APPROACH OF ACUTE

GASTROENTERITIS IN CHILDREN
The term gastroenteritis denotes infection of
gastrointestinal tract caused by pathogen like
bacteria, viruses, parasites.

Gastroenteritis covers bulk cases of diarrheal disease

ACUTE DIARRHEA
Acute diarrhea usually lasts for less than 7 days but
can persist upto 14 days.
TYPES:
Small bowel diarrhea
Large bowel diarrhea
SMALL BOWEL DIARRHEA
CAUSES:
Virus Rotavirus, Astrovirus, coronavirus,
Norwalk virus
Bacteria - Vibrio cholera, E.coli
Parasites Giardia lambia, Strongyloides
LARGE BOWEL DIARRHEA
CAUSES:
Bacteria Shigella, Salmonella, E.coli
Parasites Entamoeba histolytica, schistosomiasis
PREDISPOSING FACTORS
Infants
Infections Measles
Malnutrition
Low socio economic class
Immunodeficiency disorder
Antimalignant therapy
Drugs - Ampicillin
APPROACH
Dehydration is the common feature in diarrheal
disease.
Assessment of severity of Dehydration:
TYPES:
No Dehydration
Some Dehydration
Severe Dehydration
No Dehydration:
Alert
Not thirsty
Skin turgor is normal
Oral mucosa moist
Extremities is warm
Heart rate normal
Eyes normal ,tears present
Some Dehydration:
Irritable
Thirsty
Skin turgor goes back slowly
Oral mucosa is dry
Extremities cold
Heart rate normal, may be increased
Eyes sunken; tears absent
Severe Dehydration:
Lethargic
Thirsty but drinks poorly
Very dry oral mucosa
Extremities are cold, mottled and cyanotic.
skin tugor goes back slowly
Eye very sunken;tears absent
MANAGEMENT
TREATMENT OF DEHYDRATION
PLAN A: (TREATMENT OF DIARRHEA IN CHILDREN
WITH NO DEHYDRATION)
Fluid therapy:
Lemon water, Rice water, Soups, Coconut water,
Lassi.
ORS
Sodium - 75mEq/L
Chloride - 65mEq/L
Potassium 20 mEq/L
Citrate - 10 mEq/L
Glucose anhydrous - 75mEq/L
Continue feeding
Zinc supplement
Warning Signs: Persistent severe vomiting,
Marked thirst, Refusal to drink and eat, Bloody
stools, fever, Child not getting better within 3 days,
Drowsiness, Altered Sensorium
PLAN B: (TREATMENT OF DIARRHEA
IN CHILDREN WITH SOME
DEHYDRATION)
ORS given under supervision of medical staff for
4 hrs.
In Infants and severely malnourished,
Dehydration should be corrected over 6 hrs.
ORS 10 20 ml/kg is given for each loss of stool
Breastfeeding are continued even during
rehydration and semisolid foods are started after
deficit replacement.
PLAN C: (TREATMENT OF DIARRHOEA
IN CHILDREN WITH SEVERE
DEHYDRATION)
Children require immediate intravenous fluid 100
ml/kg either Ringer lactate or Normal saline
Incase of unavailability of IV line, the nasogastric
tube can be used for rehydration by ORS
Re-assess an infant after 6 hrs and a child after 3
hrs
The Child should be continuously assessed for
Urinary output, Electrolytes, Blood Urea, Serum
Creatinine, Glucose level.
Monitor the vitals and observe for complications.
DIETARY MANAGEMENT
Breastfed infants Breastfeeding should be continued
even during dehydration with ORS
Non Breastfed infants Milk preferrably mixed with
cereals along with other semisolid foods can be given
during or after correction of dehydration.
Foods to be avoided :
Fruit juice, junk food, spicy food, Foods with
high fibre content.
Micronutrients in the treatment of diarrhea:
Zinc, Vit-A, Magnesium.
Drugs in Diarrheal Disorders:
Anti motility Loperamide
Antibiotics Metronidazole, Co-trimoxazole,
Gentamycin, Tetracyclin.
THANK YOU