant feeding bottles
• Poor hygiene
ENVIRONMENTAL FACTORS
• Seaonality
• Poor domestic and environmental sanitations especially
unsafe water
• Poverty
MICROBIAL FACTORS
• VIRAL
• Rotavirus
• Adenovirus
• Norwalk virus
• Astrovirus
• BACTERIAL
• Vibrio cholerae
• Salmonalla spp
• Shigella
• E. coli
• Campylobacter pylori
• PARASITIC
• Gardia lamblia
• Entamoeba histolytica
• Cryptosporidium
• HISTORY
• Onset, durations and number of stools per day
• Blood in stools
• Episodes of vomiting
• Presence of fever, convulsions etc
• Type and amounts of fluids taken
• Drug history
• Immunisation history
ASSESSMENT
• GOALS
• Identify the type of diarrhea
• Look for dehydration and other complications
• Assess for malnutrition
• Rule out non-diarrheal illnesses
• Assess feeding
INVESTIGATIONS
• Stool Investigation
• Physical
• m/c/s
• virology
• U and Es, Cr
• FBC
MANAGEMENT
• Principles:
• Rehydration and maintaining hydration
• Ensure adequate feeding
• Oral supplementation of zinc
• Early recognition of danger signs and treatment of
complications
PLAN A
• May be treated at home.
• Danger signs to be explained to mother
• Diarrhea continues >3days
• Increased stool volume/frequency
• Repeated vomiting
• Increasing thirst
• Increased irritability/lethargy
• Refusal to fed
• Fever or blood in stool
AGE yrs <2 2-5 Older
children
ORS(mls) 50-100 100-200 As much as
they want
Zinc supplement 10-20mg (2.5ml-5ml)/day for 10-
14days
PLAN B/SOME DEHYDRATION
• Treated in hospital
• 75mls/kg of ORS to be given in 4hrs, if not taken orally
then NGT can be used
• If after 4hrs child still has some dehydration, again
75mls/kg of ORS to be given.
• Ineffective in:
• High stool purge
• Persistent vomiting
• Paralytic ileus
• Incorrect preparation of ORS
• When signs of dehydration disappears, ORS should be
administered in volumes equal to diarrheal losses (max
10ml/kg)
• Breastfeeding, semisolid foods continued after deficit
replacement.
PLAN C
• Treated in hospital
• Ideal fluid is 1/2SD, RL with 5% dextrose, NS or RL can be used as
alternative. NO 5% dextrose should be used.
• Total 100ml/kg should be given
AGE 30ml/kg 70ml/kg
<1 year 1hr 5hr
>1 year 30 min 2hrs 30min
• If severe dehydration is persistent repeat IV fluids
• Hydration improved but some dehydration present, shift to plan B
• If no dehydration shift to plan A
• Reassess patient every 15 to 30 min for pulses and hydration status
• Antimotility agents (loperamide) are
CONTRAINDICATED
• Antibiotic therapy in select cases of diarrhea related to
bacterial infections can reduce the duration and severity of
illness and prevent complications
• their widespread and indiscriminate use = antimicrobial
resistance.
THANK YOU!!!!